Midwife scan clinic: response to increased demand for third trimester ultrasound
In response to the high UK stillbirth rate, the Saving Babies' Lives care bundles of 2016 and 2019 recommended increased focus on reduced fetal movements and fetal growth restriction. Adopting the recommendations precipitated a sharp increase in third trimester scans, causing existing ultrasound services to be overwhelmed. A midwife scan clinic, established at Kingston Hospital NHS Trust in 2019, has been found to manage this increased scan demand efficiently and effectively. Midwife-sonographers triage scan requests, perform the scans and provide post-scan management in a one-stop-shop scenario. Evaluation of the service found that it has reduced multiple appointments, streamlined women's experience, provided continuity of care and proved cost-effective. Unexpected positive outcomes also occurred for breech presentation at term and for women under the care of the safeguarding team. Combining midwifery and ultrasound skills in a midwife scan clinic is a quality improvement initiative that facilitates the increasingly central role that ultrasound plays in fetal surveillance.
Third trimester scan demand across the UK grew by 27.9% between 2016 and 2018, (Widdows et al, 2018). Reflecting this national trend, the Kingston Hospital NHS Trust maternity unit saw a 32% increase from 2015-2018 (Figure 1). The likely reason for this rise in third trimester scan demand relates to the recommendations of the Saving Babies' Lives care bundle, version 1 (NHS England, 2016). This was produced in response to the UK stillbirth rate being higher than other comparable European nations, at 4.7 per thousand births (Office for National Statistics, 2014). The report's recommendations arose from the NHS England Mandate Objective to halve the stillbirth rate by 2030 (NHS England, 2014) by focusing on four key elements of maternity care. Two of these had a direct impact on the demand for third trimester scans: increased fetal surveillance for fetal growth restriction and increased awareness of reduced fetal movements.
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