An earlier report on antenatal screening for Down syndrome in a South Wales district identified sub-standard and variable practices. A multidisciplinary Professional Advisory Group was set up in 1996 to review the service and recommend a model of care, as well as quality outcome measures to form the standards for audit and evaluation. The programme drew heavily on evidence-based practice and the opinion and aspirations of the pregnant women. This was the first organised attempt at standardisation of the screening practices for congenital abnormalities in Wales. A year later, several goals had been achieved. Each obstetric unit now has a named Screening Midwife Specialist. The first genetic course in the UK specifically tailored for midwifes has been established. Lack of leadership in fetal medicine and ultrasound scanning was identified in one maternity unit, resulting in the appointment of two additional sonographers and a consultant obstetrician. The Professional Advisory Group produced a new, district-wide, annually updated information booklet for expectant mothers. A new information system was installed in each maternity unit to facilitate audit of outcome. Several clinical, biochemical and cytogenetic indicators were specified as quality outcome indicators and were collated and compared with the recommended standards. The uptake of serum screening has declined from around 95 to 75% in two units (to 62.9% overall, closely resembling the percentage expected based on the findings of a local survey of pregnant women). The rate of amniocentesis was significantly reduced by 28.7%, as women thought more clearly about their options and the limitations of tests. This suggests that women have a better understanding and more autonomy in making decisions regarding tests. An enthusiastic public health lead was essential in initiating and maintaining the changed programme.

1.
Al-Jader LN, Parry-Langdon N, Smith RJW: Survey of attitudes of pregnant women towards Down syndrome screening. Prenat Diagn 2000;20:23–29.
2.
Piggott M, Wilkinson P, Bennett J: Implementation of an antenatal serum screening programme for Down’s syndrome in two districts (Brighton and Eastbourne). The Brighton and Eastbourne Down’s Syndrome Screening Group. J Med Screen 1994;1:45–49.
3.
Wald NJ, Kennard A, Densem JW, Cuckle HS, Chard T, Butler L: Antenatal maternal serum screening for Down’s syndrome: Results of a demonstration project. BMJ 1992;305:391–394.
4.
Burn J, Fairgrieve S, Frank P, White I, Magnay D: Audit of maternal serum screening: Strategies to augment counselling in response to women’s views. Eur J Hum Genet 1996;4:108–112.
5.
Al-Jader LN: Antenatal screening for Down syndrome, Part II. MFPHM submission to the Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom, 1996.
6.
Crompton G, Al-Jader LN: A Strategy for Antenatal Screening for Congenital Abnormalities, the Recommendations of the Professional Advisory Group. Bro Taf Health Authority, 31 July 1997.
7.
Chitty L, Campbell S: Ultrasound screening for fetal abnormalities; in Brock DJH, Rodeck CH, Ferguson-Smith MA (eds): Prenatal Diagnosis and Screening. Edinburgh, Churchill Livingstone, 1992, pp 595–609.
8.
The Royal College of Obstetricians and Gynaecologists, Guideline Number 8. London, October, 1996.
9.
Congenital Anomaly Register and Information Service for Wales (CARIS). Annual Report, 1998, Wales.
10.
First Class Delivery: Audit Commission Report. London, 1997.
11.
Sadler M: Serum screening for Down’s syndrome: How much do health professionals know? Br J Obstet Gynaecol 1997;104:176–179.
12.
Smith DK, Shaw RW, Slack J, Marteau TM: Training obstetricians and midwives to present screening tests: Evaluation of two brief interventions. Prenat Diagn 1995;15:317–324.
13.
Fairgrieve S, Magnay D, White I, Burn J: Maternal serum screening for Down’s syndrome: A survey of midwives’ views. Public Health 1997;111:383–385.
14.
Royal College of Physicians: Prenatal Diagnosis and Genetic Screening: Community and Service Implications. London, Royal College of Physicians, 1989.
15.
Grewal GK, Moss HJ, Aitken DA, Bjornsson S, Cameron AD, Pell JP: Factors affecting women’s knowledge of antenatal serum screening. Scott Med J 1997;42:111–113.
16.
Thornton JG, Hewison J, Lilford RJ, Vail A: A randomised trial of three methods of giving information about prenatal testing. BMJ 1995;311:1127–1130.
17.
Murray J, Cuckle H, Taylor G, Littlewood J, Hewison J: Screening for cystic fibrosis. Health Technol Assess 1999;3:1–104.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.