1 / 24

Problem based learning

Problem based learning. Antenatal screening programme. Factual learning objectives. What is screening? NICE guidelines Maternal screening: Haemoglobinopathies Infectious diseases Gestational diabetes Fetal anomaly screening Ultrasonography Downs syndrome screening.

kort
Download Presentation

Problem based learning

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Problem based learning Antenatal screening programme

  2. Factual learning objectives • What is screening? • NICE guidelines • Maternal screening: • Haemoglobinopathies • Infectious diseases • Gestational diabetes • Fetal anomaly screening • Ultrasonography • Downs syndrome screening

  3. Other learning opportunities and discussion points • Ethical issues around screening • Explanation skills and problems • Different roles in MDT • Children with disabilities • Communicating risk

  4. What is screening? ‘Screening may be described as the process of looking at a population perceived to be at risk from a condition in an attempt to identify those at higher risk, in whom some intervention may be made.’ Not diagnostic Looking at general asymptomatic population

  5. WHO screening criteria • The condition should be an important one. • There should be an acceptable treatment. • Facilities for diagnosis and treatment should be available. • There should be a recognised latent or early symptomatic stage. • There should be a suitable test which has few false positives and few false negatives. • The test or examination should be acceptable. • The cost, including diagnosis and subsequent treatment, should be economically balanced.

  6. Discussion point - screening • Advantages of screening • Problems with screening • Issues with this case • Age of patient • Involvement of partner • Understanding of issues

  7. Screening programme • In England, run by UK National Screening committee. • Antenatal: • Fetal anomaly screening programme • Infectious diseases in pregnancy • Sickle cell and thalassaemia screening programme • Gestational diabetes • Newborn: • Newborn and infant physical examination • Newborn blood spot • Newborn hearing screening

  8. Counselling • Mothers should be aware of all options available to them, including the option to decline testing • Mothers should be aware of the benefits and limitations of screening tests and should understand the meaning of results to be obtained.

  9. Discussion point – giving information • How much information do mothers want? • How do we give this? • Who should give it? • When do we give this? • Does everyone need the same information?

  10. Infectious diseases screening • Who - all women • When - at booking • Why - enable treatment, minimise risk of transmission • What - blood tests • HIV • Hep B • Syphilis • Rubella susceptibility

  11. Haemoglobinopathy screening • Who: • all women in units defined as high prevalence (fetal prevalence of sickle cell disorder greater than 1.5 per 10,000 pregnancies) • In low risk units to women from high risk origins • For all women inspection of blood indices • When: • At booking • Why: • Enable treatment, identify neonates at risk • What: • Blood test for haemoglobinopathy • Red cell indices

  12. Discussion point – ethical issue of justice and equality • Is it ethical to offer screening based on prevalence in an area? • What about women who are in area with low prevalence that don’t get screened? • What about women in a high risk area but that are personally low risk that get put through screening process?

  13. Gestational diabetes • Who: • body mass index above 30 kg/m2 • previous macrosomic baby weighing 4.5 kg or above • previous gestational diabetes • family history of diabetes • family origin with a high prevalence of diabetes - South Asian, Black Caribbean, Middle Eastern • Why:identify to enable optimum monitoring and treatment • What: • Previous gestational diabetes - early self-monitoring of blood glucose or oral glucose tolerance test at 16–18 weeks, followed by OGTT at 28 weeks if the first test is normal • Otherwise - OGTT to test for gestational diabetes at 24–28 weeks

  14. Fetal anomaly screening • All women should be offered: • A screening test for Down's syndrome that meets agreed national standards • An ultrasound scan between 18 – 20 weeks 6 days to check for physical abnormalities in their unborn baby • Information to help them decide if they want screening or not

  15. Downs syndrome screening • Who – all mothers • When – between 10 and 20 weeks • Why – to offer definitive testing and option for termination if desired • What…… • A detection rate for Down's syndrome of greater than 75% of affected pregnancies with a screen positive rate of less than 3%.

  16. What….. According to NICE appropriate tests include: • from 11 to 13 weeks 6 days - the combined test • (NT, hCG and PAPP-A) • Preferred method as gives early diagnosis and only needs one visit. • Includes NT scan (done with dating scan) and bloods. • from 11 to 13 weeks 6 days and 15 to 20 weeks - the integrated test • (NT, PAPP-A + hCG, AFP, uE3, inhibin A) • Need to attend twice for NT scan before 13 weeks and then for bloods after 15 weeks.

  17. What….. • from 11 to 13 weeks 6 days and 15 to 20 weeks - the serum integrated test • (PAPP-A + hCG, AFP, uE3, inhibin A) • Need to attend twice for bloods but does not include NT scan (used if cannot measure NT e.g. due to baby position or patient body habitus) • from 15 to 20 weeks - the quadruple test • (hCG, AFP, uE3, inhibin A) • Only option for late bookers • Some special cases e.g. NT only for multiple pregnancies

  18. Then… • Calculate risk depending on woman’s age and screening results (need to know gestation to interpret) Woman's age (years) Risk as a ratio % Risk Below 20 1:1600 0.067 20 1:1500 0.066 30 1:800 0.125 35 1:270 0.37 40 1:100 1.0 45 and over 1.50 and greater 2.0 • Categorise as high or low risk and offer invasive diagnostic testing to high risk. Cut offs: • 1st trimester combined – 1:150 • 2nd trimester - 1:200 • NT alone - 1:250

  19. Discussion point –communicating risk • Quantifying risk: • “There is a 5% chance that your baby will have Downs syndrome” • “Your baby is at high risk of having Downs syndrome” • “The risk of your baby having Downs syndrome is 0.05” • “Out of 20 babies, 1 would have Downs syndrome” • “There is a 95% chance that your baby won’t have Downs syndrome” • Relative v absolute risk: • “Taking the COCP doubles your risk of having a blood clot” v “Taking the COCP increases your risk of having a blood clot from 1 in 14000 to 2 in 14000” • “This drug will result in a 34% reduction in the risk of a heart attack” (88% took drug) v “This drug will result in 1.4% fewer people having heart attacks” (42% took drug)

  20. Any questions at this point?

  21. Discussion point to finish – community orientation • How do GP, midwife and consultant work together? What are their responsibilities? • What supporting services are available?

  22. Summary • Screening • NICE guidelines • Offering information and communicating risk

  23. Thank you for listening

More Related