Establishing a Midwife-led Fetal Down Syndrome Screening Clinic in a Public Hospital Abstract

WC WONG, OL CHAN, MC LIU, SC NG, FK LAI, HL WONG, C SING, A SHAM, TK LO, WL LAU, WC LEUNG, R CHIN

Objective:
Down syndrome (DS) is the commonest chromosomal abnormality at birth. To meet the increasing demand for DS screening in advanced maternal age, a midwife-led clinic was established in an Obstetric Unit of a public hospital. This study / review aimed to evaluate the effectiveness of such a strategy.

Methods:
Our unit established a weekly half-day 3 hours clinic, run by a single midwife, looking after six women and their partners. There were four such midwives, all of whom had been specially trained for ultrasound measurement of nuchal translucency (NT), an essential feature of DS testing and accredited by the Fetal Medicine Foundation (FMF), United Kingdom. The screening programme was undertaken during weeks 11 to 13+6 of gestation. Couples received information on DS screening in the form of a leaflet and a video presentation. This was followed by individual consultation, during which the options for various DS screening tests (first-trimester combined screening, fully integrated screening, partial integrated screening, and second-trimester biochemical testing) were discussed. Ultrasound examination was then performed to measure the crown-rump length to ascertain gestational age, and NT measurement according to FMF recommendations and maternal blood tests for biochemical markers arranged. The whole process was conducted by the same midwife on a one-to-one basis. A review of the results pertaining to the first 100 women was undertaken.

Results:
The sensitivity of our DS screening was 100%, and the false-positive rate was 12%. A total of 13 invasive tests were performed for women testing positive. Among them, one DS conceptus was diagnosed. A questionnaire study showed all the women were satisfied with the service.

Conclusion:
As the demand from pregnant women for more sophisticated maternity services is increasing, establishment of midwives-led clinics could maximise the midwife’s role in providing holistic care for expectant mothers.

Hong Kong J Gynaecol Obstet Midwifery 2010; 10:75-80

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