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January 2019: Recommendation 1.8.8.1 on screening for German measles (rubella) has been withdrawn by NICE as this is no longer offered by the NHS. December 2018: Recommendations 1.3.9.1 -1.3.9.3 have been stood down and replaced with a link to up-to-date advice from the UK Chief Medical Officer. January 2017: A footnote was added to recommendation 1.6.2.2 linking to the NICE diagnostics guidance on high-throughput non-invasive prenatal testing for fetal RHD genotype (DG25). March 2016: Recommendations 1.9.1.1 -1.9.1.3 have been deleted as the guideline they were taken from has since been updated. For guidance on assessing risk of gestational diabetes, see the section on risk assessment in the NICE guideline on diabetes in pregnancy. December 2014: Recommendations 1.5.6.1 to 1.5.6.4 were replaced by recommendations in the NICE guideline on antenatal and postnatal mental health. November 2014: Recommendation 1.3.2.4 was updated to take into account NICE's guideline on vitamin D: increasing supplement use among at-risk groups. June 2010: The recommendations about smoking in pregnancy in section 1.3.10 of this guideline have been further developed in how to stop smoking in pregnancy and following childbirth NICE guideline PH26. We have removed the following recommendation from the antenatal care guideline, as well as the quick reference guide and information for the public: 1.3.10.7 Women who are unable to quit smoking during pregnancy should be encouraged to reduce smoking.
Sonography is not recognised as a speciality by the Health Act 1999, so there is no obligation for sonographers to be registered to practise. There is currently no statutory requirement for ultrasound practitioners to receive accredited training.
Many sonographers will have achieved a postgraduate certificate or diploma in clinical ultrasound. Well-established programmes leading to these qualifications are available in a number of universities in the UK and courses are accredited by the Consortium for the Accreditation of Sonographic Education (CASE). Members of the consortium include the British Medical Ultrasound Society, the Royal College of Radiographers (RCR), the Royal College of Midwives and the United Kingdom Association of Sonographers.
To achieve and attain CASE accreditation, an individual course must demonstrate that both its academic and clinical teaching programmes and its assessment methods are sufficiently rigorous to ensure that successful students are safe to practise in the ultrasound areas for which they have studied. Current postgraduate education certificates and diploma training programmes in obstetric ultrasound are designed with the provision of a safe, accurate and efficient screening service for fetal anomaly in mind.
With regard to the implementation of the National Down’s Syndrome Screening Programme for England, all professionals involved in providing antenatal screening information and services should have received the appropriate education for their roles and responsibilities and any specific tasks required.
All health professionals undertaking an ultrasound scan must have an accredited certificate in obstetric ultrasound or equivalent and also attend an appropriate communication/counselling course.
(Extracted from Antenatal screening – working standards, National Down’s Syndrome Screening Programme for England, (March 2004))964
There is a need for practical competence tests at NHS trust level. The RCOG Working Party recommends that local departments monitor standards and keep checks on them.
Trusts should have a process for retraining and updating as required but at present there is little provision for this in trust budgets. Clinical governance provides a facilitating mechanism.
The RCOG is in the process of implementing Advanced Training Skills Modules (ATSMs) and all medical staff who undertake fetal anomaly scanning should hold the relevant ATSM. Skills should be maintained by performing detailed scans in at least one and preferably two sessions per week.
Medical and midwifery staff should not undertake scans of any sort if they have not been specifically trained.
A scan to perform a fetal structural survey demands the use of modern equipment (not more than 5 years old) of modest sophistication. The scanner must be capable of performing the necessary measurements and should provide good image quality. As always, regards for safety in the use of ultrasound is paramount and minimum output should be used in accordance with the ALARA principle: as low as reasonably attainable.
(Extracted from the recommendations of the Royal College of Obstetricians and Gynaecologists Working Party on Ultrasound Screening for Fetal Anomalies.302)
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NLM Citation
National Collaborating Centre for Women's and Children's Health (UK). Antenatal Care: Routine Care for the Healthy Pregnant Woman. London: RCOG Press; 2008 Mar. (NICE Clinical Guidelines, No. 62.) Appendix H, Training and equipment standards for ultrasound screening in pregnancy.