SASUOG

South African Society for Ultrasound
in Obstetrics and Gynaecology

News

A warm welcome to the first newsletter from this SASUOG council!

We aim to publish four newsletters annually to keep members informed about what the Society does for you and new developments or issues you should know of.

It is important that all of you are aware of the fact that SASUOG is a daughter organisation of the SA Society of Obstetricians and Gynaecologists, and that we therefore share SASOG’s vision as presented in the latest newsletter from the SASOG President ( https://www.sasog.co.za/Content/Images/SASOG_PRESIDENTS_REPORT_DURBAN_2018.pdf ). As a contribution to the SASOG 2030 vision, we formulated a SASUOG 2030s vision. Please check it out on our home page!

We want to share some exciting developments in the area of prenatal screening recently.
 
GOOD NEWS FLASH!! Bold move by Discovery Health Medical Schemes (DHMS) regarding prenatal screening.

We trust that all of you are aware of DHMS’s recent introduction of the Maternity Benefit for all its pregnant members. This benefit includes availability of NIPT according to set criteria and SASUOG helped DH to refine the criteria for prenatal screening. The current maternity benefit by DHMS includes:
  • Cost of NIPT for trisomy 21, 13 and 18 for all women with a risk of more than 1 in 1000 for any of these conditions. The risk is based on either first trimester serum screening (best at 9 weeks but possible up to 13 weeks), second trimester serum screening (best at 15-16 weeks but possible up to 20 weeks) or combined first trimester screening (serum + nuchal translucency scan by a professional whose name appears on the FMF-UK website) (https://fetalmedicine.org/lists/map/certified/NT). DHMS will also cover NIPT (without prior screening) for all women older than 40 and for those who had aneuploidy in a previous pregnancy.
  • Cost of formal genetic counselling for all women with a very high risk screening result (>1 in 10), a high risk (abnormal) NIPT result or failed/ambivalent NIPT result.
  • Cost of invasive testing (medical practitioner fee as well as genetic laboratory cost) for all women who have a positive (abnormal) NIPT result (as the diagnosis needs to be confirmed).
This is a massive step forward in making prenatal screening and diagnosis accessible to many women who previously could not afford this. We are extremely grateful for DHMS’s leadership and vision and secretly hope that other medical schemes will soon follow this example! Please make sure your patients are aware of this benefit and follow the guidelines closely to ensure they don’t miss out.
 
GOOD NEWS FLASH! Information leaflet and consent form regarding prenatal screening.

SASUOG has very actively contributed towards the development of the prenatal test leaflet, designed for use during the first antenatal visit to enhance the counselling about all available screening options and to assist parents-to-be in making important decisions. The leaflet has had a very wide input, including advice from the legal fraternity, and was designed to improve understanding by pregnant couples and hence ensure truly informed consent and reduce the risk of litigation. The updated version will also soon be loaded onto the SASOG website too ( https://www.sasog.co.za/Professional/Guidelines  ) and will soon become available in the other languages of our rainbow nation! It is best to make this leaflet available to pregnant clients (as hard copy, e-mail attachment or hyperlink) before their first visit so the couple comes prepared and (partially) informed. During the consultation, the leaflet is useful as a decision aid and it can ultimately function as a signed consent form. Any feedback is welcome!
 
TIP OF THE MONTH! A small change can reduce risk significantly!

We are all experiencing the threat of litigation, and missed diagnoses of trisomy 21 are a major source of the increase in indemnity fees. Claims occur because screening was not offered at all or not all options were offered (this may improve with the use of the prenatal tests leaflet), because the screening was of poor quality (this should improve with the use of NIPT for serum screening-based risk > 1:1000) or because parents claim they were falsely reassured by the practitioner. Often the latter results from the vocabulary used to describe the test result as “low risk”, “negative”, “reassuring” or “normal”. In the context of an extremely impactful decision (i.e. to proceed with more advanced testing or not) these terms are often seen as paternalistic as they tacitly insinuate a specific course of action. It is therefore strongly suggested never to use those terms when communicating screening test results but rather to
  1. quote the risk number (1 in xxx) and make sure the couple understands the number correctly (“out of xxx pregnancies 1 has the abnormality and yyy not”)
  2. put the number into perspective (“this compares to a population risk of 1 in 500 and to the age related risk of 1 in zzz”)
  3. compare the risk to the risk of the alternative i.e. NIPT (high cost and risk of a false positive result) or invasive testing (high cost with risk of pregnancy loss of ±1 in 200)
  4. ensure the parents understand that they basically have to make a choice between two competing risks, both of which could have a life changing impact being either the live birth of a child with special needs or the loss of the pregnancy
At the end of this discussion and without being pushed into any direction by the practitioner, the couple decides what route they want to take (and the medical scheme decides whether they will fund this or not). This could be documented in your records as “The risk was quoted as 1 in xxx and balanced against the cost and risk of further testing (NIPT or invasive testing or expert referral). After careful consideration the patient decided…..

I hope you enjoyed this first newsletter and welcome any feedback on topics you would like us to discuss or issues you would like SASUOG council to address. Have a great week!

Prof Lut Geerts, President: SASUOG