New Obstetric Guidelines for the 20 Week Foetal Anatomy Ultrasound Scan which Seeks to Identify cases of Vasa Previa will save many lives
In January 2023 the Guidelines Committee of the National Women and Infants Health Programme in conjunction with the Irish Institute of Obstetricians and Gynaecologists introduced new guidelines for the 20 week foetal anatomy scan. These new guidelines make welcome and radical new recommendations governing the scope and extent of the 20 week scan that should be routinely performed.
Our firm was involved in a landmark case in July of 2022 in which our client ( an 8 year old boy) suffered hypoxic injuries at birth resulting in permanent brain injury as a consequence of the failure to prenatally diagnose a potentially lethal condition affecting his placenta and umbilical cord known as vasa previa. Please see link to report of Vivienne Trainer of RTE on the outcome of the case of Ricky Meehan (an infant) v The Rotunda Hospital
Vasa previa is a relatively rare condition that may affect between 1 in 1,500 and 1 in 2,000 pregnancies. It occurs when the foetal blood vessels that are unprotected by the umbilical cord of placenta run through the amniotic membranes and traverse the cervix. They are thus unprotected and liable to rupture with catastrophic effects during the course of labour. Prenatal diagnosis of this condition as a routine part of the 20 week foetal anatomy scan would enable the condition to be diagnosed in almost all cases and could be then treated by way of elective caesarean section at approximately 38 weeks’ gestation. before labour has begun. This would result in a 100% foetal survival rate, as compared to a 40% survival rate should the condition remain undiagnosed prelabour . The undisputed evidence is that with the use of modern doppler ultrasound techniques, the condition of vasa previa can be identified in 98% of cases and this would take no more than 30 seconds approximately if performed as an integral part of the 20 week foetal anatomy scan.
Up until now screening for vasa previa was NOT carried out in this country as a routine part of the 20 week scan. In this regard, Irish maternity units adhered to a similar non screening practice as the UK. However, many other developed countries (Australia, New Zealand, Canada, Japan, United States etc) had in recent years changed their practice guidelines to screen for this condition.
We are very happy to highlight that as a result of the successful litigation pursued by the Meehan family and the urgings of Ricky Meehan’s mother, Mrs Maria Meehan, along with others, the Irish national guidelines have now been changed. We believe that the change has been brought about as a result of the campaigning of Mrs Meehan and others assisted by this firm (please see letter written to the Minister for Health by this firm dated July 2022 here).This is a most welcome development.. The relevant recommendation of the Irish guidelines published in January 2023 is as follows:
“In cases with risk factors for vasa previa, e.g. velamentous cord insertion, placenta dysmorphology succenturiate lobed placenta, low lying placenta or bilobed placentas, multiple pregnancies and/or pregnancies conceived with invitro fertilisation (IVF), targeted screening with transabdominal ultrasound, colour doppler is recommended…A foetal medicine opinion should be sought if vasa previa is suspected”.
It is believed that adopting the above recommendation will effectively identify more than 90% of all cases of vasa previa which will probably result in the saving of up to 20 babies’ lives per year with a similar number being spared long term neurological brain injury. The new recommendations which seek to screen for this condition represent a very cogent example of how the courage of an ordinary mother who has the fortitude to pursue a just and meritorious legal cause can effect change for the better in our health system. We are delighted to have supported Mrs Maria Meehan in her heroic efforts to achieve this change. We would also wish to extend our gratitude to the relevant medics on the Guidelines Advisory Committee who supported this endeavour and have been responsible for recommending this change.
Michael Boylan, Partner