Improving the effectiveness of screening for haemoglobinopathies in primary and community care in Lambeth: antenatal findings

ABSTRACT

An antenatal screening programme for haemoglobinopathies aims to allow couples to make informed choices about reproductive options. Screening must be carried out early in pregnancy and must be supported with accurate information and a genetic counselling service. An audit in 1990 at St. Thomas' found that couples were referred for genetic counselling late in pregnancy or not at all. The aim of the study was to icrease the uptake of screening and counselling in the antenatal clinic by improving midwives knowledge of the condition and available counselling services. A research worker was employed to evaluate the intervention. METHODS: Knowledge of haemoglobionpathies, genetic risk and available services was assessed by means of a questionnaire. An audit of ante-natal screening was undertaken before and after the introduction of specific guidelines and a porforma by reviewing over 1400 antenatal notes of those recieving community or shared care. Laboratory data on the number of tests requested for both the women and their partners was obtained for the year of the first audit. RESULTS: 23/44 midwives completed the questionnaire (65 percent). Analysis of the responses indicated that hospital midwives were better informed on every question. There was a significant difference (p<<0.001 in the proportion of questions answered correctly by hospital midwives compared to community midwives (77 percent of 45 percent, 95 percent CI 17-45 percent). (AU)