guidance on antenatal screening

1. guidance on antenatal screening

2. The pregnant woman must understand the condition being screened for. • The midwife should explain about the nature, purpose, risks, benefits, timing, limitations and potential consequences of screening.

3. The woman should understand that screening is optional, and understand the risks and benefits of not undergoing screening. • the choice of continuing or terminating a pregnancy for serious fetal abnormalities

4. Local knowledge should be shared: how, where and when the test is done: • What the test results mean and potential significant clinical and emotional consequences. • The decisions that might need to be made • How and when the results will be given.

5. - misunderstandings are that Down syndrome cannot occur if it has not previously occurred in a family or that a woman is too young to have an affected baby. • Many women (and their partners) do not understand that syphilis is a sexually transmitted infection

6. -Women who decline first trimester screening should know that they can take up second trimester screening for Down's syndrome if they change their mind and that they can undergo second trimester screening for fetal anomaly at 18+0 to 20+6 weeks. • Women who decline initial screening for infections can and should be offered screening later in the pregnancy. • A partner or family member has no right to consent or decline on her behalf. Women can withdraw consent for testing at any time. This decision should be recorded.

7. The process of consent • requires adequate time. • to ensure that the woman has had the time she needs • has been enough time to ask questions, that she feels comfortable • -The amount of information needed will vary between women.

8. Issues to consider when presenting information • understand the motivations • Mothers often think that fetal anomaly tests such as ultrasound scans are an integral or mandatory part of their antenatal care. • When women are anxious or under stress, they are less able to remember the information provided

9. Parents may feel vulnerable and less able to ask questions. • This may lead to dissatisfaction

10. Midwife help woman about the test risks, benefits and the consequences of results. • - a mother whose friend or neighbour has a baby with Down syndrome may be sensitized to this possibility and overestimate the chances of it happening to her. • -Mothers who work with infirm people, or those with a disability, are most likely to seek prenatal diagnosis

11. Explaining risk • The way in which the midwife tells a mother about risk will also greatly influence how that risk is perceived. • For example, a mother who is told that her risk of a particular condition is 1 in 10 may be more. Or 1\100 This is known as the ‘framing’ effect

12. it is important that this information is presented in a variety of ways using appropriate language. • the use of the word ‘chance’ rather than ‘risk’ and that the chance

13. General principles when providing informatio n • Be clear: explain everything in terms that are not medical or complex • – be simple, concise. • Give important information first. • Give logical information such as treatment, prognosis and ways to cope. • Information may be recalled more easily if it has been presented in several forms. • For example, leaflets can be helpful.

14. Offer to answer any queries. Give contact numbers, • Do not make assumptions • Summarize, check understanding and repeat the information. • Ask whether there is anything that remains unclear.

15. -the results of all of their screening tests recorded in their hand-held notes within 14 days

16. Individual screening test considerations • Antenatal screening tests are broadly divided into those that are looking for a problem in the mother that could affect the fetus, such as an infection, the presence of a red-cell antibody, or a particular haemoglobin, which if passed on by both parents could cause an issue, or those looking directly for a problem in the fetus.

17. Fetal screening tests • Population screening of the fetus (i.e. that offered to everyone) is now directed at two areas: defining the risk of a baby having Down syndrome (trisomy 21), and the detection of specific abnormalities.

18. Screening for Down syndrome • Down syndrome is the most common cause of severe learning difficulty in children. • Around one in three of these babies are born with a serious heart defect.

19. The average life expectancy is about 60 years, although most people develop pathological changes in the brain (associated with Alzheimer's disease) after the age of 40 • Screening for Down syndrome has been driven by both health economics and maternal choice.

20. The gestational age window for a combined test starts from 10+0 weeks to 14+1 weeks in pregnancy. • The combined test comprises measurement of the crown–rump length (CRL) ,to estimate fetal gestational age (dating scan), measurement of the nuchal translucency (NT) space at the back of the fetal neck ,and maternal blood to measure the serum markers of pregnancy-associated plasma protein A (PAPP-A) and human chorionic gonadotrophin hormone (hCG).

23. The quadruple test window starts from 14+2 weeks to 20+0 weeks. A maternal blood sample is required for the analysis of hCG, alpha-fetoprotein (aFP), unconjugated oestriol (uE3) and inhibin-A.