Article Text

Defining fetal medicine practice in England 2009
  1. E Wilding1,
  2. ED Johnstone2
  1. 1Uinversity College London Hospitals, London, UK
  2. 2Manchester University, Manchester, UK

Abstract

Introduction Subspecialty training in fetal medicine is nationally regulated, but provision of service has been developed regionally, leading to variation in how and where services are provided. As a result there are few auditable standards to facilitate performance review. The authors have carried out a pilot survey of current practise to try and determine potential baseline standards that might be used for this purpose.

Methods The authors performed an internet search of fetal medicine centres in England and conducted a targeted questionnaire by telephone and e-mail of fetal medicine leads. Questions centred on services provided, invasive procedure method, result type, result speed and database/audit facilities.

Results Our search found 24 units and the response rate was 67%. All units performed amniocentesis and chorionic villous sample (CVS). 94% performed fetocide and 24% provided twin laser services. The commonest CVS technique used a double lumen, freehand, abdominal approach (47%) with only 17% performing cervical approach. All units had rapid aneuploidy testing, but result speed varied (modal response 2 days). Failure rates were not reported in the majority (69%) of units. 94% had specific fetal medicine databases and 81% reported an annual review of figures and workload.

Conclusion The authors have demonstrated that although there is broad consistency in the range of services offered, there is considerable variation in how fetal medicine procedures are performed. Further investigation to define what constitutes baseline performance is required; this will enable the creation of auditable standards of acceptable fetal medicine practice within the National Health Service.

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