Failure to offer scan can lead to poor outcomes for mother & baby

Dr Keelin O'Donoghue

Pregnant women attending one of the country’s largest maternity hospitals are exposed to “an unacceptable level of risk” because of failure to routinely offer a scan designed to detect foetal abnormalities, according to the head of foetal medicine.

In a letter seen by the Irish Examiner, consultant obstetrician/gynaecologist Keelin O’Donoghue outlines potential consequences for parents and staff at Cork University Maternity Hospital (CUMH), including:

  • The “distressing and traumatic event” of parents finding out after birth that their child has a major foetal anomaly — a scenario that happens “too frequently”;
  • Staff unable to plan appropriate care in the absence of a antenatal diagnoses with poorer outcomes for babies, and potential for litigation.

In the hard-hitting letter to senior clinicians , Dr O’Donoghue says that, in the past two years at CUMH, life-limiting anomalies which could have been “diagnosed without difficulty on ultrasound” were not.

These included babies with an encephaly (portion of the brain and skull missing), hydrocephalus (excessive fluid on the brain), thanatophoric dysplasia (severe skeletal disorder), and Patau’s syndrome (chromosomal abnormality), none of whose mothers had an anomaly scan. Presented with the diagnosis after their babies’ were born, the women had found it “extremely difficult to deal with and recover from”.

“While in these cases the infants’ individual prognoses could not have been altered, the experience of delivery could have been very different from what occurred,” Dr O’Donoghue wrote. Staff involved in these difficult deliveries were also affected by the lack of antenatal diagnosis, she said, having to deal with “an unexpectedly bad outcome and sometimes a very complicated delivery”.

“Those of us working in fetal medicine later have to explain to traumatised and/or bereaved parents how a major anomaly was not diagnosed,” Dr O’Donoghue wrote. Other colleagues, not specialised in ultrasound, felt “professionally at risk of complaints or litigation, when diagnoses are missed or found late at limited ultrasound opportunities in the emergency room or clinic”.

Moreover, there were wider implications for training of doctors. Dr O’Donoghue said it was clear from a report by the RCPI Hospital Inspections Committee, compiled following a meeting with CUMH management in 2013, that “recognition of the unit for Higher Specialist Training [in] 2016 is conditional upon this issue being resolved”.

However, the situation in her department was set to worsen, come March, with over six WTE (whole time equivalent) staff on long-term leave (sick leave, parental leave, maternity leave, maternity-related sick leave), “meaning that many of our services in the ultrasound department will be impossibly stretched, and the number of scans provided will be cut further”.

“All of the above is likely, at the very least, to lead to probing questions regarding the inequity of service provided to women attending CUMH compared to other maternity units nationally and internationally, and far more likely to lead to litigation,” wrote Dr O’Donoghue.

Just seven of 19 maternity units in Ireland routinely offer foetal anomaly scans. Dr O’Donoghue said there was “no doubt that the absence of legislation permitting termination of pregnancy for fetal anomaly has confused the debate about the provision of services to detect anomalies”.


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