Questionable Accuracy of Miscarriage Diagnoses
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A recent study suggests that current rules 'could lead to 400 viable pregnancies potentially being misclassified.' The researchers have stated that this was 'an educated guess with no evidence of how many would lead to a termination.'
In the UK, the joint report of the Royal College of Obstetricians and Gynaecologists and the Royal College of Radiologists recommends using the following criteria to diagnose pregnancy of 'uncertain viability':
1. an intrauterine gestational sac of <20mm in mean diameter with no obvious yolk sac
2. presence of a fetus or fetal echo of <6mm crown-rump length with no obvious fetal heart activity.
These thresholds have been questioned by clinicians. Professor Tom Bourne, of Imperial College London told BBC News that 'we found the cut-off values were not entirely safe because they can be associated with a misdiagnosis of miscarriage in a small number of cases, and our view is that there shouldn't be any risk.' Professor Bourne also argues that 'the cut-offs should be about 25mm instead of 20mm for the sac and 7mm for an embryo without a heartbeat. He also wants a greater emphasis on repeat scans.' I agree with this viewpoint. These pregnancies are very much 'wanted' pregnancies and any risks involved should be minimised in order to help the child be carried to term.
In contrast, Professor Siobhan Quenby of University Hospital Coventry has stated that she really doesn't 'think many mistakes are being made' but she welcomes greater attention and clarity on the issue. Regardless of how many mistakes are being made, efforts should be made to reduce this figure. Professor Quenby further points out that 'people were aware of the issues with the guidance and if there was any doubt, further tests, not a termination, would take place.' She confirmed that it is 'very common that people come back for a second scan' instead of the decision being made purely on the basis of the first scan.
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Vicky Kunzli - Trainee Solicitor
Clinical Negligence Team
RoyalCollege of Radiologists, Royal College of Obstetricians and Gynaecologists, Guidance on Ultrasound Procedures in Early Pregnancy. RCR/RCOG: London, 1995
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