Only 20% of hospitals replied to queries about their guidelines on how to deal with scans in early pregnancy, write ALISON HEALYand MARTIN WALL
THE HEALTH Service Executive yesterday declined to answer specific queries about the policies of the State’s maternity hospitals regarding scanning in early pregnancy.
The Irish Timescontacted 20 hospitals providing maternity services but just four replied to the queries raised.
The hospitals were asked if they had written protocols in place regarding scanning in early pregnancy; if it was hospital policy to get a second opinion when no foetal heartbeat was detected; and if it was policy to conduct a second scan in such cases.
While the HSE did not answer these specific queries, it issued a general statement last night outlining some new policies and saying attempts would be made to standardise procedures across the hospitals.
Dr Barry White, the HSE’s national director for quality and clinical care, said: “In a number of the cases discussed in the media in recent days, the practices were unacceptable and this reinforces the need to implement standardised care across the system and to ensure compliance with this by audit and review.”
Prof Michael Turner, clinical lead of the HSE’s obstetrics programme, advised hospitals that it was important to not to consider a scan in isolation, but to consider the pregnant woman’s history and other investigations.
Earlier, the Rotunda Hospital, the Coombe Women and Infants University Hospital, Dublin’s Mount Carmel Hospital and Galway University Hospital responded to the queries raised by this newspaper.
A spokesperson for the National Maternity Hospital was not available, while the regional HSE offices referred the queries about hospitals in their catchment area to their national press office. However, this did not address the specific questions asked.
The master of the Rotunda Hospital, Dr Sam Coulter-Smith, said all its work in the early pregnancy unit was governed by written protocols. He said a second scan would be conducted if an early pregnancy of six to nine weeks was involved because the dates given could be wrong by one or two weeks. The second scan would be conducted a week or more later, to ensure that there was no doubt, he said.
He said patients were free to seek a second opinion if they doubted a result. Such requests were not uncommon.
The Coombe hospital has written guidelines regarding scans for early pregnancy loss. A spokesman said second scans were always performed if the findings in the first scan were inconclusive or if there was any uncertainly regarding the gestational age of the pregnancy.
On RTÉ radio yesterday, Prof Seán Daly from the Coombe said the diagnosis of miscarriage could be “challenging” when the pregnancy was less than nine weeks old because the foetal heart might not be visible.
“The difficulty is that when you don’t see a foetal heart, can you be absolutely sure that there is no foetal heart?,” he asked. “I think that comes with experience and adequate training and is dependent upon proper equipment.”
A spokeswoman for Dublin’s Mount Carmel Hospital said the work of its early pregnancy unit was guided by a set of written protocols.
“All patients are scanned by qualified experienced sonographers and our written protocols follow RCOG [Royal College of Obstetricians and Gynaecologists] guidelines,” she said. “All our images are kept on hard disc and available for perusal at any time.”
Asked about procedures at Galway University Hospital, the HSE West said a second opinion from another healthcare worker was given in cases where a foetal heartbeat was not detected. It said that if there was still no foetal heart beat recorded, then a second scan was performed to ensure an accurate diagnosis.
It said that these measures were introduced at the hospital in 2006 following an incident of an incorrect diagnosis of a missed miscarriage.
Of more than 70,000 births in Ireland each year, there are approximately 14,000 miscarriages.