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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Julie D Clark, BSc MPH, Sue Payne, Dr, and Peter Donnelly, MD MPH MBA FRCP. Lothian NHS Board, Deaconess House, 148 Pleasance, Edinburgh, United Kingdom, 0131 536 9296, Julie.Clark@lhb.scot.nhs.uk
Background:
Ultrasound has a number of valuable functions in obstetrics including dating, confirming viability, counting the number of fetuses and the exclusion of certain fetal anomalies. Some concerns exist about the routine use of ultrasound in obstetric practice for screening for fetal abnormalities, in particular the justification, effectiveness, objectives, costs and potential hazards. The most recent report “Ultrasound screening for fetal abnormalities” from the UK Royal College of Obstetricians and Gynaecologists (RCOG) recommends that a two scan regime (i.e. a booking scan at 10-14 weeks followed by a fetal anomaly scan at 18-20 weeks) should be routinely offered to all pregnant women. Substantial literature exists on the benefits of routine versus targeted scanning, including a number of key trials under randomised controlled conditions. Current practice in Scotland for fetal anomaly scanning varies across different Health Board areas and Edinburgh has a policy of targeted scanning which is currently under review.
Methods:
In order to inform discussions surrounding a change in policy we have attempted to calculate screening parameters through spreadsheet analysis using a database of fetal abnormality held at the Simpson’s Memorial Maternity Pavilion in Edinburgh.
Results:
We have documented the sensitivity, specificity, positive predictive value and negative predictive values for the current targeted fetal anomaly scan and explored some of the problems associated with collecting, analysing and interpreting the data.
Conclusions:
The decision to change policy, in this case moving from targeted to routine fetal anomaly scanning, is not always based on the most robust evidence, and has to take into account organisational and political constraints.
Learning Objectives:
Keywords: Screening, Policy/Policy Development
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.