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Antenatal Screening

Antenatal Screening. Rebecca Sykes. Contents. Pregnancy schedule. Week 8 to 12 Midwife – Booking appointment - bloods Week 12 to 14 Dating Scan Week 16 Midwife – results of screening Week 18 to 20 Anomaly Scan Week 25 Midwife Week 28 Midwife – Anti-D, Bloods

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Antenatal Screening

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  1. Antenatal Screening Rebecca Sykes

  2. Contents

  3. Pregnancy schedule • Week 8 to 12 Midwife – Booking appointment - bloods • Week 12 to 14 Dating Scan • Week 16 Midwife – results of screening • Week 18 to 20 Anomaly Scan • Week 25 Midwife • Week 28 Midwife – Anti-D, Bloods • Week 31 Midwife – only if first pregnancy • Week 34 Midwife – Discuss birth plan, 2nd Anti-D • Week 36 Midwife – Check position of baby, consider ECV • Week 38 Midwife • Week 40 + Midwife – membrane sweep each week and discuss IOL at 41 weeks

  4. Screening Bloods • Thalassaemia – All women • Sickle cell disease – High risk women (family origins and geographical areas) • HIV • Hepatitis B • Syphilis • Rubella

  5. Screening for Down’s, Edward’s and Patau’s • 10-14 weeks – Combine Test • Bloods – PAPP-A (pregnancy associated plasma protein-A) and free B-hCG • Ultrasound – Nuchaltranslucency • 14 – 20 weeks – quadruple test • Bloods – Free B-hCG, alpha fetoprotein, inhibin-A and unconjugated estriol • Both give high or low risk • Anything more than 1:150 – Offer diagnostic testing

  6. Chorionic Villus Sampling • Invasive diagnostic test • Performed between 11+0 and 13+6 • Allows examination of fetal karyotype from placental biopsy • Accuracy 97.5% - 99.6% • Miscarriage risk – 2% • Performed transabdominally usually

  7. Amniocentesis • Invasive diagnostic test • Performed between 15 weeks and 16 weeks – can be done at any time • Accuracy 98-99% • Miscarriage risk – 0.5 -1% • Allows examination of fetal karyotype • Rapid testing (results in 24-48 hours). • Down's syndrome (trisomy 21). • Edward's syndrome (trisomy 18). • Patau's syndrome (trisomy 13). • Turner syndrome. • Klinefelter's syndrome. • Other sex chromosome anomalies. • Performed transabdominally usually

  8. Anomaly scan • Look at fetal bones, heart, brain, spinal cord, face, kidneys and abdomen. • Anencephaly • open spina bifida • cleft lip   • diaphragmatic hernia  • gastrochisis • exomphalos • serious cardiac abnormalities  • bilateral renal agenesis • lethal skeletal dysplasia  • Edwards' syndrome, or T18  • Patau's syndrome, or T13

  9. Non-Invasive Prenatal screening • Can be done around 10 weeks • Taking a maternal blood sample +/- USS • Costs between £350-£550 • Down’s, Edward’s and Patau syndrome – very accurate • Other clinics look for micro-deletions – unsure how accurate this is or useful • Results take 10-14 days • Reports as low risk or high risk • High risk will be offered CVS or amniocentesis

  10. Any Questions?

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