Untrained staff ‘fail to detect 90% of foetal defects’

DEFECTS in unborn babies are not always detected because there are not enough expertly-trained personnel to perform ultrasounds, an expert in foetal abnormalities has warned.

Prof Fergal Malone, the newly-appointed professor and chair of the Department of Obstetrics and Gynaecology at the Royal College of Surgeons (RCSI) and the Rotunda Hospital, Dublin, said up to 90% of congenital abnormalities can go undetected if an unskilled person carries out screening.

"There is good evidence now that if you're not trained and you're not following a proper set of guidelines, you're only going to pick up 10-15% of congenital abnormalities and that's a tragedy," he said. "If you have someone who's skilled using proper equipment doing an ultrasound scan you can pick up between 75-80% of all abnormalities, and I'm not just talking Down Syndrome here, I'm talking about holes in the heart, spina bifida, cleft lip, a huge range of abnormalities."

Prof Malone said there were obstetricians without specific training in ultrasound and prenatal diagnosis who carry out a limited ultrasound to measure the baby's size or the way it is lying.

"And that's fine, but it's just a tiny window of what you can see with ultrasound. So a patient who has a scan done at 18 weeks to measure how big the baby is is going to assume that everything has been checked from head to toe but that's a wrong assumption."

He said because there was no requirement on the companies that sell ultrasound machines to sell them only to people who have certain qualifications, "frankly, there's nothing to stop anyone going and buying an ultrasound machine and start scanning."

Prof Malone said, at a minimum, every pregnant woman should have a proper ultrasound scan at about 18-20 weeks.

Prof Malone said there was a need for a national screening programme to improve the detection rate for congenital defects.

"I think that we need to come up with a national set of guidelines that those of us in the field who do prenatal screening could easily get together and say OK, we think pregnant women should be offered the following tests and we could come up with a list of what those tests could be."

Prof Malone said the challenge would then be to make a case to Government to fund the tests, which he insisted should not be confined to women considered "high risk", such as those over 35.

"By its essence the word screening means that you go out into the whole population and you screen everyone to find those of the highest risk. That's the true value of screening it's not reserving it for some super-special high risk patients."

He said while there was a higher risk of Down Syndrome in women over 35, more Down Syndrome babies are born to women under 35 because more women that age are giving birth.