Fetal Heart Scan: news and articles

1. How to sponsor training (in UK NHS maternity hospitals)

Would you like to sponsor the charity to provide Hands-on Fetal Heart Scan Training to your hospital?
(Follow the link to "Item 11" at bottom of page)

2. Volunteer Fetal Heart Scan Trainers

Are you are interested in becoming a Volunteer Trainer?

Basic requirements include:

• Experience of fetal scanning, especially fetal cardiac scanning
• Willingness to learn and teach the "5 Transverse View" protocol
• Ability to travel, good presentation & training skills and an aptitude for training others, enthusiasm & patience
• A real interest in working with a charity and making a contribution to improving the detection of fetal cardiac defects
• Be able to spare approx. 1/2 day per week

Your geographic location may be important, as we can cover more of the UK by having a network of Volunteer Trainers in different areas.

We can pay reasonable travel expenses.  In addition, you may be able to apply for local funding to support you.

Please contact us for more details (preferably by email).

3. Guidelines for Ultrasound Screening, 2008

These guidelines update the Royal College of Obstetrics and Gynaecology (RCOG) guidelines for Ultrasound Screening (July 2000).

(ref. www.rcog.org.uk/index.asp?PageID=1185)  

Quality & Audit

There are several important recommendations in this area, including:

"... hard copy or preferably video recordings ... when abnormalities are found, or when specific structures are seen which may appear suspicious" (4.4.1)

"Every unit should audit its results with respect to the detection of fetal abnormalities on an annual basis. The results of the audit should be included in the information provided to women, for example in a patient information leaflet" (4.6.1)

"The continual monitoring of results in terms of accuracy of diagnosis is mandatory" (4.6.2)

Our Notes:  The charity's experience is that the quality of record keeping is highly variable and we recommend (as a minimum) a simple "referral" log for all suspected anomalies that are referred (i.e. date, mother's name & NHS no., mother's gestational age, sonographer name and findings).  This allows an audit to be created and feedback from neonatal and postnatal data to be matched.

Ultrasound equipment should be no more than 5 years old

"A scan to perform a fetal structural survey demands the use of modern equipment (not more than 5 years old) of modest sophistication. The scanner must be capable of performing the necessary measurements and should provide good image quality. As always, regard for safety in the use of ultrasound is paramount and minimum output should be used in accordance with the ALARA principle - As Low As Reasonably Attainable". (7.1)

Our Notes:  Ultrasound equipment has advanced considerably in the last 5 years.  Modern equipment with correct fetal echo settings and probes, capable of imaging the tiny, fast-moving structures of the fetal heart, allows screening scans to be performed faster and more reliably, so that a full "5 View" fetal heart scan could be performed within the time allowed for a routine scan.

4. Screening in Europe

Many countries in Europe perform a routine scan at around 20 weeks, including Croatia, Denmark (from 2004), France, Ireland, Germany, Portugal, Sweden, Switzerland and the UK. *

The Netherlands have just started routine antenatal screening at 20 weeks and the FMF Netherlands (Fetal Medicine Foundation in The Netherlands) are promoting the 5 View Protocol.

* Source:  Eurocat, Prenatal Screening Policies in Europe, 2005 (compiled by University of Ulster).

5. Communication Skills: "Breaking bad news"
As the detection of fetal heart anomalies before birth increases, there are implications for communicating potentially "bad news" at an earlier stage.  This has an impact on sonographers & parents alike.

Part of our training initiative to detect more fetal heart defects and improve information to parents, is concerned with how health professionals tell parents "bad news" and how parents cope. 

Note:  It is important to understand that some parents do not perceive the news they receive as being "bad" - especially if the news is conveyed sensitively and the defect is relatively "small" and the prognosis is "good".  In this case, it may be simply "news".

This is a complex area, requiring good communication skills and we are fortunate that we are able to collaborate with Antenatal Results & Choices (ARC) who offer professional training in communications skills as well as information to parents on antenatal screening.

One of the standard ARC course is "Communication skills and breaking bad news: the implications of antenatal screening and testing".  This is a generic day which looks at communication skills and breaking bad news (with a brief overview of grief and bereavement) in its wider context within fetal ultrasound screening.  See ARC for more info. of courses in your area.

In September 2004, we invited ARC to hold a study day for about 20 sonographers & healthcare professionals from hospitals who have received our "hands-on" training.  This was a very useful day to help understand the particular problems & pressures faced by sonographers.  We observed:

• Sonographers are unique in the fact that they have no time to prepare the breaking of bad news (of a suspected congenital problem). They may have only met a mother a matter of minutes before realising that there is a problem. Other health care professionals usually have information about a patient and time set aside to deal with them.
• There are often severe time limitations for sonographers. If they give extra time to one mother, a queue is probably building up outside the room. This is not ideal for breaking bad news.
• Practices vary tremendously between departments. Some are not allowed to tell a mother anything, while others can refer immediately for a second opinion.
• Heart problems are complex and change over time and can be very difficult to explain to a mother. There are a high number of false positives. The tendency is to use fetal position or poor views as reason for referral.

Further articles:  The March 2005 issue of Reverberations (from UKAS) was dedicated to this topic.

Each department should decide how they approach the detection and communication of congenital defects.

6. Conferences & Fetal Echo Courses
BMUS, UKAS & most major fetal medicine (or fetal cardiology) centres run courses in fetal heart scanning.
See BMUS (British Medical Ultrasound Soc.) and also see a list of Fetal Cardiology related conferences. 

"5 View" Courses: 
We do not have accurate information as to which courses promote a systematic "5 view" scan, but we believe it is becoming more widespread, so please ask the organisers.

One course that does describe the fetal heart in 5 transverse views, was held at the National Heart & Lung Institute (NHLI), London (part of Imperial College School of Medicine) and includes ultrasound views & morphological correlates:

Fetal Echocardiography for the Obstetrician & Sonographer, October, NHLI, Imperial College, London

A 2-day course including lectures, echo-morphologic correlates and "hands-on" sessions, suitable for echo-cardiographers of wide-ranging abilities and those who have not yet begun to examine the fetal heart. 

Download details  |  Registration: email the organisers  |  More IC courses:  Imperial College: short courses

Note:  We welcome courses that promote a systematic "5 view" scan of the fetal heart to contact us.