Resource issue affects safe maternity care

  • Niall Hunter, Editor

The Institute of Obstetricians and Gynaecologists has said any possible past cases of babies who died unnecessarily as a result of erroneous fetal scanning would have been reported immediately.

It has also indicated that maternity units may currently be prevented from sticking to best practice guidelines due to a shortage of staffing and resources.

The Institute pointed out that is a matter for the HSE or hospital to supply the resources and equipment to the appropriate standard.

It was commenting on the current controversy over fetal scanning misdiagnoses, in which a number of women revealed that their babies were saved after they had insisted on a second scan.

There have been concerns that there may have been cases where a second opinion was not provided and "viable" pregnancies may have been terminated in error.

The Institute, however, told that it was highly unlikely that such incidents would not have been reported immediately.

"If such an event did take place, it is clearly expected that it would be reported. We strongly urge those involved in the debate to avoid causing unnecessary fear among mothers and expectant mothers."

This reiterates the statement by the HSE's Clinical Lead for Obetetrics and Gynaecology, Dr Michael Turner, last week that he had never heard of such an event taking place.

The HSE is currently reviewing cases over the past five years to determine how many patients were recommended drug or surgical treatment when the diagnosis of miscarriage had been made in error and when further checking had demonstrated that the pregnancy was viable.

The Institute, which is the main professional body for obstetricians and gynaecologists in Ireland, said women in Ireland should have confidence in the maternity services.

"There are in the region of 80,000 births per year in Ireland, and, even working with limited resources and increased demand, outcomes are comparable, if not more favourable, than in other European countries."

The Institute of Obstetricians and Gynaecologists has said no junior doctor should be carrying out fetal scanning unsupervised.

Answering a series of questions from on the fetal scanning scandal, the Institute said no junior doctor should be practising unsupervised unless judged to be competent in carrying out scans through examination and competency assessment.

"All trainees should follow protocols and clinical guidelines outlined in their maternity unit," the Institute said.

The fetal scanning controversy has raised, among other issues, questions over the practice of having trainee doctors interpreting ultrasound scans unsupervised and unchecked by other staff.

The Institute said it currently advises doctors to refer to guidelines developed by the Royal College of Obstetricians in London in relation to the diagnosis and clinical management of women with early pregnancy loss

Asked if it was concerned that all maternity units might not be following these guidelines, the Institute said while it is useful to look at guidelines from other jurisdictions, it is difficult to transpose these guidelines directly where there are different levels of staffing and resources.

"Maternity units nationwide adopt the recommendations outlined in the guidelines depending on the local availability of properly trained obstetrical, midwifery, ultrasonographic and ancillary staff, the availability of ultrasound equipment that is fit for purpose and hospital facilities suitable for and designated to early pregnancy assessment unit functions," the Institute said.

It stressed it is a matter for hospital management to supply the resources and equipment to the appropriate standard.

The Institute said to ensure patient safety, it is important that guidelines are followed in public and private practice at a national level.

It said the Institute and the HSE are now developing guidelines for obstetrics and gynaecology to be implemented at national level.

It added that due to the recent controversy surrounding fetal scanning, implementing guidelines for early pregnancy assessment will now take precedence in this process.

Asked if training recognition would be withdrawn from units not following existing guidelines, the Institute said a range of factors affect whether it recognises a centre for training. "The Institute would withdraw training where a unit had failed to meet requirements of the training programmes on a consistent basis."

On double-checking of scans, the Institute said it would be concerned if a second scan was not offered and if there was any question with regard to the interpretation of the scan, particularly with very early pregnancy scans.

"The issue of double-checking of scans by sonographers is a matter for the HSE or the employing agency. Many hospitals will not have a dedicated qualified sonographer. In general, scans are carried out by consultants or senior trainee doctors who have been judged to be competent in carrying out scans through examination and competency assessment."

In some cases, the Institute said, midwives with the relevant training may carry out scans.

"It should also be pointed out that scans have varying levels of complexity and that the vast majority of scans can be carried out without the highest level of expertise. A greater level of expertise will be required for more complex situations, particularly in very early pregnancy. Scans may have limitations and therefore should not be viewed in isolation from a patient's history."

Read more on the scanning scandal here

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