Maternity services. Volume I, Report together with appendices and the proceedings of the committee.

  • Great Britain. Parliament. House of Commons. Health Committee.
Date:
1992
Catalogue details

Licence: Open Government Licence

Credit: Maternity services. Volume I, Report together with appendices and the proceedings of the committee. Source: Wellcome Collection.

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    210. The booking visit, or first visit, to a health professional regarding an established pregnancy, is the time at which the first assessment of risk is made. In this context, risk means the perceived likelihood of the pregnancy developing a predictable complication. At the present time, our ability to predict abnormality remains limited.?8? Although we can identify a sub-group of the population in which the majority of risk will occur, many women with pregnancies at risk of abnormality will have a normal outcome, and some women apparently normal at booking will develop complications. Nonetheless, prenatal screening and diagnosis relies largely on selecting women at increased statistical chance of a fetal or maternal abnormality, to define a sub-group to whom special tests may be offered. 211. The diagnosis of major congenital defects has been a major area of advance over the last ten or more years. The Royal College of Obstetricians and Gynaecologists told us that in respect of genetic screening and prenatal diagnosis: “This aspect of antenatal care is now applicable to .. all pregnant women, two percent of whom may unsuspectingly be carrying a fetus with a major abnormality”’.7°4 The College have pointed out that ultrasound can be used both for routine screening and for diagnosis, and that up to 70 per cent of major malformations can be diagnosed.**° However, in many districts, women are not yet routinely offered a mid-trimester anomaly scan.7*° 212. In each district there needs to be an effective system for the delivery of prenatal diagnosis. The relevant recommendation of the 23rd Study Group of the Royal College of Obstetricians and Gynaecologists on Antenatal Diagnosis of Fetal Abnormalities was that: “Effective delivery of prenatal diagnosis (PND) cannot be achieved until each District General Hospital has a consultant obstetrician with a special interest in PND, to take responsibility for the organisation of ultrasound, invasive procedures, patient information and professional education’’.”®’ 213. To ensure the success of such screening programmes, there needs to be an effective audit. The RCOG working party suggested that this needs an adequate malformation register. “Current systems (of PND) are inadequate because information is incomplete. For many (often individually rare) conditions there is merit in organisation of malformation registers at a regional level but interlinked nationally”’.?*8 Such registers require a cooperative approach between the various districts. 214. Professor Malcolm Ferguson-Smith, Professor of Genetics wrote: ‘““Voluntary screening programmes should be available to all mothers.’’*8? We also had evidence of concern over the provision of genetic services. Dr Dian Donnai emphasised the need for co-ordination between the maternity services and the genetic services??? and Dr Bernadette Modell told us that: “Part of the reason why the services are inadequately delivered is that nobody is responsible for ensuring that “community genetic services” are delivered to the community”’.??! We dealt extensively with the Genetic Services in our earlier report on Preconception. 22 At the time of agreeing this report we still await the Government’s response. 215. Anne Rider, a midwife, suggested in her evidence that: “The obstetric team might screen all pregnant women once, probably at 20 weeks when the results of screening including ultrasound anomalies scan and AFP results are available. This could give obstetricians and the women of normal pregnancies confidence that the correct type of management has been agreed. It could also act as a social interview between the obstetrician and the woman from which the woman would be reassured that a full range of obstetric back- up services are available to her should a complication arise”’ and that thereafter *83See e.g. Pregnancy and Risk, eds Stirrat and James, John Wiley & Sons, London, 1989 *84Ev p 139 285i bid 286i bid *87Ev page 142 *88i bid 289M{S142 290M S22 9IN{ $333 HC (1990-91) 430-1, paras 122-138