Pregnant women should have two scans, Scottish agency says
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《英国医生杂志》
All pregnant women in Scotland should be routinely offered two ultrasound scans to check the health of the fetus, a Scottish NHS agency has recommended. Currently the service is offered by just over half of Scotland抯 maternity units.
NHS Quality Improvement Scotland (NHS QIS) has carried out a full assessment of the clinical and cost effectiveness of routine ultrasonography in the first 24 weeks of pregnancy. It has concluded that a system that offers scans in both the first and second trimester is the most efficient method of detecting fetal abnormalities.
Introducing such a system across Scotland is expected to push up the costs of ultrasonography by more than 50%—from the current ￡6.3m ($11.9m; �9.3m) to ￡9.6m. Discussions are taking place between NHS QIS and the Scottish Executive about implementing the recommendation. Meanwhile NHS QIS wants hospitals to start preparing action plans now to introduce the new system. The fact that additional trained staff will be needed, together with new scanning equipment, may mean that full implementation will not take place for two years or more.
The recommendation in Scotland is in line with guidelines produced by the National Institute for Clinical Excellence in England and Wales in October last year (BMJ 2003;327:1009). NHS QIS is recommending that women be offered their first scan between the 10th and 13th week of pregnancy. This scan should be part of a wider set of tests that includes nuchal translucency measurement and measurement of two maternal serum markers to check for chromosomal abnormalities. The second scan should take place between 18 and 22 weeks and is aimed at detecting developmental problems such as spina bifida and cardiac problems.
A survey of maternity units carried out as part of the assessment found that first scans are currently being carried out at between 8 weeks and 16 weeks. Just under half the units did this scan within the recommended 10-13 weeks. Only 57% of units offer a routine second scan in addition to a first trimester scan.
NHS QIS抯 interim director for health technology assessment, Dr Harpreet Kohli, said: "Ultrasound scanning is currently provided in different ways at different hospitals in Scotland. Women are offered ultrasound at different stages of pregnancy and undergo various types of tests to assess the potential risk of conditions like Down抯 syndrome and spina bifida. Implementation of our advice will bring consistency to the service in Scotland and offer reassurance to the majority of pregnant women about their baby抯 health."
Routine Ultrasound Scanning Before 24 Weeks of Pregnancy is available at www.nhshealthquality.org(Edinburgh Bryan Christie)
NHS Quality Improvement Scotland (NHS QIS) has carried out a full assessment of the clinical and cost effectiveness of routine ultrasonography in the first 24 weeks of pregnancy. It has concluded that a system that offers scans in both the first and second trimester is the most efficient method of detecting fetal abnormalities.
Introducing such a system across Scotland is expected to push up the costs of ultrasonography by more than 50%—from the current ￡6.3m ($11.9m; �9.3m) to ￡9.6m. Discussions are taking place between NHS QIS and the Scottish Executive about implementing the recommendation. Meanwhile NHS QIS wants hospitals to start preparing action plans now to introduce the new system. The fact that additional trained staff will be needed, together with new scanning equipment, may mean that full implementation will not take place for two years or more.
The recommendation in Scotland is in line with guidelines produced by the National Institute for Clinical Excellence in England and Wales in October last year (BMJ 2003;327:1009). NHS QIS is recommending that women be offered their first scan between the 10th and 13th week of pregnancy. This scan should be part of a wider set of tests that includes nuchal translucency measurement and measurement of two maternal serum markers to check for chromosomal abnormalities. The second scan should take place between 18 and 22 weeks and is aimed at detecting developmental problems such as spina bifida and cardiac problems.
A survey of maternity units carried out as part of the assessment found that first scans are currently being carried out at between 8 weeks and 16 weeks. Just under half the units did this scan within the recommended 10-13 weeks. Only 57% of units offer a routine second scan in addition to a first trimester scan.
NHS QIS抯 interim director for health technology assessment, Dr Harpreet Kohli, said: "Ultrasound scanning is currently provided in different ways at different hospitals in Scotland. Women are offered ultrasound at different stages of pregnancy and undergo various types of tests to assess the potential risk of conditions like Down抯 syndrome and spina bifida. Implementation of our advice will bring consistency to the service in Scotland and offer reassurance to the majority of pregnant women about their baby抯 health."
Routine Ultrasound Scanning Before 24 Weeks of Pregnancy is available at www.nhshealthquality.org(Edinburgh Bryan Christie)