NEW GUIDELINES URGE IMPROVED COMMUNICATION FOR MUMS
The Australasian Society for Ultrasound in Medicine (ASUM) has launched new guidelines mapping a way forward for sonographers to open dialogue and be more transparent with obstetric patients about the results of their scans.
ASUM Chief Executive Lyndal Macpherson said the guidelines were the result of broad collaboration with a multidisciplinary team including parent groups, patient advocates, sonographers, radiologists and obstetricians and had a clear priority to improve care for expectant parents by improving communication between them and health professionals, particularly when there are unexpected or ambiguous fetal or maternal findings.
The guidelines build on PhD research by sonographer Dr Samantha Thomas Sonographers’ level of autonomy in communication in Australian obstetric settings, and feedback from expectant parents who were keen to have reassurance from their sonographer the baby was developing well rather than waiting for their next specialist or midwife appointment.
Ms Macpherson said the guidelines were not mandatory but rather were a first step in opening parentcentred communication in obstetric ultrasound with a focus also on collaboration and continuity of care between sonographers, reporting specialists and referrers.
“Opening up clear lines of communication with a set of guidelines that will help public and private settings consider this model, really responds to what parents are wanting and improves the healthcare on offer to patients,” Ms Macpherson said “Our pilots in public and private settings have been an overwhelming success. Sonographers are on the frontline conducting these scans and parents are telling us delayed communication from the day of the scan until the next time they see a doctor concerns them.
“This is not only about communicating findings with parents but also equipping sonographers to share their communication with the reporting doctor so there is a clear understanding of the information being shared across all professionals in the care team.
“Ongoing management of a complicated diagnosis will of course sit with the doctor patient relationship, but our new guidelines can support sonographers to start a clear, unambiguous, compassionate, and judgement-free communication process, that is sensitive to the parent journey.”
Parent-centred communication in obstetric ultrasound has trialled in Fiona Stanley Public Hospital, Perth, and PRP Diagnostic Imaging – Eastwood, NSW, with a high rate of parent and clinician satisfaction. “When forming organisational policies – public facilities and private radiology and obstetric practices may refer to ASUM’s Parent-Centred Communication in Obstetric Ultrasound Guidelines to consider implementing new ways of working with sonographers and parents,” Ms Macpherson said.
The Pink Elephants Support Network consulted closely on the guidelines and Board member Dr Melanie Keep said after the loss of her own baby at 11 weeks in 2019, she was moved to ensure other women experienced more open and supportive communication when faced with unexpected and sometimes traumatic pregnancy news.
ASUM would like to draw attention to recent research conducted by the University of London and the Katholieke Universiteit Leuven, Belgium, published in the November 2011 issue of Ultrasound in Obstetrics and Gynaecology.
The studies suggest that, given inter-observer variability in ultrasound measurements and the significant variation in early embryonic growth, a more conservative approach to the diagnosis of early pregnancy loss is warranted.
The recommendation which has been temporarily endorsed by the RCOG (Royal College of Obstetricians and Gynaecologists) suggests a mean sac diameter (MSD) cut off >25mm and a crown rump length (CRL) cut off >7mm be introduced to minimize the risk of a false positive diagnosis of miscarriage.
While this research awaits confirmation from other centres ASUM suggests interim caution and highlights the importance of transvaginal confirmation of early pregnancy failure.
It should also be noted that many other factors are used when assessing early pregnancy failure, including the presence of a yolk sac, shape of the gestation sac, position within the uterine cavity or cervix, progress from a previous scan and correlation with known gestational age especially in IVF pregnancies.
Fergus Scott MB BS FRANZCOG DDU CMFM COGU ASUM President
Simon Meagher MB BCH BAO (Hons) BSc (Hons) FRCOG FRANZCOG FRCPI DDU COGU Policy and Standards Chair
24 October 2011