Dear Colleague,

Thank you for participating in our UK Based - Consensus Procedure on First Trimester Anomaly Screening.

Data from our recent survey show that there is very unequal access to anatomical screening at the 11-13 week scan around the UK. Some centres undertake no anatomical screening (only measuring CRL and NT), others perform very basic anatomy screening, and some do quite advanced screening.

This results in significant inequity of care. It also raises issues around the consistency of patient information provided and whether referral pathways are effective. Our research has shown that a protocol based approach to the first trimester anomaly scan significantly improves detection rates. Therefore, a standardised approach will help all centres that wish to perform early anatomy screening.

What is the Objective?

We would like to develop consensus amongst sonographers, midwives and doctors regarding the following questions:

1) What role should first trimester ultrasound play in fetal anomaly screening in the UK?

2) How should first trimester anomaly screening be performed?

3) What anatomical views should be obtained?

4) Which fetal anomalies should be targeted?

5) How should positive or suspicious findings in the first trimester be followed-up?

Our aim is to develop UK recommendations for best practice in the form of (i) a basic protocol, which could be used as a standard by NHS units wishing to offer first trimester anatomy screening to all women, and (ii) an extended protocol for women deemed to have a higher chance of fetal anomalies.

For the purposes of the questionnaire please assume that training, equipment and time are available.

What is a Delphi Consensus Procedure?

The Delphi procedure is a well-established consensus development method. It involves an anonymous process whereby participants are initially asked to provide their views on a series of statements. The results are summarised and fed back to participants with increasing detail over subsequent rounds. With each iteration, the participants are allowed to revise their opinion in light of the group feedback until relative consensus has been reached.

What considerations should we take into account?

Please use your routine clinical practice and professional experience to guide your answers to the questions asked.

The following considerations are worth keeping in mind:

  • Prevalence of fetal anomalies
  • Their severity/lethality
  • Detection rates for anomalies using first trimester ultrasound
  • Anatomical views required to examine first trimester anatomy
  • Likelihood of inconclusive or false positive findings
  • Difficulty, skill level and time required to obtain the anatomical views in question. However, any future screening program would address resources required to meet the objectives.

How much time commitment will be required from participants?

The first questionnaire should take approximately fifteen minutes to complete. We anticipate that we will need you to complete a further one to two surveys (each taking ten mins to complete).

What about my data?

All information collected from participants will be kept strictly confidential. All analysis will be anonymous and in aggregate form. We will ask for your email address for the sole purpose of contacting you for participation in future rounds of the consensus procedure. We will not share or disclose your email with anyone else. All data collected, including your email, will be held on a secure server in the Netherlands, in keeping with GDPR Standards.

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