Wednesday 22 November 2017

'Babies dying due to lack of routine scans'

Expert in foetal abnormalities says State is lagging behind rest of the world when it comes to offering routine checks

Diagnostics of pregnancy
Diagnostics of pregnancy
Donal Lynch

Donal Lynch

Ireland is one of the worst countries in Europe and "way behind the rest of the world" when it comes to scanning for foetal abnormalities, according to one of the national experts on the subject, Professor Fergal Malone.

Around 1,500 cases of foetal abnormalities are identified in Ireland each year.

Prof Malone, who heads the obstetrics department at the Rotunda Hospital, was speaking in the wake of a survey which showed that only 13 of the country's 20 pregnancy centres routinely screen for conditions such as Down Syndrome or heart defects.

This means that a majority of Irish children with foetal abnormalities are not born into "an optimal setting", and problems that could be easily dealt with if the correct specialists were on hand escalate into emergencies.

The problem lies with the division of medical specialists who are involved in the care of infants inside and outside the womb. "Obstetrics and paediatric services in Ireland are quite divorced from each other," explains Prof Malone.

"In many other countries around the world if you deliver a baby and it has a heart defect, it's no problem, there is a cardiologist on site. In Ireland you can deliver a baby at 2am in Letterkenny Hospital and it has a heart defect and all of a sudden you have to call the Air Corps to fly the baby down to Crumlin."

This has resulted in the deaths of babies, and it will continue to do so, says Prof Malone. "It's a real tragedy. You have an otherwise healthy baby dying because it doesn't get the right care. We are completely deficient in this regard compared to other countries. It doesn't matter where you go: Eastern Europe, Western Europe, the US, Australia, New Zealand, routine scanning for foetal abnormalities is done in almost 100 per cent of pregnancies.

"For example, I have regularly seen Polish mothers and they can't believe how it's done here. They are amazed that you have to be persistent, to ask, and in some cases to pay for these scans. And these scans are not new, they've been around a long time."

This is an economic issue for parents as much as it is for hospitals. Prof Malone said we have a "de facto two-tier system" with babies born with serious medical conditions to parents who can afford to pay privately for scans tending to do much better than those born to poorer parents, who have not sought a scan.

Many expectant mothers in Ireland do not understand that there is a difference between the routine scans that are done at eight or 10 weeks -- indicating only whether the child has a heartbeat or not -- and detailed scans which can identify a range of conditions. This is why parents are often surprised in the delivery room when a foetal abnormality is identified.

The failure to offer scans across the board is principally to do with funding. Unlike screening for cervical or breast cancer there is no ring-fenced budget in Ireland for screening for foetal abnormalities.

Prof Malone said that in previous years there may have been suggestions that Irish people were "more moral or religious" than parents from other countries. This, in turn, resulted in some hesitancy on the part of doctors to suggest screening because of sensitivity around issues to do with abortion. This, he said, is no longer the case: "We have found that Irish patients want to be scanned as much as patients from anywhere."

Dr Peter McParland, director of the National Maternity Hospital, was recently quoted as saying that scans are "not about terminations" but Prof Malone said this depends on the case. What parents do with the information they get changes, depending on the foetal abnormality identified.

"In general we have found 70-80 per cent with certain foetal abnormalities will choose to travel to the UK for an abortion", he said.

"There are others, however, for which patients tend to continue with their pregnancy. With heart defects the majority tend to continue on with their pregnancy. Most prenatally diagnosed cases of Edwards Syndrome (a lethal chromosome-related condition) also continue on. Probably the majority of patients who have a prenatally diagnosed Down Syndrome do choose to travel to the UK to terminate. We find that parents take a nuanced view, depending on the implications for them and their families."

The solution for parents, who are concerned that they need a scan, is "to be empowered to ask the right questions," said Prof Malone. "Patients have to be their own advocates. If there is seen to be a demand or an awareness then you may see hospital managers look again at how they could make more of an effort to streamline resources towards scanning."

Irish Independent

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