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NHS Fetal Anomaly Screening Programme

NHS Fetal Anomaly Screening Programme. Marie Coughlin Screening Lead January 25 th 2010. Today’s Session. First of 6 Antenatal & Newborn sessions throughout 2010 Same format will be used – feedback on this would be useful. Reasons for Today’s Session.

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NHS Fetal Anomaly Screening Programme

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  1. NHS Fetal Anomaly Screening Programme Marie Coughlin Screening Lead January 25th 2010

  2. Today’s Session • First of 6 Antenatal & Newborn sessions throughout 2010 • Same format will be used – feedback on this would be useful

  3. Reasons for Today’s Session • As a result of ChaMPs commissioned review of screening • A need to further engage public health in Antenatal & Newborn Screening Programmes • At the request of public health screening leads • Part of C&M Screening Action Plan • Thought it useful to invite commissioners also

  4. Aim of the Session • To increase knowledge base within public health

  5. Session Format • Overview of UK NSC/NWSHA structure • Overview of Fetal Anomaly Screening • Review of patient pathway • Data and QA • Future developments • Questions/comments

  6. Overarching Structure • UK NSC oversees 6 Antenatal & Newborn Screening Programmes • SHA coordinators with regional and national role • NWSHA coordinator jobs out to advert • UK NSC has defined accountability & governance structure for SHA, PCT and provider

  7. Purpose of Fetal Anomaly Screening • Aim to offer women 2 ultrasound tests at 10-12 weeks and 18-20 weeks of pregnancy • First scan for dating and pregnancy viability • Second scan screens for major structural anomalies • Down’s Syndrome Screening Programme now part of Fetal Anomaly Screening Programme • Screens for down’s syndrome between 10-18 weeks depending on local screening strategies

  8. Cont… • Aspires to give women an informed choice • Does not screen for all conditions • For down’s syndrome only gives an indication of risk, does not confirm • Unlike other screening programmes, emphasis not on high uptake rates

  9. Cont... • Conditions screened for: • Alobar Holoprosencepathy (HPE) • Anencephaly • Bilateral Renal Agenesis • Cleft Lip/Palate • Congenital Diaphragmatic Hernia (CDH) • Congenital Heart Disease • Down’s Syndrome

  10. Cont… • Conditions screened for: • Edward’s Syndrome (Trisomy 18) • Exomphalos (Omphalocele) • Gastroschisis • Lethal Skeletal Dysplasia • Spina Bifida • Trisomy 13 (Patau’s Syndrome)

  11. Patient Pathway…

  12. NHS Fetal Anomaly Screening Programme (FASP) Rebecca Till Screening Midwife Macclesfield District General Hospital 26th January 2010

  13. Aim Programme breakdown Strategies & Tests Pathways

  14. Fetal Anomaly Screening Programme

  15. Down’s Syndrome Screening Recommendations 75% detection rate (DR) for 3% false positive (FP) 90% detection rate (DR) for 3% false positive Benchmark timeframe - April 2010

  16. Screening Strategies 1st Trimester Combined Quadruple Test

  17. 1st Trimester Combined Biochemical markers in maternal serum (10-14 weeks) BhCG PAPPA-A 87%DR - 3%FPR (1:150) Nuchal Translucency Scan (11-13+6 weeks)

  18. The Quadruple Test (2nd Trimester) 15-21+6 weeks Gestation Maternal Age Ethnicity Smoking Weight 84% DR - 5% FPR PAPP-A BhCG BhCG PAPP-A Alpha-feta Protein Unconju- gated Oestriol Alpha-feta Protein Unconjugated Oestriol

  19. Fetal Anomaly UltrasoundAims & Objectives Verbal Consent PAPP-A

  20. Fetal Anomaly Ultrasound Abnormalities Development Show fetus/heartbeat Listed anatomy Measurements Discuss results Printed handout

  21. Patient Pathway and Timelines Screening Timeline Pathway for Trisomy 21 Screening Pathway for raised NT > 3.5mm Pathway for Fetal Anomaly Screening

  22. Conclusions Robust Implications on Implementation Resources

  23. Data, Performance & QA • Very difficult to obtain data – not held centrally • Trusts required to produce annual report • QA for laboratories • Developing QA for the rest of the service – NW coordinator roles will aid this

  24. Future Developments • 1st trimester screening for Down’s Syndrome to be implemented by April 2010 • C&M PCTs not on target for this • QA function to be developed further • I.T. system to improve data collection to be developed

  25. Questions/Comments • How/who monitors annual reports within PCT organisations? • How can we achieve 1st trimester screening by April 2010? • With regard to QA, how do we assure our Boards that local programmes run satisfactorily?

  26. My Questions • Did you find this session useful? • What will you do differently as a result of this session?

  27. Thank You

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