Prenatal screening and diagnosis: a survey of health care providers' knowledge and attitudes

AIM: To survey the knowledge and attitudes of health care providers in Western Australia, Australia towards prenatal screening and diagnostic procedures for fetal anomalies. DESIGN: A self-administered mail survey. SAMPLE: 30 obstetricians and 313 general practitioners (GPs). RESULTS: Overall, relative to GPs, obstetricians expressed more positive attitudes towards prenatal tests. Moreover, GPs felt they had a greater need for additional information. Further group differences were found in attitudes towards the value of the tests and confidence in the availability and ease of coordination of follow-up services according to geographical area. Female health care providers were significantly more confident about the availability of follow-up services and had higher knowledge scores. They were also more likely to practice in the metropolitan area. Further group differences were found in attitudes according to participation in professional development. CONCLUSION: Overall, health care providers felt antenatal screening and diagnostic tests were valuable and they felt they could benefit from further information. Knowledge was high, however, it is unclear whether this knowledge is being communicated to women. Given that antenatal practices are rapidly evolving, continuing education and ongoing professional development is critical.     

双胎妊娠染色体异常的产前筛查及产前诊断

双胎妊娠发生胎儿畸形、染色体异常的风险较单胎妊娠高。近年来双胎妊娠发生率和高龄产妇数量不断增加,双胎妊娠的早期筛查以及产前诊断十分重要。早孕期,颈项透明层(nuchal translucency,NT)超声筛查是重要手段,不建议单独使用血清学筛查;中孕期超声结构筛查对检出胎儿结构异常有一定意义。无创产前基因检测技术的发展,对降低侵入性产前诊断的风险有重要意义,但由于目前临床证据尚不充分,双胎妊娠行无创基因检测仍需谨慎。     

双胎妊娠非整倍体异常的产前筛查与产前诊断

双胎妊娠非整倍体产前筛查较单胎复杂。应在早孕期确定孕周、绒毛膜性并测量颈项透明层厚度。早孕期联合筛查优于中孕期血清学筛查,但检出率明显低于单胎妊娠。无创产前检查用于双胎筛查仍需更多研究数据。双胎之一胚胎停育将影响早孕期筛查的准确性。产前诊断时区分标记双胎是需要注意的重要问题。     

Complementary medicine use among attendees at a rural health screening clinic

The objective of this study was to investigate the use of complementary and alternative medicines (CAM) in a group of older rural Australian attending a multi-disciplinary health screening clinic. The average age of all participants (n = 102) was 66 ± 10 years (range 49–89) and 61% were female. Three-quarters (78%) of respondents had used at least one CAM product within the past 12 months and 66% had visited a CAM practitioner. The most frequently used CAM were vitamin/mineral supplements (54%) followed by herbal supplements (28%). Among products named by respondents that they were currently using the most frequently cited were omega-3/fish oils (28%) and glucosamine (24%). The main source of information for most respondents (53%) was doctors and pharmacists followed by family and friends (28%). Almost half (46%) had not discussed their use of CAM with their doctor and only 15% had discussed their CAM use with a pharmacist. Respondents were not found to hold strongly pro-CAM or anti-CAM health beliefs. This study demonstrates that while older, rural Australians do not have significant pro-CAM beliefs they do have high use of CAM. Based on the types of products used it is suggested that CAM use forms part of these individuals’ self-management strategies.     

Genetic screening in reproductive health care

Genetic screening is used to identify individuals who have genetic variations or mutations that are associated with a particular disorder. Genetic screening may be useful to plan for periodic evaluation, implementation of preventive strategies, or initiation of therapeutic interventions. Current practice is to offer carrier screening for certain genetic diseases during the preconception encounter or more commonly as part of early prenatal care.     

The impact of prenatal group B streptococcus screening as a national health policy in Taiwan

Objective

There was no national data on group B streptococcus (GBS) infections in Taiwan. Until 2012, when prenatal GBS screening was introduced to obstetric practices as a national health policy aimed at reducing neonatal GBS infections. The purpose of this study was to examine the impact of this national health policy on the incidence of maternal GBS colonization and neonatal GBS infection rate. Relatedly, the clinical characteristics of neonatal GBS infection were investigated to determine the correlations between the incidence of maternal GBS colonization and the neonatal GBS infection rate.

Impact of the creation of a specialized clinic for prenatal blood sampling and follow-up care in pregnant women

ObjectiveTo evaluate (1) the effect on gestational diabetes mellitus (GDM) screening rates of having a specialized clinic for pregnant women offering blood sampling and screening for GDM, and (2) the impact on perinatal outcomes of having early GDM screening and follow-up provided by the specialized clinic.MethodsWe performed a retrospective cohort study, based on electronic health records. We compared data from women who delivered during a period when the Blood Sampling in Pregnancy (BSP) clinic was operating (2008–2009; n = 2780) to a time period before the clinic was established (2006–2007; n = 2591). During the 2008–2009 period, we compared data from women who had GDM screening in the first trimester with women who had screening during the second trimester and with women who were not screened.ResultsFollowing the creation of the BSP clinic, overall GDM screening rates reached 72.4% in 2008–2009, compared with 48.9% in 2006-2007 (P < 0.001) and GDM screening was more likely to be performed in the first trimester (36.7% vs. 0.4%; P < 0.001). During the period when the BSP clinic was operating (2008-2009), women who had GDM screening in the first trimester had lower rates of Caesarean section (15.7% vs. 22.1 %; P < 0.001) and neonatal complications (bradycardia: 3.6% vs. 6.8%; P = 0.003; respiratory distress: 9 6% vs 13 2%; P = 0 02; and admission to NICU: 15.4% vs. 26.8%; P < 0.001) than women who did not perform GDM screening.ConclusionIn our population, creation of a clinic offering specialized care to pregnant women improved GDM screening rates. With the support of the BSP clinic, women who had early GDM screening were less likely to undergo Caesarean section and their offspring had fewer perinatal complications.     

外来孕妇与本地孕妇产前检查和妊娠结局的对照研究

目的:调查上海户籍与非上海户籍孕妇围产保健方面存在的差距,分析流动人口平产分娩点对改善外来孕妇围产期保健状况、减少不良妊娠结局发生的作用。方法:回顾分析2004年7月至2005年6月在复旦大学附属上海第五人民医院浦江分院流动人口平产分娩点及上海市第五人民医院产科住院分娩的5528例孕妇。分为分娩点非上海户籍、五院非上海户籍和五院上海户籍3组。结果:分娩点外来孕妇产前检查覆盖率为92.98%,仅次于综合医院沪籍孕妇,但产检4次以上的比例不足1/3,与其他两组差异显著。分娩点调查对象的妊娠结局普遍好于综合医院的外来孕妇,剖宫产率仅为21.10%,明显低于其他两组。两组外来孕妇中,不良妊娠结局的发生随产检次数的增加而减少,来自分娩点孕妇的低体重儿、过期产的发生并未因产检次数增加而得以抑制。结论:通过普及产前检查,流动人口平产分娩点在改善外来孕产妇妊娠结局方面有成效。但外来孕产妇仍缺乏足够的围产保健,应进一步加强系统产前检查和提高质量,切实改善外来流动人口的母婴保健状况。     

Obstetric care in a health maintenance organization and a private fee-for-service practice: a comparative analysis

This study compares the quality of obstetric care provided for patients in two distinct groups: a federally-qualified health maintenance organization and a private fee-for-service practice. Patients of both groups were delivered in the same hospital with resident coverage equally accessible to both groups. From January 1979, through December 1981, the period of the study, the physician group delivered 2385 patients, 57% of them from the health maintenance organization and 43% from the fee-for-service practice. Not only were comparisons of maternal and fetal outcomes available for the two patient groups, but the yearly trends and individual performances of the physicians were available as well. This paper addresses the question, all other things being equal, is the level of care and ultimate outcome the same for both groups of patients? The results in some instances showed surprising differences.     

Acceptability of prenatal HIV screening at the primary care level in Nigeria.

A survey of 333 pregnant women receiving antenatal care at the primary healthcare centres in Sagamu Local Government Area of Ogun State, southwest Nigeria was conducted between January and March 2005 to assess the acceptability of prenatal HIV screening among them. A total of 325 (97.8%) of the respondents were aware of HIV/AIDS but only 181 (54.3%) of them believed it is a problem in Nigeria. A total of 257 (77.2%) respondents agreed to undergo voluntary counselling and HIV testing (VCT). Multivariate logistic regression analysis of associated factors indicated that being married, self-perception of no risk of HIV infection, awareness of benefits of prenatal HIV testing and Christianity are independent predictors of acceptance of prenatal HIV testing in this population. Most of the respondents (78.9%) who were unwilling to take the test cited fear of being infected with its consequences of stigma and discrimination as the reason for their attitude. The survey suggests that a successful integration of VCT programme into the existing primary healthcare services for prevention of vertical HIV transmission is feasible in this part of Nigeria.     

Use of a microcomputer network for history taking in a prenatal clinic

A stand-alone microcomputer was installed at St. Bartholomew's Hospital to obtain the booking (first prenatal) history. This system has many well-documented advantages over the manual method, particularly with respect to the completeness and quality of the history produced. However, a single microcomputer system is unable to deal with the load of a busy clinic, and initially, several independent terminals were required. We now describe the installation of a local area network to link several microcomputers with a single database in the Antenatal Clinic at Queen Charlotte's Maternity Hospital.     

Participation in prenatal screening tests and intentions concerning selective termination in Finnish maternity care

AIMS: The study examined how prenatal screening tests are presented to women, factors associated with women's participation in screening, their experience of decision-making and intentions concerning pregnancy termination, and hospital data on rates of selective terminations. METHODS: Questionnaires were given to pregnant women visiting maternity centres in two Finnish towns in which serum screening was offered (n = 1,035) and in one town where midtrimester ultrasound screening was offered (n = 497). Response rates to the questionnaires were 88 and 85%, respectively. Other questionnaires asking about selective terminations following detected fetal disorders were sent in 1993 to all public hospitals with obstetrics or gynaecology departments (response rate 100%). RESULTS: The serum screening test had usually been offered to women as a free choice, but for 22% of them it was presented as a routine procedure. Most women (92%) underwent serum screening and most (86%) found the decision to participate or not easy. In almost every aspect of presentation and participation studied, serum and ultrasound screening differed from each other. 85% of respondents to ultrasound screening answered that it was offered as a routine procedure. Close acquaintance with a person with congenital disability was negatively associated with participation in serum screening and with the intention to terminate pregnancy in case of a detected disability. 27% of women in the serum screening survey and 22% in the ultrasound survey declared that they would have declined pregnancy termination if a fetal disorder had been detected. However, according to the hospitals' data, only 13% of pregnancies with a serious fetal disorder detected were continued. CONCLUSIONS: All prenatal screening tests, including ultrasound examinations, require an adequate process of informed consent. Because the aim of such tests is to detect fetal malformations and syndromes, health care professionals should discuss the implications with women before they decide. Because acquaintance with a disabled person was found to associate with participation in screening and with intentions about selective termination, women's perceptions of lives of the disabled should receive more attention in future studies.