Stillbirth risk raised by lack of a scan at 20 weeks
Doctor says scan often only offered where pregnancy is high-risk
MANY families could avoid the pain of a stillbirth if all pregnant mothers were simply given 20-week scans, a leading obstetrician has said.
Dr Keelin O’Donoghue said some conditions that would otherwise lead to stillbirth could be treated if they were identified in time.
However, in many hospitals, the 20week scans – known as ‘anomaly scans’ because they highlight foetal anomalies at an early stage – are only offered to women seen to be high-risk.
The HSE has previously said just six of our 19 maternity units offer anomaly scans to all women, but even this figure is disputed by doctors, who say the scans are not universally available in them.
Dr O’Donoghue, a consultant obstetrician and gynaecologist at Cork University Maternity Hospital, and head of the pregnancy loss research group at University College Cork, told the Irish Mail on Sunday: ‘There are some babies who, if they are undiagnosed, could potentially have a much worse outcome, so if you have a major congenital heart defect, babies need immediate access to cardiac surgery. There is no doubt that, for specific conditions, diagnosing can make a difference to outcome.’
She said: ‘We should be able to provide anomaly scans to every woman. That should be basic. In my own hospital we do not provide anomaly scans to 100% of women yet, although in the last year this has been recognised as a priority.’
A stillbirth is when a baby dies in the womb or is born with no sign of life at 24 weeks and weighing 500g or more. In Ireland, one in 200 births ends in a stillbirth, making 360 a year. That is ten times more common than cot deaths, according to HSE statistics.
Baby Adam King, one of Dr O’Donoghue’s patients was diagnosed with brittle bone syndrome after scanning, and received treatment while still in the womb as part of a clinical trial based in Sweden.
The obstetrician said: ‘One of the important things about standards and strategies is that everyone has access to the same level of care wherever they are, that the level of care is standardised and it wouldn’t matter what part of the country you’re in, that you have access and you have choice.
‘It is different now in different places, that is for sure. The hospital groups are aiming to provide a network of care, but some groups are a little further down the road of development than others.’
Next weekend Cork hosts the International Stillbirth Alliance Conference bringing researchers, medics, midwives and others working in maternity together to discuss this topic.
Dr O’Donoghue said: ‘There are a number of issues in maternity services. Bereavement care and pregnancy loss is one, access to ultrasound services is another, gynaecology waiting lists for services is another. There are a couple which are quite important nationally, and need to have a greater priority and keep being brought to attention.’
Referring to a limited number of conditions known as fatal foetal anomaly, Dr O’Donoghue said: ‘A proportion of stillbirths are caused by foetal anomalies; 25% nationally of stillbirths. If every woman had access to scans, you expect to pick up the majority of major anomalies. Parents are referred to specialists and their options are discussed. If you don’t have access to the scan, you are going to have undiagnosed major anomalies.
‘Whatever has happened to the baby in conditions like anencephaly or Edwards Syndrome has happened. The scan isn’t going to fix it. It can diagnose it and parents can tell what is going to happen.’
Dr O’Donoghue added: ‘We need to increase awareness of the risks without scaring women. People don’t talk about it when it happens, and then you don’t expect it to happen to you. Stillbirth is not on the radar. There is high awareness of the risk of miscarriage in the first trimester and women often think when they reach 12 weeks that now everything is fine.’
She added: ‘Ante-natal care is preparing for birth, but it should also highlight risks and anticipate them. It is a common question we get asked; why did no-one tell me this could happen?’
Little Adam was treated while still in the womb
There are 360 stillbirths in Ireland every year