Replies to LegCo questions

LCQ17: Prenatal check-up services of Hospital Authority

Following is a question by the Hon Tang Ka-piu and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (June 25):

Question:

I have received a complaint alleging that while the result of the fetal morphology scan (ultrasound scan) conducted for a pregnant woman at the Prince of Wales Hospital showed no abnormal prenatal development, the woman subsequently gave birth to a baby suffering from arthrogryposis multiplex congenita (AMC) and cleft palate. After lodging a complaint with the Hospital Authority (HA), the woman was told that the ultrasound scan was conducted for her by a Mainland doctor participating in medical exchange at the public hospital. As the hospital did not maintain records of ultrasound images, there was no way to tell if there had been any mistake involved in the scan. In this connection, will the Government inform this Council whether it knows:

(1) in the past three years, the number of cases in which the ultrasound scans conducted at public hospitals detected possible (and later confirmed) cases of AMC (with a breakdown by the gestational age of the pregnant woman when the ultrasound scan was conducted) and the number of new-born babies diagnosed with the illness;

(2) if HA has formulated guidelines on the procedures for conducting ultrasound scans by doctors as well as the qualifications required of the doctors conducting the scan; if so, of the details of the guidelines, the basis of their formulation and the last revision date, as well as how HA monitors compliance by doctors with such guidelines; if not, the reasons for that and whether it will consider drawing up such guidelines;

(3) if HA has put in place measures to ensure that healthcare personnel clearly explain the purposes and restrictions of ultrasound scans to pregnant women, and to ensure that the latter understand the contents of the explanations; if so, of the details; if not, the reasons for that and whether it will consider drawing up such measures;

(4) if HA has set up a mechanism to review the accuracy of the diagnoses made using ultrasound scans; if so, of the details; if not, whether it will set up such a mechanism; and

(5) if HA has set up a mechanism to handle complaints about the antenatal checks conducted by midwives and Mainland doctors participating in medical exchange; if so, of the details; if not, the reasons for that?

Reply:

President,

(1) Arthrogryposis multiplex congenital (AMC) is an extremely rare disease. According to a large-scale research in Europe, the incidence rate of this disease is less than 0.01 per cent. The abnormalities arising from AMC may aggravate as gestation advances. As there is no standard gestational age for the onset of this disease, diagnosis for the majority of cases can only be confirmed after the birth of the babies.

The Hospital Authority (HA) has not maintained statistics on the number of cases of AMC.

(2), (3) and (4) The Government attaches great importance to providing appropriate and comprehensive prenatal services for pregnant women. The Maternal and Child Health Centres of the Department of Health and the obstetrics departments of HA provide a comprehensive prenatal shared-care programme for pregnant women during the entire pregnancy and delivery process. The first prenatal check-up includes checking of personal and family medical history, physical and gynaecological examination, urinalysis for glycosuria and proteinuria and blood test. Depending on the conditions and wishes of the pregnant women, the healthcare personnel will, where necessary, arrange specific tests including fetal morphology scan (ultrasound scan), blood sugar and oral glycemea tolerance test, amniocentesis, chorionic villus sampling and umbilical cord blood sampling.

The regular prenatal check-up items in public hospitals do not include ultrasound scan. If there is special clinical need, the attending doctor will arrange an ultrasound scan for the pregnant woman between her 18th and 22nd weeks of pregnancy. An ultrasound scan usually checks the foetus' size, heart rate, the fundamental structure, the position of the placenta, etc. Although some abnormalities of the foetus can be detected by the ultrasound scan, not all abnormalities can be identified. Some research conducted in Europe indicated that about half of the abnormalities cannot be detected accurately before the 24th week of pregnancy.

The training and examinations concerning ultrasound scans for pregnant women are managed by a working group set up by the departments of obstetrics and gynaecology under the HA. Only after undergoing a series of systematic training and passing the written and practical examinations can an obstetrician and gynaecologist or midwife conduct the ultrasound scan.

In general, all pregnant women will be given a set of information leaflets before the ultrasound scan is performed. Based on such information, the healthcare personnel will explain the uses and limitations of the scan and other points to note. After the scan, the healthcare personnel will explain the results to the pregnant woman and answer her enquiries. Obstetricians and gynaecologists will arrange re-examinations or further checking for the pregnant women according to their clinical needs on a case-by-case basis. The departments of obstetrics and gynaecology will also monitor cases of ultrasound scan regularly to ensure the quality of service.

(5) HA has put in place a two-tier complaint mechanism for handling public complaints against its services (including the prenatal check-up service for pregnant women).

In the first tier, all complaints will first be handled by the respective public hospitals. Upon receipt of a complaint case, the Patients Relations Officer will pass it to the department concerned for follow-up and examination. The complainant will be informed of the results after investigation. If he/she is not satisfied with the investigation results or the reply of the hospital, he/she may file an appeal to the HA's Public Complaints Committee (PCC) via the second tier of the complaint mechanism. As a committee under HA comprising members from different sectors of the community, the PCC will handle and adjudicate all appeals against HA in an independent, fair and impartial manner.

Ends/Wednesday, June 25, 2014
Issued at HKT 15:39

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