Ultrasound estimation of fetal weight is a highly influential factor in antenatal management, guiding both the timing and mode of delivery of a pregnancy. Although substantial research has investigated the most accurate ultrasound formula for calculating estimated fetal weight, current evidence indicates significant error levels. The aim of this systematic review was to identify the most accurate method, whilst identifying sources of inaccuracy in order to facilitate recommendations for future practice. Seven studies met the inclusion criteria and 11 different formulae were assessed; ultrasound calculation of fetal weight was most commonly overestimated. The Hadlock A formula produced the most accurate results, with the lowest levels of random error. Methods incorporating just two measurement parameters were inconsistent, producing large random errors across multiple studies. Key sources of inaccuracy included difficulties obtaining accurate fetal measurements in late gestation; the remainder were operator dependent, including lack of experience and insufficient training and audit. The accuracy of ultrasound estimated fetal weight has improved in the last decade, though a lack of consistency remains evident. National implementation of a rigorous audit programme would likely improve accuracy further, and increase the confidence and clinical value of the method.

This is a repository copy of Breaking bad and difficult news in obstetric ultrasound and sonographer burnout: Is training helpful?.

This is a repository copy of Managing the unmanageable: A qualitative study exploring sonographer experiences of and training in unexpected and difficult news delivery.

Background Studies indicate there is a need to improve the delivery of unexpected news via obstetric ultrasound, but there have been few advances in this area. One factor preventing improvement has been a lack of consensus regarding the appropriate phrases and behaviours which sonographers and ultrasound practitioners should use in these situations. Aims To develop consensus guidelines for unexpected news delivery in Early Pregnancy Unit and Fetal Anomaly Screening Programme NHS settings. Methods A workshop was conducted to identify priorities and reach consensus on areas of contention. Contributors included interdisciplinary healthcare professionals, policy experts, representatives from third-sector organisations, lay experts and academic researchers ( n = 28). Written and verbal feedback was used to draft initial guidance which was then circulated amongst the wider writing group ( n = 39). Revisions were undertaken until consensus was reached. Results Consensus guidelines were developed outlining the behaviours and phrases which should be used during scans where unexpected findings are identified. Specific recommendations included 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. ‘foetus’), 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. Conclusions These recommendations can be used to develop and improve news delivery interventions in obstetric ultrasound settings. The full guidelines can be accessed online as supplemental material and at https://doi.org/10.5518/100/24 .

Expectant parents report negative experiences of receiving unexpected news via ultrasound. There is a need to improve communication in this setting, but a lack of understanding on how to achieve this. This systematic review aimed to synthesise findings from qualitative studies exploring experiences of expectant parents or healthcare professionals when a fetal abnormality or unexpected finding was identified via ultrasound. MEDLINE, EMBASE, CINAHL and PsycINFO were searched using three blocks of terms (fetal abnormalities; ultrasound; experiences). Qualitative studies exploring the disclosure of pregnancy complications during ultrasound examinations were included and analysed using meta‐ethnographic synthesis. The review was conducted according to PRISMA and eMERGe guidelines. The review identified 28 studies. News delivered via ultrasound can be viewed as a journey involving five phases (expectations of ultrasound scans; discovery; shock; decisions and planning; adaptation). How well this is navigated depends upon the extent to which information needs and support needs are met. Ultrasound is a uniquely challenging situation to communicate difficult news as there is the potential for news to be communicated immediately. Care quality could be improved by the provision of written information and the use of correct terminology to describe abnormalities.