POLICIES, STATEMENTS & GUIDELINES Home About BMUS About Ultrasound Conference & Events BMUS Journal Ultrasound Training & Qualifications Policies, Statements & Guidelines  Policies, Statements - Home  Press Statements  Fetal Measurements  ASUM Site Links  Safety Statements  Training/Education Statements  Clinical Protocols   BMUS Members Sign In  Membership No.   Password    Request password   BMUS STATEMENT ON CONFIRMATION OF EARLY FETAL DEMISE BY ONE OR MORE OPERATORS Context: BMUS has recently received enquiries about confirmation of this distressing situation for the patient, particularly in respect of whether there is a need for a second party to scan the patient to confirm fetal demise. BMUS response: There is no national policy on this issue and investigations show a variance in clinical practice between units. However, the Association of Early Pregnancy Units advise where a missed miscarriage is suspected that two operators should scan a patient to confirm the diagnosis. Practice appears to be divided between: i. A diagnosis made by one Sonographer/Ultrasound Practitioner who advises patient accordingly; ii. A diagnosis confirmed by second party and patient advised accordingly.     This may create doubt in the patients mind that the original diagnosis is not correct and they may question the professional integrity of the Sonographer/Ultrasound Practitioner. It may create false hope that the original diagnosis was incorrect. This situation is often very distressing for the patient, particularly if the examination has been done transvaginally as the transducer then has to be reinserted prolonging the examination when a second scan is performed. However, some staff have expressed that this approach may benefit the patient as confirmation by a second party confirms there to be no doubt in the diagnosis. BMUS recommends that: it should not be necessary for a second member of staff to confirm embryonic/fetal demise as long as the primary Sonographer/Ultrasound Practitioner is confident of the diagnosis;   a second opinion should be sought if there is any doubt in diagnosis;   if the patient may gain psychological benefit from having a second Sonographer/Ultrasound Practitioner involved, for example, if she finds the diagnosis hard to accept, a second scan by another professional should always be available and be actively offered;   a second scan is performed in 7 days in accordance with RCOG guidance2 if the embryo measures < 6mm or if there is an apparently empty gestation sac with a mean sac diameter measuring < 20mm;   practice must be supported by a robust local protocol which defines standard practice in the Trust. There should be consistency of staff approach to this situation and no variance in staff practice both for governance and to avoid unnecessary distress to the patient;   the gold standard for evidencing early pregnancy failure/fetal demise is to archive a cine clip showing absence of fetal heart motion and an M-mode image to demonstrate life/death at the time of the scan. REFERENCES: 1. www.earlypregnancy.org.uk/whoarewe.asp (guidelines) 2. Hinshaw K. The Management of Early Pregnancy Loss. Royal College of Obstetricians and Gynaecologists Green - Top Guideline (No.25), October 2006, RCOG Press, London (www.rcog.org.uk) BMUS Professional Standards Sub-group Hazel M Edwards Sue Halson-Brown Janette Keit Darryl Maxwell Carmel M Moran Julie M Walton On behalf of BMUS, 1 April 2010  Back To BMUS Clinical Protocols