Guidance for antenatal screening and

ultrasound in pregnancy in the evolving

coronavirus (COVID-19) pandemic
Information for healthcare professionals
Version 1: Published Monday 23 March 2020

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 Authors
Matthew Jolly, NHS England & NHS Improvement

Myles Taylor, BMFMS

Jane Fisher, ARC

Nadia Permalloo, PHE

Annette McHugh, PHE

Christoph Lees, Imperial College/ISUOG

Pranav Pandya, UCLH/PHE

Eddie Morris, RCOG

Jo Mountfield, RCOG

Tim Draycott, RCOG

Pat O’Brien, RCOG

Ranee Thakar, RCOG

Sue Ward, RCOG

Jennifer Jardine, RCOG

Sophie Relph, RCOG

Gemma Goodyear, RCOG

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1. Introduction
There are 3 antenatal screening programmes:

• Sickle cell and thalassaemia (SCT)

• Infectious disease in pregnancy screening (IDPS)

• Fetal anomaly screening (FASP)

Pregnant women with existing type 1 and type 2 diabetes should also be offered eye screening at, or soon after,
their first antenatal visit and after 28 weeks of pregnancy. Find out more.

These screening programmes are time critical and we should continue to offer timely screening as specified in
the NHS section 7a service specifications.

If staffing levels start to impact on such time critical services, the local screening team should inform their senior
management team and commissioners to discuss contingency and mitigation planning. Further guidance is
provided about changes that can be adopted to the fetal anomaly screening pathway.

2. Assessment of women presenting for screening

and/or scanning
All women should be asked to attend alone if possible or with a maximum of one partner/visitor.

2.1 Screening for possible coronavirus infection

All women should be initially screened before entering the department to see if they have symptoms that are
suggestive of COVID-19, or if they meet current ‘stay at home’ guidance.

If a woman currently meets ‘stay at home’ guidance the appointment should be rebooked after the isolation
period ends:

• Symptomatic women: rebook after 7 days from when symptoms started.

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 • L iving with others who have symptoms of coronavirus: rebook after 14 days (all household members must
stay at home for the duration).

Please provide a patient information leaflet (a template is provided as a guide in appendix A).

2.2 Rebooking appointments

The local service should decide how best to manage rebooking of appointments (blood tests and/or scans), the
woman should be informed of their new appointment.

The woman should be informed that if she remains symptomatic or develops symptoms she must not attend
her appointment,instead she should phone her maternity service for advice.

2.3 Failsafe
A local failsafe should be established to ensure that all women are reoffered and attend appointments. Follow
local protocols for follow up of women who do not attend.

3. Fetal anomaly screening where appointments are

rearranged
3.1 Women who decline screening
Book a dating scan and/or anomaly scan.

3.2 Women who wish to have screening for trisomy 21, 18 and 13 but have
missed combined screening (11+2-14+1 weeks)
If seen at:

14+2 to17+6 perform a dating scan and offer quadruple screening for trisomy 21. Use head circumference (HC)
for the quadruple test.

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 18+0 to 20+0 perform anomaly scan and offer quadruple screening for trisomy 21. Use head circumference
(HC) for the quadruple test.

20+1 to 23+0 perform anomaly scan only. The anomaly scan is the screening test for trisomy 18 and 13 in this
instance.

3.3 Anomaly scan

The screening window is 18+0 to 23+0.

If indicated, refer to Fetal Medicine service in line with FASP guidelines.

If gestation is 23+1 or greater, perform full clinical ultrasound examination of the fetus irrespective of gestational
age and if indicated refer as per local guidelines.

4. Modifications for services

4.1 Capacity
Trusts will have differing capacity issues as the pandemic evolves. The advice is to continue with usual national
screening programmes as specified for as long as possible. If the service is only able to provide a single scan,
it is recommended that this is performed at 18+0 to 20+0 weeks with the option of the quadruple test for
women who wish to be screened for trisomy 21. The anomaly scan is the screening test for trisomy 18 and 13
in this instance.

4.2 Staffing numbers

Daily discussion should be scheduled with senior team members with oversight of the pathway to review
service provision. In the event that there is insufficient staff to provide the service, scans should be prioritised in
the following order:

• Anomaly scan at 18+0-23+0 weeks

• Ultrasound +/- screening at 11+2-14+1

• Growth scans

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 If, for any reason, an ultrasound examination is not possible the quadruple test can be offered based on the Last
Menstrual Period (LMP) between 14+2 to 20+0 weeks.

Although the performance of the quadruple test with scan measurements is marginally better than without a
scan, quadruple testing using LMP remains an acceptable screening test in this instance.

4.3 Additional measures

Triage growth scans

To reduce the workload to the ultrasound screening unit a local policy should be implemented to review all
referrals for a growth scan prior to booking an appointment.

Probe cleaning
Refer to RCOG guidance for healthcare professionals

Refer to Public Health England guidance

Appendix A: Template (that can be adapted with

local details) for maternity services to use if they
wish
Information for pregnant women who cannot have their scheduled appointment today and need to have
their appointment rescheduled due to COVID-19.

If you have symptoms of COVID-19 you must not attend your appointment but phone your maternity service
for advice.

Maternity units may wish to provide additional information to pregnant women which includes the following:

• Reason they are unable to have their appointment today for example: they have suspected Covid-19

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 or have been in contact with someone who has recently had the infection.

• When they will have their appointment rescheduled.

• How they will be contacted about the new appointment date.

• If they don’t hear from maternity service (it would be advisable to have a time frame for example if
you don’t hear within 1 week please contact), how and who they should contact

For further information about COVID-19 please visit here.

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 DISCLAIMER: The Royal College of Obstetricians and Gynaecologists (RCOG) has produced this
guidance as an aid to good clinical practice and clinical decision-making. This guidance is based on
the best evidence available at the time of writing, and the guidance will be kept under regular review
as new evidence emerges. This guidance is not intended to replace clinical diagnostics, procedures
or treatment plans made by a clinician or other healthcare professional and RCOG accepts no
liability for the use of its guidance in a clinical setting. Please be aware that the evidence base for
COVID-19 and its impact on pregnancy and related healthcare services is developing rapidly and the
latest data or best practice may not yet be incorporated into the current version of this document.
RCOG recommends that any departures from local clinical protocols or guidelines should be fully
documented in the patient’s case notes at the time the relevant decision is taken.

@RCObsGyn @rcobsgyn @RCObsGyn

Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ
T: +44 (0) 20 7772 6200 E: covid-19@rcog.org.uk W: rcog.org.uk Registered Charity No. 213280