Issue link: http://digitaleditions.uberflip.com/i/1388210
115 Maternity and Obstetrics NMH Annual Rep t | 2020 Table 4 outlines the ultrasound anomalies diagnosed using the RCOG/RCR classification for the last 10 years. There were a total of 354 abnormalities detected by ultrasound. In addition there were 83 chromosomal anomalies diagnosed giving a total of 437 congenital abnormalities for the year. The majority of diagnoses within the hospital population are made by midwife sonographers/radiographers and are usually seen within 24 hrs by a fetal medicine consultant where appropriate. We continue to see an increase in the number of external referrals and if these are deemed urgent they can usually be seen within 24 – 48 hours. There is a daily high risk clinic which is staffed by a consultant in which these patients can be seen. Where appropriate genetic testing, surgical, neonatal and genetic counselling is arranged pre-delivery and the patient usually attends the fetal medicine unit for the remainder of the pregnancy. The weekly perinatal meeting continues to be an excellent forum for multi-disciplinary discussion of these complex cases. These meetings are attended by obstetricians, maternal fetal medicine specialists, neonatologists, a geneticist, paediatric radiologists, pathologists and microbiologist, midwifery and nursing staff, laboratory staff, social workers and medical students. We also provide a fetal cardiology clinic in conjunction with a paediatric cardiologist. In addition to these specialist clinics there is a twice weekly neonatal consultant-led clinic where couples with complex cases meet with the neonatologist and discuss the ongoing management and anticipated care following birth. Termination of Pregnancy from Fatal Fetal Abnormalities/Life Limiting Conditions (FFA/LLC) 2020 was the second year since the Health (Regulation of Termination of Pregnancy) Act 2018 was passed into law and permitted access to abortion in Ireland. There were 28 patients seen at the National Maternity Hospital who met the criteria for FFA/LLC under Section 11 of the Act and underwent termination of pregnancy. The majority (25) of these cases were looked after at the NMH and the remaining 3 returned to their referring hospital for delivery. The NMH terminations take place in a private room in the middle of a busy ward which is suboptimal and does not give appropriate privacy. Many units, including our own, have conscientious objectors who need to be respected. There are issues nationally and locally including; interpretation of some aspects of the Health Act, lack of perinatal/neonatal palliative care, lack of universal ultrasound/prenatal screening/lack of an appropriate genomics service, which require urgent attention by the HSE/NWHIP. Whilst the absolute numbers are not large, the time and workload that each of these cases entails is considerable. There are often multiple visits involving screening, ultrasound diagnosis, discussion of diagnostic procedures, interpreting results, informing patient of results, neonatal input and consideration of options before further visits and their admission. Information is given in a clear balanced manner about their options and that they will be fully supported in whatever path they choose. Not all couples with FFA/LLC choose termination of pregnancy and these couples are followed up in the Fetal Medicine Unit with a care pathway outlined for the remainder of the pregnancy and delivery with appropriate psychological, bereavement and chaplaincy support. At all times we endeavour to keep general practitioners and referring clinicians informed. We are indebted to Barbara Cathcart and Heather Hughes, who largely coordinate all of the above in a very calm, sensitive and efficient manner. There is however, an urgent need for appropriate administrative support. Dr Claire Flahavan, Perinatal Therapist, continues to offer a much needed and valuable support service for couples who find themselves in these very distressing situations with excellent patient feedback. Fetal Cardiology Programme (Dr Siobhan Corcoran) The Fetal Cardiology service at The National Maternity Hospital is a busy tertiary referral service ...almost 49% of the hospital population were 35 years of age or more (compared with nearly 31% 10 years ago) and 10.7% of those were aged 40 or more.