Can Stillbirths be prevented?20 Oct 2014
It has been reported in the press that as many as half of stillbirths in the UK could be prevented if a simple test, namely, a Doppler scan is carried out. Apparently there are approximately 4,000 recorded stillbirths per annum in the UK.
A still birth is the death of a fetus in the womb after 24 weeks into the pregnancy and often this happens to a woman when there are no apparent risk factors. Although research has shown that often a stillbirth happens due to a problem with the placenta and the flow of blood between the mother and baby in utero.
A leading obstetrician and professor of foetal medicine, Professor Kypros Nicolaides has said that if all women are offered Doppler scans during pregnancy this will allow the blood flow between the placenta and the unborn child to be measured. He told BBC’s Panorama that “We have demonstrated through extensive research that you can identify more than 90% of those cases from the 12-week assessment. ……. We can easily avoid them and we can do so through very simple adjustments in the way we deliver antenatal care.”
A Doppler scan is a straightforward scanning technique rather like an ultrasound scan and it can be used to measure blood flow in various parts of the body. It can actually be carried out at the same time as a normal dating ultrasound scan and apparently most ultrasound scanners have the ability to carry out the Doppler scan at the same time. Portable Doppler scans are also available and these can be used by midwife’s or doctors when visiting pregnant women in their home. Normal dating scans are carried out at 12, 22 and 32 weeks of pregnancy. Doppler scans are routinely carried out in circumstances where a pregnancy is classed as ‘high risk’ such as in circumstances where a baby is affected because it is a twin (ie sharing the same placenta); the mother is rhesus negative; the baby is not growing at the rate it should or the baby is affected by parvovirus.
Another factor in favour of the Doppler scans are that the costs of carrying out the scan per pregnancy is believed to be £15, when in the scheme of things is very little expense considering the potential number of babies that can be saved.
Professor Jason Gardosi is a director of the Perinatal Institute in Birmingham and he uses a tape measure to measure the size of his patients pregnancy bump and he then plots the growth on a chart. If the measurements are not within normal limits he will investigate further. He told Panorama “that hospitals adopting his technique have seen a 22% drop in stillbirths and that his method costs no more than 50p per pregnancy. He estimates that this measurement and plotting technique could prevent around 1,000 stillbirths each year in the UK”.
Professor Gordon Smith at the department of obstetrics & gynaecology at the University of Cambridge is of a different view and believes that although these methods and tests were likely to lead to “positive results, firm clinical evidence was needed” before any changes to antenatal care. He said “we have to provide the evidence that what we’re wanting to do is safe, effective and cost-effective.”
Any changes to medical care (including antenatal care) which can achieve a positive outcome for patients in a cost effective manner without affecting the health of a patient can only be a good thing. If stillbirths can be prevented as a consequence of the Doppler scan then surely this must be the way forward for antenatal care.
Partner & Head of Clinical Negligence Department.