REPEAT SCANS should be carried out on women in early pregnancy if there is any doubt about the viability of their foetus, the chairman of the Institute of Obstetricians and Gynaecologists said yesterday.
It follows the case of 13-week- old Michael Redmond whose parents were told by staff at Our Lady of Lourdes Hospital in Drogheda that he had died in the womb.
Dr Michael O’Dowd said, however, that if the person carrying out the scan was properly trained and if they were using a good scanning machine, “they should definitely” be able to give an answer as to whether the pregnancy was ongoing or not.
He said he believed “the vast majority” of professionals in Ireland followed guidelines developed by the Royal College of Obstetricians and Gynaecologists (RCOG) in London in relation to the diagnosis and clinical management of women with early pregnancy loss.
These state that early pregnancy-assessment units should have access to transvaginal ultrasound with staff appropriately trained in its use and that “for pregnancies of uncertain viability, in order to confirm or refute viability, a repeat scan at a minimal interval of one week is necessary”.
He said the Institute of Obstetricians and Gynaecologists at the Royal College of Physicians of Ireland had however decided recently to develop its own guidelines.
And obviously because of the unfortunate events that have unfolded with these parents, they will be high on the agenda.”
Several women have recently come forward with stories of having had misdiagnosed miscarriages, something which had caused anxiety among those who may have been told they miscarried in the past but who never asked for second confirmatory scans. Dr O’Dowd however said he believed the vast majority of women probably had nothing to worry about.
He pointed out that the RCOG guidelines stated that viability of a foetus “will be uncertain in approximately 10 per cent of women at their first early pregnancy assessment unit visit”. Therefore there would be no doubt in the other 90 per cent of cases.
It is those women who fell into the 10 per cent category who should be called back a week later for a second scan, he said.
He said while it was not normal practice at this stage to get a second opinion on every scan where a heartbeat could not be found, “in the current circumstances, I’m sure everybody would be keen to have that in place until our own national guidelines are introduced”.
Asked whether many of the scanners used in early pregnancy assessment units were obsolete, Dr O’Dowd said he understood there would now be a full review of services in all maternity hospitals. He also stressed that most women who miscarried unfortunately came into hospital “in the act of miscarrying”.
Meanwhile, the HSE’s national director of quality and clinical care, Dr Barry White, said in most situations, “a mandatory second scan would seem to be the appropriate way to go” in future.
Former master of the Coombe Dr Seán Daly said miscarriage was very common, affecting up to one in three pregnancies, but making the diagnosis in early pregnancy could be very challenging, even with good equipment. “So it’s very difficult to say how often that diagnosis has been erroneously made but I have no doubt it happens.”
Proper training of staff and having protocols around early pregnancy ultrasound would reduce the number of times erroneous decisions were made, Dr Daly added.