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
UK National
Screening
Programme
Chromosomal
(Down’s
Syndrome
Screening)
Equality of
access
Structural
(18-20+6 Week
anomaly scan)
Equitable
Service
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
PAPP-A
Alphafeta
Alpha-feta
Protein
Protein
BhCG
BhCG
Unconjugated
Unconjugated
Oestriol
Oestriol
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Fetal Anomaly Ultrasound
Aims & Objectives
Two
Ultrasound
Scans
PAPP-A
Structural
Dating &
Anomalies
Viability (8+
(18-20+6
weeks)
weeks)
Screening
Choices
Management
and
Termination
Options
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Verbal Consent
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