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Up to 30 babies’ lives could be saved each year through new screening process, solicitor says

Maternity service publishes 12 new guidelines designed to standardise obstetric care

Original article published on The Irish Times.

Pregnant women at risk of a complication known as vasa previa should be screened for it at about 20 weeks, according to new guidelines for maternity care.

The recommendation could save the lives of up to 30 babies a year, according to solicitor Michael Boylan, who has campaigned on the issue.

While Mr Boylan and families who have lost babies to the complication sought the introduction of routine screening, the recommendation from the HSE National Women and Infants Programme and the Institute of Obstetricians is for targeted screening of women with risk factors for vasa previa.

These risk factors include low-lying or bi-lobed placentas, multiple or IVF pregnancies, velamentous cord insertion (where the umbilical cord is attached incorrectly) and placental dysmorphology (malformations).

Vasa previa is a pregnancy complication that can lead to severe blood loss for the foetus if not carefully managed. It occurs in about one in every 2,500 deliveries, but more frequently in IVF pregnancies. When identified early, the complication can generally be avoided through a Caesarean delivery.

Mr Boylan said the new guidelines would help identify more than 95 per cent of vasa previa cases and save 20-30 lives a year and prevent a like number of survivors suffering disability.

Prof Keelin O’Donoghue, clinical lead for the guidelines, said routine scanning for the condition could lead to over-diagnosis so the recommendation was to focus on women at the highest risk. The scan will look at whether the cord is correctly inserted and will involve additional checks where risk factors are present.

The recommendation on vasa previa appears in guidelines on foetal anatomy ultrasounds. This is one of 12 new clinical practice guidelines in obstetrics and gynaecology published on Friday by the HSE National Women and Infants Programme and the Institute of Obstetricians, which aim to promote a standardised approach to care across the country.

“The primary focus of the guidelines is to improve the quality of care, with the aim of improving consistency,” said Dr Cliona Murphy, clinical director of the programme. The guidelines, which are available on the HSE website, also include a plain language summary for non-specialists.

Other guidelines cover areas such as early terminations, post-menopausal bleeding, vaginal birth after Caesarean section and post-partum haemorrhage.

New guidelines on stillbirths say postmortems should be offered to parents in all cases. All cases of stillbirth should be discussed with a local coroner before the issue of a postmortem is raised with the baby’s parents, the guidelines recommend. Parents should be under no obligation to provide consent for a postmortem and their decisions to decline one should be respected.

All maternity services should have a dedicated specialist who is experienced in the field of bereavement and loss, and parents should be provided with the opportunity to see or hold their baby after birth.

All pregnant women should be offered a foetal anatomy ultrasound examination between 18 and 22 weeks as part of standard antenatal care, according to a separate set of guidelines.