A study focused on the provision of maternity ultrasound services in the Republic of Ireland has revealed that one third of pregnant women in Ireland are still not offered routine fetal anomaly ultrasound. The study indicated that variations continue to exist in relation to maternity ultrasound services in Ireland, particularly highlighting the inconsistent availability of fetal anomaly ultrasounds. The internationally accepted minimal schedule for antenatal ultrasound usually comprises of two examinations; a dating ultrasound in the late first trimester followed by a fetal anomaly scan, performed between 20-22 weeks’ gestation.
The Royal College of Obstetricians and Gynaecologists (RCOG) has recommended that all pregnant women should be have the choice to avail of both ultrasounds to ensure accurate pregnancy dating, as well as the diagnosis of fetal anomaly, since 2000. This two-stage ultrasound approach was also endorsed by the UK National Institute for Health and Clinical Excellence (NICE) in 2008. The National Maternity Strategy was published by the Department of Health in January 2016, where a key recommendation was that all women should have “equal access to standardised ultrasound services, to accurately date the pregnancy (and) to assess the fetus for ultrasound diagnosable anomalies as part of a planned Prenatal Fetal Diagnostic Service”.
As part of the study, a telephone survey of all Irish obstetric units was undertaken in February 2017 where standard questions relating to the provision of maternity ultrasound services in their unit for the year 2016 were asked of the respondents.
In total, 100 per cent of Irish maternity units successfully engaged with the survey and in all cases a senior clinician was contacted to ensure that respondents had a thorough knowledge of the services provided in their unit.Approximate annual delivery rates for 2016 ranged from 1062 to 9186 births,a nd the total number of combined births was 65,500. All 19 units have a dedicated Early Pregnancy Assessment Ultrasound service available, while a dedicated maternity ultrasound department is present in 16 (84 per cent) of the units.
Fetal anomaly ultrasound is offered universally to all women in 7 units (37 per cent), selectively to some women in 7 units (37 per cent) and not offered at all in the remaining 5 units (26 per cent). Among the units offering selective anomaly scanning, the percentage of women receiving a scan ranges from 10-42 per cent. Overall 41,700 (64%) women receive a fetal anomaly ultrasound nationally.First trimester pregnancy scanning is offered universally to all women in 53 per cent of units, offered but does not meet international criteria for first trimester ultrasound in 26 per cent of units and is not offered in the remaining 21 per cent. The survey noted that routine first trimester ultrasound performed in a dedicated ultrasound department by a suitably qualified sonographer is offered to just 47 per cent of women nationally.
Since the publication of the National Maternity Strategy in 2016, some staff expansion had occurred in two out of the 19 units. However, in another two out of 19 units ultrasound staffing levels had declined over the same time period. The authors expressed their disappointment that their findings have reflected those of the previous two national ultrasound surveys (in 2007 and 2012), confirming that there has been no expansion in Irish maternity ultrasound services over the last decade. The authors of the study stated that, while they welcome the publication of the National Maternity Strategy and other recently published national clinical guidelines recently published, they strongly recommend the development and implementation of an Irish guideline on obstetric ultrasound.
They wrote: “Without recognition of the deficit that currently exists in both the numbers of suitably qualified sonographers as well as in the provision of facilities and equipment, we will be unable to meet one of the fundamental aims of the 2016 National Maternity Strategy; equal access to standardised ultrasound services to every pregnant woman in Ireland”. The authors proposed that a national guideline should set out the standard components of the anomaly ultrasound scan, in addition to specifying the training of sonographers and setting requirements for ultrasound machines and image storage.
The study was published in the July/August edition of the Irish Medical Journal.