Can Stillbirths be prevented?

The press has reported that as many as half of stillbirths in the UK could be prevented if a simple test, namely, a Doppler scan, is carried out.  There are approximately 4,000 recorded stillbirths per annum in the UK.

A stillbirth 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. However, research has shown that a stillbirth often happens due to a problem with the placenta and blood flow 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, the blood flow between the placenta and the unborn child will be measured.  He told BBC’s Panorama, “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 do so through very simple adjustments in how we deliver antenatal care.”

A Doppler scan is a straightforward scanning technique rather than an ultrasound scan and it can be used to measure blood flow in various body parts.  It can be carried out at the same time as a normal dating ultrasound scan; apparently, most ultrasound scanners can carry out the Doppler scan at the same time.  Portable Doppler scans are also available and these can be used by midwives 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 pregnancy is classed as ‘high risk’ such as in circumstances where a baby is affected because it is a twin (i.e. 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 is that the cost of carrying out the scan per pregnancy is believed to be £15, which 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. He uses a tape measure to measure the size of his patient’s pregnancy bump and 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 want 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 a patient’s health 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.