Ask the trainer

We recently held a Q&A session on our Facebook page with Anne Rhodes, our very talented Head of Training. Below are some of the excellent questions and answers that were covered…

Q: How long have you been training and is it just sonographers you teach?

Anne: I have been teaching fetal heart scanning for many years in a fetal medicine unit as part of my NHS role as a Specialist Midwife Sonographer. I’ve probably been teaching for around 8 years. I teach medical students, midwifery and ultrasound students, sonographers, obstetric and paediatric doctors.

Q: A question that we get asked a lot is…How accurate is the 20 week pregnancy scan?

Anne: The Fetal Anomaly Screening Programme (FASP) indicates 11 conditions and their current detection rates.
The detection rate for serious cardiac anomalies is currently around 50%.

Q: Do you have links to any other support groups?

Anne: So we have really good relationships with ARC (Antenatal Results and Choices), Little Hearts Matter and we also have our own closed Facebook group which is a valuable support for parents & families.

Tiny Tickers: You might find this link really useful on our website re: other resources

Q from Nicola: Is it possible for you to put me in touch with another parent who has or has had a baby with the same issue as me?

Anne: Sometimes families do ask us if they can be connected to someone we know of with the same condition. At times like this, we have in the past contacted another family to ask their permission to pass on a contact details. It is not something we routinely offer though.
Your cardiac liaison nurse may be in a better position to offer a service like this.

Tiny Tickers: Or you can also join our Parents Group on Facebook – we know a lot of parents have found the connections made on that forum to be a useful support.

Q from John: Given that certain CHD cannot yet be diagnosed at the standard 20 week scan, and often the unbalanced blood pressure of newborns also masks a CHD, as it did for our sons VSD, what are the things hospitals should be doing post natal to ensure a CHD is diagnosed asap?

Think HEARTAnne: All babies have the mandatory Newborn and Infant Physical Examination (NIPE) after birth. This will include listening to baby’s heart.

There are also signs and symptoms that health professionals and parents can be made aware of that may indicate an undetected heart condition. At Tiny Tickers we promote the Think HEART campaign. There is an added screening test that can be done called pulse oximetry. You may have read about it? It is a non invasive screening test that will detect the amount of oxygen in the baby’s blood. Currently, this test is not mandatory in England and it is up to each individual hospital trust whether they provide this service.

John: We were told it’s nigh on impossible to spot the VSD our son had, at the 20 week scan. Is this still the case or has technology moved on now?

Anne: Great question. Although technology has moved on, examining a baby’s heart at 20 weeks can still be very challenging. The fetal heart at 20 weeks is about the size of an acorn. Also there can be lots of factors that affect the quality and optimisation of the image making it very difficult to asses the structure of the septum The position of the baby is one of those factors. Awkward positions and the size of the baby’s heart at 20 weeks can make it a challenge. VSDs can be in any part of the septum and some may be easier to see than others depending on their location.

Q from Beccy: Another question about antenatal screening….my son was born with multiple muscular VSDs which were found postnatally. I had two abnormality scans – the second was just to look at the heart as his position was awkward at the first. I also had several growth scans and doppler scans from 28 weeks right up to his birth. I try not to dwell on this as his issues were discovered relatively early but sometimes I really struggle to understand how nothing could have been picked up with such a close level of monitoring?

Have you been told at your antenatal scan that there may be a problem with your baby's heart?Anne: Scanning babies hearts at 20 weeks can be quite challenging due to their size, especially when babies are not in an optimal position. Once the anatomy scan is complete, it is not routine for sonographers to re-examine the structure of the heart at growth scans or further doppler scans. In fact, it can be even more difficult to get a good view of the heart later in pregnancy. Many people think that because the heart has grown it is easier to see. However, as the baby gets bigger, it becomes much harder to obtain good views. Ultrasound does not penetrate bone and the baby’s ribs can cause a good amount of shadowing which stops the sonographer getting a good clear image.

Q from Danielle: Hello! My first baby had critical aortic stenosis which was undiagnosed through pregnancy and was dramatically found out at 3 days old! What can I expect for my next pregnancy as I’m really nervous about the scans? 

Anne: Thanks so much Danielle – really sorry to hear that – it must have been a very tough time for you. And huge congratulations. It’s an exciting but understandably overwhelming time. For all subsequent pregnancies, you should be offered a fetal echo at your nearest tertiary centre. This scan is a little more in depth than the standard heart views seen at the 20 week scan. The cardiac clinic at the tertiary centre is run by fetal and paediatric cardiologists who will be aware of your previous baby’s condition from the referral.

Q from John – As much as pulse oximetry machines can and do diagnose CHD at birth, in your experience do you think with current funding it’s a viable option for small provincial hospitals or will we have to rely on stronger training for sonographers as the best option in the shorter to medium term?

Anne: Pulse oximetry machines are used for screening. There are lots of screening choices in the NHS throughout pregnancy and they are used to filter those with a positive result down a certain pathway towards diagnostic testing. At Tiny Tickers, we believe that there is good evidence to show the benefits of routine pulse oximetry testing. We do supply pulse oximetry machines to those hospitals that wish to include routine testing for all newborns but, as you’re aware it’s not yet mandatory, therefore it is a postcode lottery at the moment. As a CHD charity, we however do not want cost to stand in the way of all babies having access to this test. Also in the meantime, we will continue to provide sonographer training to all hospitals that provide the 20 week anatomy scan in the UK because we believe that keeping sonographers updated and with continual training, this will help increase the antenatal detection rate of CHD.

Also a useful statistic: 97% of sonographers who have had our training thought it would increase their confidence for referring potential abnormalities. And 100% of respondents thought that they would change their practice as a result of training.

Tiny Tickers:…with the small, more community-led hospitals, that again is something we’re trying to tackle through our pulse oximetry project. We’re trying to ensure that those midwives practising in the community also have access to our machines – often this is done via the larger NHS trust that they belong to. In very rural areas it is vital that they have access to this important equipment so we try and help where we can.

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About Anne

As a specialist sonographer with a focus on fetal cardiac scanning, Anne has devoted much of her career to the advancement of understanding the importance of early detection of cardiac abnormalities in unborn babies. Anne has responsibility of our UK-wide training in fetal cardiac scanning techniques and works tirelessly to do everything possible to help to train NHS sonographers to be able to recognise cardiac abnormalities in the antenatal period.

Find out more about our pulse oximetry campaign, Test for Tommy, here.

Find out more about our sonographer training, here.