Existence and quality of written antenatal screening policies in the United Kingdom: postal survey
Antenatal units are generally unaware of screening guidelines for women at increased risk of having a baby with genetic defects including Down's syndrome and cystic fibrosis, finds research in this week's BMJ. The guidelines were issued by the Royal College of Obstetricians and Gynaecologists following a national confidential inquiry of antenatal care.
In 1999, researchers at St Mary's Hospital in Manchester surveyed 242 obstetricians and 273 midwives throughout the UK about their awareness of the national confidential inquiry and its effects on practice. Midwives were also asked to submit their unit's written policies, which were assessed using the Royal College's written criteria.
Of 181 obstetricians who responded, 29 (16%) were aware of the inquiry, 13 (7%) were aware of the specific recommendations for Down's syndrome and 6 (3%) aware of those for cystic fibrosis. Of 160 midwives who responded, 33 (21%) were aware of the inquiry, 27 (18%) were familiar with the recommendations for Down's syndrome and 9 (6%) those for cystic fibrosis. Overall, 39 units (24%) lacked local and regional policies for Down's syndrome, 55 (34%) for neural tube defect, 104 (65%) for blood disorders and 125 (78%) for cystic fibrosis. Where written policies existed, they varied widely in adherence to the guidelines, and only one covered all five points.
National guidelines and local written policies should be adopted to promote informed choice and equity of service, say the authors. Units without an identified person responsible for antenatal screening face the risk of being overwhelmed by advances in the field, and national audits will be compromised if no single person can be approached for reliable information, they conclude.
Kirsty Challen, Research Assistant, Genetic Enquiry Centre, St Mary's Hospital, Manchester, UK Email: kirstychallen@hotmail .