Serum screening for Down's syndrome Private patients may receive less counselling

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6965.1372b (Published 19 November 1994) Cite this as: BMJ 1994;309:1372

EDITOR, - I support the conclusions of two recent papers on antenatal biochemical screening for Down's syndrome, which emphasise the importance of counselling before and after blood is drawn.1,2 Deana K Smith and colleagues describe the state of knowledge of women when the test is offered in districts that have introduced testing on the NHS. The situation is much worse in districts where testing is available only privately. Many women (about a third of pregnant women aged over 35 in this hospital) pay to have the test done by laboratories offering it privately. Some receive appropriate counselling but many do not. This unit has seen several women who assumed that a positive result of screening meant that the fetus had Down's syndrome, many with a negative result who insisted on amniocentesis, and some with a positive result who decided not to proceed to amniocentesis; some of them have stated that if they had been fully informed about the test they would not have had it.

The test should be introduced in all areas and to women of all ages. Adequate resources must be provided so that women can discuss the test with knowledgeable professionals both before deciding to have it and if the result is positive. Those in the primary care team and antenatal clinics need help in understanding the test so that they can provide women with the information they need to make an informed decision on whether to have it. This must include the chance for an important minority, for whom the test is inappropriate, to opt out. — P A BOYD


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National policy would ensure consistency

EDITOR, - The first routine NHS screening programme for Down's syndrome was set up in Wales, and in our report on its first year we stated that increased provision for counselling was …

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