NNFM Nordic Network -‐ Fetal Medicine
April 14 -‐ 2015 Gothenburg Invasive Fetal Medicine
A workshop on Nordic collabora7on in invasive fetal
medicine – supported by Nordic Council
Challanges within invasive fetal medicine and fetal therapy ! Rare condiEons -‐ how to gain rouEne Low cases load – paHern recogniEon may fail Training on paEents can be fatal for the fetus Decreasing numbers of CVS aMer NIPT Cut down’s by hospital owners !
AIM of today !
To create collabora7on across our Nordic borders hopefully resul7ng – along the way -‐ in improvements for our pregnant women and
pa7ents by establishing networks for educa7on and competence development for doctors working within invasive fetal medicine.
The funding by Nordic Council ApplicaEon: Send January 2014, concerning the establishment of a Nordic collaboraEon within competence development in the invasive part of the fetal medicine -‐ NO responce !
200.000,-‐D.kr. oktober 2014 – very suddenly More funding will depend on: Establishings las7ng agreements between our Nordic departments
The funding by Nordic Council 200.000,-‐ D. Kr. for this meeEng to cover:
accomodaEon transports foods and meeEng faciliEes ect.
43 parEcipants today 19 applied for funding
KS responsible for accounEng in details can be transported to next year/ or returned
NC has encouraged us to apply for a next meeEng/conference in 2016 . More funding will depend on: Establishings las7ng agreements between our Nordic departments
VIP message
All details for reimbursement through Karin – must be filled out TODAY – and all reciepts possible passed on to Karin !! Karin will pay the hotel directly at check out Thursday -‐ before for those who need it.
Tuesday April 14th A workshop on Nordic collaboration in invasive fetal medicine – supported by Nordic Council Moderators: Karin Sundberg – Rigshospitalet Copenhagen
Peter Lindgren – Karolinska Stockholm 11.00-11.15 am - Welcome to NNFM by Bo Jacobsson, Sahlgrenska Gothenburg. – Introduction: Karin Sundberg (DK) and Peter Lindgren (SE). 11.15-11.35 am – Invasive Fetal Medicine – organisation Denmark, Karin Sundberg. 11.35-12.10 am – Invasive Fetal Medicine – organisation Sweden, Peter Lindgren. 12.10-12.30 pm – Invasive Fetal Medicine – organisation Norway, Torbjørn Eggebø. 12.30-13.30 pm Lunch 13.30 – 13.50 pm – Invasive Fetal Medicine – organisation Finland, Aydin Tekay. 13.50 – 14.05 pm – Invasive Fetal Medicine – organisation Iceland, Hildur Hardardottir. 14.05 – 14.15 pm – Overview Nordic countries – Olav Bjørn Petersen – Århus-DK. 14.15 – 14.45 pm Fetal aortic valvuloplasty, Mats Mellander (SE) 14.45 – 15.45 pm Coffee/cake in smaller work shop groups of mixed nationalities
Brainstorm concerning future potential collaboration fields, including competence development of Nordic doctors in invasive fetal medicine. 15.45 – 16.00 pm Break 16.00 – 16.45 pm Reporting by the groups and discussion of proposed ideas and eventual constitution of a stearing group on invasive competence development under NNFM. 16.45 – 17.00 pm Conclusions, Karin Sundberg (DK) and Peter Lindgren (SE) 19.00 pm Dinner at the Clarion Hotel Post
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DENMARK
Invasive Fetal Medicin – Organisation
by Karin Sundberg Fetal Medicine Dept. Rigshospitalet - Copenhagen
Denmark -‐ demographics • 5,6 mill inhabitants • Public health care system • 55-‐60.000 deliveries/year • 21 obstetric departments • ”All” deliveries take place in public hospitals • 99% of the prenatal care in public hospitals
• > 95% aHend 1. trimester T 21 screening Føtodatabasen – Astraia DFMS – Dansk Føtalmedicinsk Selskab
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Dansk CytogeneEsk Centralregister
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CVS – Amniocentesis in Denmark
Undertaken at 16 departments in Denmark – some do less than 100/year !!!
Greenland and Faroe Islands only do Amniocentesis.
BIG PROBLEM for educaEon and competence maintainance !!
Quality sEll good – all use same TA technique and
needleguide – very low naEonal spontaneous aborEon rate
Future quality ?
Centralised invasive procedures in Denmark to Rigshospitalet
Intrauterine blood transfusions – all (15 to 34 weeks) Intrauterine therapeu7c drains
thorax – ”bladder” Treatment of TTTS – by laser or cord occlusion (16-‐24 weeks) Complicated monochorionic cases twin/triplets op7ng for selec7ve fe7cide by cord occlusion / radiofrequency abla7on (resent).
Invasive procedures at the 4 larger university hospitals in Denmark
Fetal reduc7ons -‐1. trimester Selec7ve fe7cides -‐ discrepancy
Centralised invasive procedures in Denmark to Rigshospitalet
Our invasive team is presently:
Lisa Neerup Jensen, Kirsten Søgaard and Karin Sundberg Can be contacted on 0045 35 45 08 77
We receive paEents from all other Nordic Countries – referred from public hospitals second opinion or for invasive treatment . A tradiEon started by Connie Jørgensen – Head of Department unEl 2012 – leO us for Malmoe-‐ is now head of Emma Klinikken !
Danish organisa7on – legal termina7ons !
Free aborEon unEl 12+0 week for persons on Danish ground gestaEonal age determinated by CRL or LMP
AMer 12+0 weeks up to 22+0 weeks The regional aborEon council is applied by the MD in charge ! Five regionale councils cover the country Level of severity evaluated – consistency!!!
Each aborEon council has 3 members: A MD in OB/GYN, A person from the social authoriEes A psyciatrist In simple cases usually by phone -‐ answer within 24 hours
If terminaEon is denied – the paEent can appeal to the superior NaEonal aborEon appeal council of 3 persons too regulated by The NaEonal Health Authority -‐ SST.
ExcepEons – only for lethal condiEons or severe maternal health issues.