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There are vast inequalities across maternal and infant mortality with the developing world accounting for the majority of the burden and within countries rural areas expecting worse outcomes than urban. These inequalities are linked to health care service delivery. This review focuses on obstetric ultrasound service and its potential to improve maternal and newborn health in low resource settings. A systematic search of English literature was conducted to identify current knowledge regarding use of ultrasound in low resource settings. Access to obstetric ultrasound in the developed world is almost universal. Access to obstetric ultrasound is instrumental in identifying potential obstetric risks, leading to improvements in maternal and newborn health outcomes. In contrast to this, access to obstetric ultrasound in the developed world is poor, particularly in rural areas. Innovations in teleradiology and portable ultrasound offer opportunity for improved ultrasound access in low resource settings, including opportunity for service coverage in rural and remote areas. The literature illustrates considerations for service provision in a broad range of settings in the developing world. Practical implications are vastly different in these settings and include infrastructure, economic resources, training and cultural acceptability. The versatility of ultrasound also offers a wide range of non-obstetric clinical applications. This review demonstrates promising benefits of obstetric ultrasound in poorly resourced settings with potential improvements in maternal and infant mortality and also highlights the need for large scale trials in these settings.