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.

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