[CG] Alterations to Ultrasound pathways – Covid 19

This document will be reviewed on a monthly basis or sooner if the clinical situation changes.

All women should be called the day before to enquire if they, or any family member, has fever or new onset continuous cough. If this is the case, the scan will be rearranged after 14 days. (7 days if the woman lives alone).

Clinicians should review all scan lists the week before to advise which scans can be cancelled/rescheduled. These clinicians should provide advice and coordinate care of women who are forced to miss appointments.

All units should provide a list of medical sonographers within their unit.

Where possible, scans should be reviewed within the scan department to reduce footfall in other areas of the unit. This is likely to apply to those women referred by their community midwives for issues such as suspected SGA/presentation .

No partners to be present for any scan – patient able to video scan but not if this adds to the appointment time.

NT screening to continue as part of booking scan (each unit to make efforts to co-locate venepuncture and NT scanning to reduce a  woman’s wait and movement). 

USS: For women with suspected or confirmed COVID‐19 if possible combined first trimester screening should be delayed until after the recommended period of self‐isolation is complete; if this would mean being beyond the gestational window for the first trimester screen a senior decision on urgency and potential risks/benefits should be sought as a second trimester screen could still be offered after the self‐isolation. For the fetal anomaly scan, again, if delaying the screen would mean going beyond the recommended gestational window a senior decision on urgency and potential risks/benefits should be sought as to whether the screen should be undertaken. If it is deemed that the ultrasound scan cannot be delayed until after the recommended period of isolation, infection prevention and control measures should be arranged locally to facilitate care. Pregnant women in self‐isolation who need to attend should be contacted by a local care coordinator to re‐book scans, preferably at the end of the working day. Ultrasound equipment should be decontaminated after use in line with national guidance.

 

All scan lists to be reviewed the week before. If a scan was arranged to coincide with an antenatal clinic appointment it should be considered whether the woman still needs to attend for an antenatal clinic appointment and appropriate arrangements made to reschedule. It is envisaged that this process will be carried out by a senior obstetrician with support from medical records and midwifery staff.

Growth scans will only be offered at 32 weeks and 36 weeks only unless any of the following are present;

• Type 1 or type 2 diabetes
• MCDA/DCDA twin pregnancy
• Previous loss or delivery for fetal reasons  <32 weeks
• Severe PET in this pregnancy <32 weeks
• Significant APH in this pregnancy <32 weeks

Women who are pregnant following assisted conception will no longer be offered growth scans. They will continue to be offered IOL at term.

Booking scans +/- NT screening and fetal anomaly scans will continue as before but there will be no second appointment for incomplete views.

Offer one scan at 18 weeks. If this is carried out between 18+0-20+0  this will allow dating, fetal anomaly, option of 2^nd trimester screening for trisomy 21 and placental localisation in women with a previous section.

(Anomaly scan 18+0- 23+0, 2^nd trimester screening 14+2-20+0)

This approach is based on the fact that the impact on staffing is likely to be most reduced in the next 12 weeks hence the shift to focus on growth in the third trimester rather than earlier.

RCOG guidance suggests screening for fetal growth restriction in pregnant women with confirmed Covid 19 illness. Ideally, referral for antenatal ultrasound should be organised for 14 days after resolution of the acute illness although it is acknowledged that this may not be possible.