NHS England has published version 3 of the Saving Babies Lives Care Bundle (SBLCBv3) to continue building on the work of reducing preterm and still birth rates, neonatal and maternal deaths in England.
This latest version has been published with time for departments to plan for the implementation by March 2024.
A new element has been introduced to help manage those women and pregnant people with pre-existing diabetes in pregnancy. There is also a focus on reducing health inequalities which have been highlighted in recent data and reports. The input of sonographers into saving babies lives is essential and anything that can be done to save the life of one more baby is so important to parents.
SBLCBv3 should be read in association with other key documents including the March 2023 publication of the ‘Three year delivery plan for maternity and neonatal services’ and relevant NICE and RCOG guidance.
The two main elements relevant to ultrasound are element 2 ‘Fetal growth: risk assessment, surveillance, and management’ and element 5 ‘Reducing preterm births and optimising perinatal care’.
Safe working
The SoR was asked to provide feedback on an early draft of the guidance. Gill Harrison, Professional Officer for Ultrasound at the SoR said: “We were pleased to be able to have sight of the document prior to publication, to input feedback on behalf of sonographers. Not all feedback was incorporated, as it was quite specific to sonographers and possibly not as relevant to this wider guidance”.
The SoR does believe that some comments were relevant to support safe working practices for parents and sonographers and want to highlight further factors that should be considered, in addition to those highlighted within the document to meet the requirements of SBLCBv3:
From a sonographer perspective, clarity is needed in relation to section 2.7 which recommends that: “Women who are designated as high risk for FGR (for example, see Appendix D) should undergo uterine artery Doppler assessment between 18+0 to 23+6 weeks gestation”.
The guidance later states that: “Trusts are encouraged to invest in training of Ultra sonographers [sic] to perform uterine artery Doppler alongside the fetal anomaly scan with the opportunity to reduce the number of serial scans for growth that a woman would require during the pregnancy”.
Extra time
The Fetal Anomaly Screening Programme (NHS FASP) in England commissions and pays for the two screening scans in pregnancy and makes specific recommendations for examination times. For the first trimester, screening scan a minimum of 20 minutes (1) should be allocated for a singleton pregnancy and 30 minutes (2) for the second trimester ‘20 week scan’ in order to complete the necessary components required for the screening programme.
The SoR advises that extra time should be factored into appointments when additional elements are added to the examination eg a minimum of 10 minutes added to the 20 week scan appointment for uterine artery Doppler assessment and an additional 10 minutes for cervical length assessment. An alternative would be to rebook for an additional appointment, however parent convenience and choice should be considered, where possible, to reduce health inequalities.
Our further points are:
- The guidance encourages Trusts to comply with BMUS guidance for audit of growth scans. Protected time would be required for this role, to facilitate a supportive learning culture within the ultrasound team.
- SBLCBv3 suggests that: “Providers with capacity may wish to use assessment of Middle Cerebral Artery (MCA) Doppler pulsatility indices (PI) in addition to umbilical artery Doppler to help identify and act upon potential fetal compromise in later pregnancy (after 34+0 weeks), but evidence to guide practise is due in the next 12-24 months and Trusts may wish to consider waiting for this before implementation”. Trusts may want to consider training sonographers in the technique prior to publication of the evidence, to ensure preparedness if required.
- Developing a role for a SBL sonographer lead might support sonographer career development, enhanced satisfaction and increased integration with the multi-professional team. This could include providing dedicated time for audit of growth scans (as encouraged within the SBLCBv3) and cervical length measurements, education, research and liaison with the wider antenatal team.
- In addition to audit of growth scans, it is important to ensure that ultrasound equipment quality assurance is undertaken in line with SoR and BMUS guidance (section 2.9) (3) This should cover all machines used for fetal assessment, regardless of their location and include portable ultrasound scanners in clinics or on the ward.
References
1. Public Health England with NHS England and NHS Improvement Public Health Commissioning. (2019). NHS public health functions agreement 2019-20: Service specification no.16. NHS Fetal Anomaly Screening Programme – Screening for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome (Trisomy 21, 18 & 13). Available at: https://www.england.nhs.uk/publication/public-health-national-service-specifications/.
2. Public Health England with NHS England and NHS Improvement Public Health Commissioning. (2019). NHS public health functions agreement 2019-20: Service specification no.17. NHS Fetal Anomaly Screening Programme – 18+0 to 20+6 week fetal anomaly scan. Available at: https://www.england.nhs.uk/publication/public-health-national-service-specifications/.
3. SoR and BMUS (2022) “Guidelines for Professional Ultrasound Practice” 7th ed., Society of Radiographers and British Medical Ultrasound Society. ISBN: 978-1-909802-81-0. https://www.sor.org/learning-advice/professional-body-guidance-and-publications/documents-and-publications/policy-guidance-document-library/sor-and-bmus-guidelines-seventh-edition.