Antenatal Screening

The government outlined a commitment to establishing a National Antenatal and Neonatal Sickle Cell & Thalassaemia Screening Programme (NHS Plan 2000). A multidisciplinary Committee was convened in 2002.

The screening programme, www.sickleandthal.org.uk, recommend that all pregnant women in England be offered screening for Thalassaemia, based on the routine full blood count indices, whilst offering screening for sickle cell and other haemoglobinopathies to all women living in high prevalence areas and to minority ethnic (high risk) women in low prevalence areas. Areas of England where there are significant minority ethnic communities are deemed high prevalence whilst areas with few minority ethnic communities are deemed low prevalence.

Combined list of high prevalence and low prevalence Trusts - http://sct.screening.nhs.uk/cms.php?folder=3670#fileid12939

It is recommended that women should be offered screening by ten weeks of pregnancy in order to identify, as early as possible and certainly before twelve weeks of pregnancy, a couple who are at risk of producing a child with a clinically significant disease. Once identified an-at risk woman / couple are offered the option of prenatal diagnosis and if required subsequent termination of an affected pregnancy if selected.

National Institute for Health and Clinical Excellence (2008) Antenatal care: Routine care for the healthy pregnant woman – Clinical Guideline London: NICE

Counselling

London North West Healthcare NHS Trust, is in a high prevalence area, therefore all women booking for confinement of pregnancy at Central Middlesex Hospital, Northwick Park Hospital and in the London borough of Brent and Harrow are offered screening at the first antenatal booking contact. The blood sample is sent to the electrophoresis laboratory, at Central Middlesex Hospital. If a woman is found to have inherited an unusual haemoglobin gene the result is relayed to the specialist midwife/ specialist nurse at the Brent Sickle Cell & Thalassaemia Centre, who will write to the woman inviting her for genetic counselling and testing of the baby’s father.

In accordance with national guidelines where a pregnancy is at-risk of producing a child with a clinically significant disease the couple is offered prenatal diagnosis (PND) preferably before twelve weeks of pregnancy.

The type of test offered will depend on how advanced the pregnancy is. Commonly one of two types of tests is offered: Chorionic Villus Sample (CVS) or Amniocentesis, see Prenatal Diagnosis