52.1 Availability and uptake of testing
The range of tests available, policies for testing and uptake by women vary regionally. Overall, approximately 50% of pregnant women participated in nuchal translucency ultrasound in 2007–08 . A Victorian study found the uptake of combined first trimester screening to be 70–80% in recent years .
Studies in Victoria and Queensland have shown higher uptake of testing in metropolitan areas and in private health care and lower rates of diagnosis of Down syndrome in urban areas and public health care. Lower rates of access to testing in rural areas may reflect lack of transport, low levels of support and income in these areas and women’s attitudes. However, it has been suggested that low uptake of testing among women from low socioeconomic groups reflects lower rates of informed choice rather than women’s attitudes .
A West Australian study found the lowest uptake of testing was among women who were Aboriginal (14.9%), living in remote areas (38.0%), under the age of 25 (40.2%), in the lowest socioeconomic group (41.6%) and with three or more children (48.4%). Logistic regression analysis showed all socio-demographic factors to be strongly associated with screening behaviour, with adjustment for ethnicity, socio-economic status, age, parity and area of residence.
A study into testing for chromosomal anomalies among Aboriginal and Torres Strait Islander womenhas highlighted the importance of providing information about testing and identified challenges involved in offering testing, particularly in remote areas. These included late presentation in pregnancy, difficulties establishing accurate gestational age, limited consultation time to discuss the testing process, competing priorities in antenatal care, confusion about what needs to be done and when, and organisational logistics (eg women’s travel, where to send blood, referral procedures).
Support all women to access testing for chromosomal anomalies in a timely manner.
Approved by NHMRC in December 2011; expires December 2016
52.2 Health professional education
Health professionals caring for pregnant women should undertake continuing education regarding testing for probability of chromosomal anomalies and be aware of current tests available and the settings in which they can be implemented. This includes education about:
- the conditions being tested for, life outcomes, lived experiences of families and individuals with the condition and supports available for families and individuals with the condition
- delivery of ‘challenging news’ rather than ‘bad news’ with respect to chromosomal conditions.
52.3 Accreditation of ultrasound operators
The ability to achieve a reliable measurement of nuchal translucency depends on appropriate training and adherence to a standard technique to achieve uniformity of results among different operators RANZCOG.. Accreditation of ultrasound operators to conduct nuchal translucency measurement should be through the Nuchal Translucency – Ultrasound, Education and Monitoring Program administered through
52.4 Quality assurance
All laboratories used for testing must be accredited by the National Association of Testing Authorities (NATA). External and internal quality control measures should be in place.
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- O’Leary P, Breheny N, Reid G et al (2006) Regional variations in prenatal screening across Australia: stepping towards a national policy framework. Aust NZ J Obstet Gynaecol 46: 427–32.