Review finds ultrasound service shortcomings

Approximately a third of pregnant women are still not routinely offered a scan that can detect fetal abnormalities, 17 years after experts recommended it form a routine part of antenatal care.

The deficiency is among a range of shortcoming in maternity ultrasound services highlighted in the latest edition of the Irish Medical Journal. Others include:

• No expansion in Irish maternity ultrasound services in the past decade;
• Just seven of 19 maternity units offer a fetal anomaly ultrasound to all women;
• Seven offer it selectively;
• Five (26%) don’t offer it at all;
• Routine first trimester ultrasound (pregnancy dating scan) performed in dedicated ultrasound department by a suitably trained sonographer is offered to 47% of women nationally.

The findings are based on a telephone survey of obstetric units in February by doctors/researchers at Cork University Maternity Hospital.

The authors of the review, titled Maternity Ultrasound in the Republic of Ireland 2016, point out that the “widely accepted minimal schedule for antenatal ultrasound comprises two examinations: A dating ultrasound in the first trimester, followed by an anomaly scan, usually performed between 20-22 weeks”.

Early detection of anomalies can help parents decide whether to continue with or terminate the pregnancy, in jurisdictions where this is legally permissible, state the authors. They point out that second trimester fetal anomaly ultrasound is “routinely recommended by all obstetric policy makers”.

The benefits include: If an anomaly is detected, the baby’s delivery can be planned, enabling rapid access to necessary specialists. Diagnosis can also give parents a chance to adjust mentally to the challenges of the pregnancy, delivery, and birth.

As far back as 2000, the Royal College of Obstetricians and Gynaecologists recommended that all pregnant women be offered both a first trimester dating scan and a fetal anomaly scan. This position is endorsed in the National Maternity Strategy, published in 2016, but which, to date, has not led to an expansion in maternity ultrasound.

The authors said it was “disappointing” to confirm there had been “no expansion” in maternity ultrasound services in the past decade. They call for “substantial investment” by policymakers .

In 2016, 41,700 (64%) of women received a fetal anomaly scan.