Fetal congenital abnormalities occur in 2-5% of the fetal population and represent a significant cause of morbidity and mortality. Currently, all women in England are offered second trimester ultrasound screening between 18-20 weeks gestational age for prenatal diagnosis of fetal anomalies, managed under the aegis of the Fetal Anomaly Screening Program (FASP).

Recent studies have shown that first trimester ultrasound between 11 and 14 weeks can diagnose over half of all prenatally detected major anomalies in low risk and high risk populations. This suggests that first trimester anomaly screening has the potential to be a valuable addition to prenatal care. However, there is little consensus as to whether this screening is clinically reliable enough for use in daily practice and many questions remain regarding the logistics of how first trimester screening should be optimally performed at a population-wide level. There is currently no UK guidance recommending whether or how first trimester anomaly screening should be performed, what the objectives of this scan should be, or whether implementation of such screening on a national level would be feasible.

This talk will explore the evidence base supporting first trimester anomaly screening, the systems factors which could be utilized to improve screening performance and highlight the challenges which still remain for implementation of such a screening test. The results from recent collaborative work with Public Health England assessing current first trimester ultrasound practice and existing NHS resources in England will be discussed. In addition, evidence from two national studies exploring the views of parents and screening experts across England will be shared, with an emphasis on understanding how first trimester anomaly screening might be designed to meet the needs of relevant stakeholders. Finally, ongoing and future work towards the development of standards for a first trimester fetal anomaly screening program in the UK will be discussed.