New guidelines for delivering unexpected news in obstetric ultrasound

Today sees publication of new and very welcome guidelines for the way in which sonographers and ultrasound practitioners deliver unexpected and possibly difficult news when scanning in pregnancy.

That news may be the diagnosis of a miscarriage or ectopic or molar pregnancy; or findings that suggest this may be the case but it’s not yet certain.  It may indicate something unusual or concerning in the baby’s development, or confirmation that a baby or babies has or have died.

The way that this news is delivered is hugely important and we believe that these new guidelines can make a very positive difference to women and their partners facing unexpected, difficult or distressing news, as Amy notes:

Three of my miscarriages were discovered at the scan stage and while some sonographers were kind, others were so clinical and all used the same language which still haunts me: “this isn’t a viable pregnancy”.

Developed with input from health professionals, women and their partners and charities (including the Miscarriage Association), the guidelines provide specific suggestions for words and phrases which practitioners can use in a range of situations and settings.

Behaviours matter as well as words, and the guidelines focus on key aspects of the whole ultrasound experience, from the first hello through to discussing next steps.  They emphasise too that it’s important not to make assumptions on how patients may feel about the scan findings but to be ready to express empathy.

Specific recommendations include that:

• honest and clear communication should be prioritised, even with uncertain findings;
• technical terms should be used, but these should be written down together with their lay interpretations;
• unless expectant parents use other terminology (e.g. ‘fetus’), the term ‘baby’ should be used as a default, even in early pregnancy;
• at the initial news disclosure, communication should focus on information provision;
• expectant parents should not be asked to make decisions during the scan.

The guidelines were featured on BBC Breakfast today and the coverage can be seen at https://www.instagram.com/tv/CDgoOp-hD49/ .  Our thanks to M.A. media volunteer Lydia Boyd for sharing her experience on the programme.

You can find the full guidelines at https://journals.sagepub.com/doi/full/10.1177/1742271X20935911