NHS Fetal Anomaly Screening Programme

Marie Coughlin Screening Lead

January 25th 2010

Today’s Session First of 6 Antenatal & Newborn sessions throughout

2010

Same format will be used – feedback on this would be useful

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

Aim of the Session

To increase knowledge base within public health

Session Format

Overview of UK NSC/NWSHA structure

Overview of Fetal Anomaly Screening

Review of patient pathway

Data and QA

Future developments

Questions/comments

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

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

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

Cont...

Conditions screened for:— Alobar Holoprosencepathy (HPE)

— Anencephaly

— Bilateral Renal Agenesis

— Cleft Lip/Palate

— Congenital Diaphragmatic Hernia (CDH)

— Congenital Heart Disease

— Down’s Syndrome

Cont…

Conditions screened for:— Edward’s Syndrome (Trisomy 18)

— Exomphalos (Omphalocele)

— Gastroschisis

— Lethal Skeletal Dysplasia

— Spina Bifida

— Trisomy 13 (Patau’s Syndrome)

Patient Pathway…

NHS Fetal Anomaly Screening Programme (FASP)

Rebecca Till

Screening Midwife

Macclesfield District General Hospital

26th January 2010

Aim

Programme breakdown Strategies & Tests Pathways

Fetal Anomaly Screening Programme

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

PAPP-A

Fetal Anomaly UltrasoundAims & Objectives

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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

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

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?

My Questions

Did you find this session useful?

What will you do differently as a result of this session?

Thank You