28 January 2010 Donna Kirwan National Projects Officer to Weeks Fetal Anomaly Scan National Standards for England ‘Into the next decade’

Donna Kirwan Professor Martin Whittle Professor Peter Soothill Professor Alan Cameron Mr Tim Overton Mrs Rita Phillips Dr. Colin Davies Dr. Trish Chudleigh Administrative support: Mrs Jackie Williams

Obstetric ultrasound ,444,180 Department of Health

1 Coordinating group

2 Leadership

3 Consent

The fetal anomaly scan should be discussed as an option, rather than an inevitable aspect of routine antenatal care for it to be meaningful

4 Scan appointment

30 minutes

5 Scan base menu

Ultrasound scan base menu Head & neck Brain & nuchal fold Face Lips Chest 4 chamber view & outflow tracts Lungs Abdomen Stomach Abdominal wall Bowel Renal pelvis Bladder Spine Vertebrae Skin covering of spine Limbs (a) Limbs (b) Femur (one only) Hands (present) Feet (present) Uterine cavity Amniotic fluid (subjective volume) Placental site

6 Normal variants

‘Normal variants’ Increased nuchal fold > 6mm Ventriculomegaly >10 mm Echogenic bowel Brighter than bone Renal pelvic dilatation > 7mm Small size compared to the dating scan Significantly < 5 th centile on national charts

7 11 conditions

11 auditable conditions ConditionDetection Rate (%) Anencephaly98 Gastroschisis98 Edwards’ syndrome95 Patau’s syndrome95 Open spina bifida90 Bilateral renal agenesis84 Exomphalos80 Cleft lip75 Lethal skeletal dysplasia60 Diaphragmatic hernia60 Serious cardiac abnormalities50 ≥ 50%

Where are we? Where do we want to get to? How will we get there? How will we know we’ve got there?

It’s not just to get a scan picture

Lines of accountability Standards & measures Quick wins Explicit written arrangements Coordinating group Monitoring CommissioningEducation & Training Coordinating group Leadership

From 1 April 2010