Routine screening for pregnancy complication ‘could prevent 25 baby deaths a year’, Minister told

The deaths of up to 25 babies a year could be prevented through the introduction of routine screening of pregnant women for a rare complication in pregnancy called vasa previa, Minister for Health Stephen Donnelly has been told.

Another 15 babies could be spared significant brain injury by screening at 20 weeks for the condition vasa previa, said veteran medical negligence lawyer Michael Boylan.

Mr Boylan, who has represented two families affected by the condition, has written to the Minister urging the immediate introduction of screening for vasa previa. He claims the State could save “a huge amount of fetal death, morbidity and human misery now and in the future in Irish maternity units” by checking for the condition during mid-pregnancy anomaly scans.

Vasa previa is a pregnancy complication that can lead to severe blood loss for the foetus if not carefully managed. It occurs in about one in every 2,500 deliveries, but more frequently in IVF pregnancies.

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With the condition, blood vessels connecting the umbilical cord lie over or near the entrance to the birth canal. During labour, the exposed vessels can burst, causing severe blood loss or death.

One study showed a death rate of 56 per cent where the condition was not diagnosed, but when identified early, complications can generally be avoided through a caesarean delivery. With a scheduled c-section, the survival rate is 97 per cent.

Last June, nine-year-old Ricci Meehan settled a High Court action for an interim payment of €1.5 million after his mother Maria sued over the care provided when she was pregnant. It was alleged his brain injury resulted from a failure to diagnose vasa previa during four ultrasound examinations at the Rotunda Hospital.

The settlement for Ricci, who was represented by Mr Boylan, was made without admission of liability.

The UK does not routinely scan for vasa previa but other countries, including Australia, Japan, New Zealand and Canada, now do so, said Mr Boylan.

While acknowledging the lack of certain data on the prevalence of the condition, he arrived at his estimate for mortality from vasa previa by extrapolating from an analysis of its impact in the UK.

“Given that vasa previa has such a high perinatal mortality, that ultrasound has such a high sensitivity for the condition, and that caesarean delivery before labour is highly effective in preventing perinatal mortality, it is incongruous that routine screening for vasa previa is still not recommended in Ireland.”

The Institute of Obstetricians has convened an advisory group to examine the issue of vasa previa screening, according to its chairman Dr Sam Coulter-Smith.

Vasa previa is very rare and very difficult to screen for, he pointed out. “It requires a lot of additional time as part of the 20-week anomaly scan, and an experienced sonographer who can search for aberrant blood vessels across the cervix.”

It is not possible to identify women who are at higher risk because of the random occurrence of the condition, he said.

Mr Donnelly said any changes to screening practice will be made on the advice of the National Screening Advisory Committee, which is due to publish its work programme shortly.