nhs fetal anomaly screening programme marie coughlin screening lead january 25 th 2010
TRANSCRIPT
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NHS Fetal Anomaly Screening Programme
Marie Coughlin Screening Lead
January 25th 2010
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Today’s Session First of 6 Antenatal & Newborn sessions throughout
2010
Same format will be used – feedback on this would be useful
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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
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Aim of the Session
To increase knowledge base within public health
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Session Format
Overview of UK NSC/NWSHA structure
Overview of Fetal Anomaly Screening
Review of patient pathway
Data and QA
Future developments
Questions/comments
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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
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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
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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
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Cont...
Conditions screened for:— Alobar Holoprosencepathy (HPE)
— Anencephaly
— Bilateral Renal Agenesis
— Cleft Lip/Palate
— Congenital Diaphragmatic Hernia (CDH)
— Congenital Heart Disease
— Down’s Syndrome
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Cont…
Conditions screened for:— Edward’s Syndrome (Trisomy 18)
— Exomphalos (Omphalocele)
— Gastroschisis
— Lethal Skeletal Dysplasia
— Spina Bifida
— Trisomy 13 (Patau’s Syndrome)
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Patient Pathway…
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NHS Fetal Anomaly Screening Programme (FASP)
Rebecca Till
Screening Midwife
Macclesfield District General Hospital
26th January 2010
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Aim
Programme breakdown Strategies & Tests Pathways
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Fetal Anomaly Screening Programme
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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
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Screening Strategies
1st Trimester Combined
Quadruple Test
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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)
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The Quadruple Test (2nd Trimester)
15-21+6 weeks
Gestation
Maternal Age
Ethnicity
Smoking
Weight
84% DR - 5% FPR
PAPP-A
Alpha-feta Protein
BhCG
Unconjugated Oestriol
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PAPP-A BhCG
Alpha-feta
Protein
Unconju-gated
Oestriol
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PAPP-A
Fetal Anomaly UltrasoundAims & Objectives
Verbal ConsentQuickTime™ and a
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Fetal Anomaly Ultrasound
Abnormalities
Development
Show fetus/heartbeat
Listed anatomy
Measurements
Discuss results
Printed handout
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Patient Pathway and Timelines
Screening Timeline
Pathway for Trisomy 21 Screening
Pathway for raised NT > 3.5mm
Pathway for Fetal Anomaly Screening
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Conclusions
Robust
Implications on Implementation
Resources
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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
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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
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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?
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My Questions
Did you find this session useful?
What will you do differently as a result of this session?
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Thank You