University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
1
The Management of Screening and Diagnostic Test Results
during Pregnancy, Childbirth and the Puerperium
During pregnancy there are a number of screening tests offered to women to enable the health
professionals to detect any potential problems, and monitor their pregnancy to achieve a
satisfactory outcome.
These tests may include blood tests for the mother, Ultrasound Scans (USS) to exclude
anomalies and monitor fetal well being, and screening tests for the baby before and after birth to
exclude certain rare conditions. (see Appendix ‘NHS Screening Timeline’)
This protocol is informed by National Guidance on screening for Cystic Fibrosis,
Haemaglobinopathies and Blood Spot Screening. It covers any specimen taken from a patient
for haematology, biochemistry, microbiology or histology to be sent to the laboratory.
It includes results of Ultrasound Scans, Amniocentesis and Screening tests from the mother and
baby, and diagnostic investigations in pregnancy and the early postnatal period. A ‘National
Screening Leaflet’ is given to women at booking.
It is important that these tests are performed at the appropriate times, and that the results of these
tests are reported back to the appropriate health professional, and to the women.
This Trust offers Consultant Care, Shared care and Midwife Led care, so it is important there is a
system in place that ensures all results are performed by, and reported to the relevant person.
AIM
During a woman’s episode of care, continuity can be difficult to assure as care may be given in a
variety of places and by different professionals who can be involved at any stage.
This protocol aims to promote responsibility and accountability for results of investigations, as
well as giving guidance to the process. It will aid communication between professionals
providing care and the woman. It will identify a process that ensures that results of investigations
are followed up and actioned by the appropriate health professional within an acceptable time-
scale.
CONSENT AND RECORD KEEPING
The woman is reminded to present her ‘patient-held’ pregnancy records for all appointments
with all health professionals to facilitate recording of essential data.
At the booking interview the midwife must confirm that the woman has, read and understood the
information regarding ‘Routine blood tests in pregnancy’ or the information in the patient-held
records
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
2
The Audit Form for viral studies must be completed by the midwife, which confirms which
blood tests have been agreed and taken.
A copy is forwarded to the HIV midwife once the results are obtained, and a copy is filed in the
notes.
PROCESS
The professional taking the routine blood tests must complete, date and sign the relevant section
in the patient-held record.
The professional at the next appointment is responsible for ensuring that the results have been
returned, entered into the appropriate section, dated and signed, and that the woman is informed.
Antenatal Care / Reporting Results
Full / Shared Care – reports are returned to the antenatal clinic (ANC) with a copy to GP
- abnormal results are dealt with by the ANC as
appropriate (See relevant Flow Charts)
Community Led Care – reports are returned to GP surgery with a copy to ANC. Depending on
test, GP or MW will action or ANC will liaise with Consultant as appropriate (see relevant flow
charts).
When completing pathology forms, if copy to GP required the name and surgery must be
entered on the form.
Triple Test Results
When a woman opts for this test a date is given following a ‘Dating USS’ to ensure the test is
taken at the most appropriate time. The woman will be informed of the results within 7-14 days.
Full / Shared care results are reported to ANC,
‘Low’ risk results are:
- reported to the woman and documented in a register in ANC ~ FGH
- reported to the woman and filed in the notes at WGH
- reported to the woman by letter at RLI
‘High’ risk results are telephoned directly to the senior midwife in ANC, who will inform the
woman via the telephone / community midwife. Amniocentesis is offered and arranged within
one week.
Community Care results are sent directly to GP Surgery.
Low risk results: - the woman will be informed by letter.
High risk results: - results received by ANC - the community midwife is notified and will
inform the woman directly, either by a home visit or by telephone. Amniocentesis is then
offered; the community midwife will inform the ANC of the result and the woman’s decision
regarding amniocentesis. This will be arranged within one week
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
3
Amniocentesis Results
Normal results:
FGH – results to ANC and the woman informed by telephone. Full report is filed in the health
records.
At WGH – results are sent by letter and / or telephoned directly to the woman
Abnormal results are faxed from Bolton directly to relevant consultant’s secretary: The
consultant is informed and confirms results by phone. The secretary / midwife contacts the
woman directly to arrange an appointment with the consultant – usually the same day / ASAP. If
unable to contact the woman the community midwife will be asked to make direct contact to
arrange the appointment.
Acute inpatient test results
Diagnostic tests results performed whilst an in-patient are returned to the maternity unit. It is the
responsibility of the obstetric / midwifery team to ensure these results are actioned and filed in
the notes. Results can also be obtained via the INDIGO system. If results need actioning after
discharge the GP is informed and / or the woman contacted directly.
The discharging midwife is responsible for ensuring all test results are completed prior to
transferring care to the community team. Any results pending prior to discharge should be
highlighted in the discharge summary.
Community Care (ante and postnatal )
The named midwife is responsible for ensuring incomplete inpatient test results are followed up.
The Blood Spot Screening is performed on the baby on day 5. Details of the test will be entered
into the patient-held record (red book) for Health Visitor information, and documented in
personal care plan
The Blood spot Screening test must be sent immediately by first class post to Willink, and must
arrive within 48 hours of the test being taken.
The mother will be informed that the Health Visitor and GP will receive the results within 6
weeks. Positive results will be sent to the Community Child Health Team for follow-up
arrangements.
AUDIT
Records will be audited on an annual basis to ensure compliance with this protocol.
Willink also perform their own Audit of Blood Spot Screening.
JULY : REVIEW DATE 2010 JAP/SK
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
4
Sreening Tests MATRIX
In pregnancy Results reported to
Gestation
Test /s
Consultant / Shared
Care
Community Care
Action
Booking
8 – 15 weeks
10 -14 weeks
Full Blood Count
ABO Group
Rhesus Status
Haemaglobinopathies
Antibody Screen
Rubella Antibodies
Syphilis
Hepatitis
HIV / HEP
Dating USS
Blood for early Downs
Copy to
ANC GP
ANC GP
ANC GP
ANC GP
ANC GP
ANC GP
ANC GP
ANC GP +
HIV MW
ANC GP +
HIV MW
Copy to GP
Copy filed in health
records
ANC
Copy to
GP / MW ANC
GP / MW ANC
GP / MW ANC
GP / MW ANC
GP / MW
GP / MW
GP / MW
GP / MW + HIV MW
GP / MW + HIV MW
ANC GP +
HIV MW
GP / MW
GP
Rh Neg –women informed personally and a Leaflet given - added to register in ANC –
offered prophylactic Anti-D
Rh Pos with antibodies – community / ANC Midwife will refer woman to consultant
Pos Results – woman referred to GUM Clinic / HIV Midwife
As above
As above
Women with positive results are referred by HIV Midwife to a specialist
Women informed by Letter
11 – 13 weeks
15 - 20 Weeks
(optional)
Nuchal Translucency
USS (if performed – only
offered to women with
high risk Downs/
Multiple Pregnancy)
Serum Screening for later
Downs
ANC
ANC
Low risk results to GP /
MW
High risk results to
ANC
Informed of results by telephone – GP Surgery by letter
Low risk women informed by letter / telephone
High risk women informed by personal contact or phone
Amniocentesis offered for within one week
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
5
18 - 20 Weeks Anomaly USS
NAD
Abnormality detected
NAD
Abnormality detected
Copy to woman and for notes
Ultrasonographer contacts ANC directly – woman seen by midwife and Obstetrician
ASAP
Gestation
Test /s
Consultant Care
Community Care
Actions
16 - 24 Weeks
Amniocentesis
Normal results by letter
/ telephone to woman
and ANC
Abnormal results faxed
directly to consultant
/ANC– confirmed by
telephone
N/A
Within one week
Woman contacted by consultant’s secretary or Midwife– see consultant asap
28 Weeks - can be
taken up to 34 weeks
Antibody Screen + FBC
ANC
GP / MW
Actioned according to results ( see flow charts)p11
Considered at 28
weeks if BMI > 35
GTT
Results to FAU
Copy to GP
FGH
GTT performed in FAU – Results to FAU – woman informed. If abnormal result FAU
midwife arranges appointment with Diabetic Nurse and / or Mr Misra
WGH – women referred to FGH or RLI
Random Tests
Random blood sugar
GTT
Kleihaur
PIH screen
LFT’s
Hepatitis C
TORCH
Antiphospholipid
Lupus screening
Haemaglobinopathies
Virology for Chickenpox
Any other non-routine
test
USS – serial / random
ANC or Maternity unit
Documented in patient-
held notes
All these test results would be reported to ANC or Maternity unit / FAU and actioned
by the midwifery / medical team
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
6
Pre-Op LSCS – taken
up to 5 days pre-op
FBC + G+S
Bloods taken in FAU
Results to Mat Ward
Results to maternity ward – health records for pre-op LSCS are kept on ward.
Abnormal results referred to SPR / Consultant for action
Maternal and Neonatal Postnatal Tests Results coordinated and actioned By
Test
When taken
Actions and by whom
Maternal
Kleihaur
Within 48hrs of
delivery
Results to maternity unit + Anti-D ordered and given by midwives as appropriate. Results and actions documented
in health records and care plan
Full Blood Count
FBC / G+S / Clotting
screen
Day 3 if low Hb or C/S
Pre –op / PRN for
PPH
Results to maternity unit + actioned by midwives / ward clerk. If discharged GP / Comm MW informed for action
If taken in Community midwife will FU with Pathology.
Urgent results to maternity unit, telephone or INDIGO, received and actioned by midwifery and obstetric staff
INR / APPT
PRN
Results to unit – obstetric team informed. Haematology input if changing from heparin to warfarin. If woman at
home telephoned with result + instructions on warfarin dose.
FU GTT for gestational
diabetics
6 weeks postnatal
Appointment given to woman by discharging midwife – form completed – form and appointment entered into FAU
diary.
Taken in FAU by midwife – results sent to GP and Diabetologist for action. If woman fails to keep appointment
FAU midwife will initiate contact.
Neonate
Cord bloods for Rh status
/ FBC / SBR
At Delivery
Results to maternity unit and entered into Rhesus book. Midwives arrange and administer Maternal Anti-D if
required.
Serum Bilirubin +/or
Coombes if jaundiced /
Blood Glucose
PRN
When test performed on maternity unit results received there. Midwives will inform attending paediatrician for
action. If in community midwife will FU
Newborn Blood Spot
Day 5
Taken by community midwives on day 5. Results to Blackhall Unit Kendal. Forwarded to Child Health Services
and distributed to appropriate Health Visitor, who the relays result to parents.
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
7
Swab screen –
PROM
Group B strep
Pyrexia etc
At delivery Responsibility of midwives to follow up results within 48 hrs – refer to paediatrician if treatment required and
inform mother. If transferred to community care ward midwife will inform community midwife of results and
required actions
Random investigations during antenatal and postnatal period
Gestation
Test
Consultant Care
Community Care
Action
Random
Ante and postnatal
MSSU
- taken as inpatient
- record on summary
sheet
- taken as outpatient
- taken in community
Results to maternity
unit
Result to ANC – copy
to GP
Results to maternity
unit – copy to GP
Results to GP
Ward midwife will inform obstetric team if treatment required, inform woman
and file report in notes
ANC midwife will inform GP and woman if treatment required
GP + community midwife will action if treatment required. Community
midwife will record in pt-held records at next visit
Antenatal / Random
HVS for –
Chlamydia
C+S
Group B Strep Inv (taken
@ 28 weeks if previous
history)
Results to maternity
unit or ANC
Copy to GP
Results to GP if taken
in community
Ward, ANC or community midwife will action if treatment required. Obstetric
team or GP will treat. Midwives will inform woman.
Results will be recorded in notes or pt-held records as appropriate
Positive Group B strep results must be highlighted in the notes for management
in labour
Positive Chlamydia Result – referred to GUM Clinic
Following a
Stillbirths / Fetal
Abnormality
Maternal and neonatal
bloods and swabs
TORCH screen etc
Results to Consultant
Health records kept by Consultant – all results to Consultant via maternity unit
and Secretary. FU appt after 6 weeks to give findings to parents
Postnatal when
previous positive
Serology
Syphilis
HIV
Hepatitis
Results to Maternity
Unit and HIV Midwife
Copy to GP
Results to GP if taken
in community
Results actioned by HIV Midwife/ Physician involved and protocol followed
Random I pregnancy
Kleihaur – if sensitising
episode suspected
Results to maternity
unit
Treatment arranged by midwives as required. Results and actions recorded in all
health records
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
8
FULL BLOOD COUNT RESULTS
(IN PREGNANCY)
COMMUNITY CARE
Results to GP
Copy to ANC
FULL / SHARED CARE
Results to ANC
Copy to GP
NORMAL RESULTS
NOTES
Filed and documented in
health records
ABNORMAL RESULTS
Hb 9 – 10.5gms
Inform + Treat by GP
Hb < 9gms
Refer to Consultant for treatment and
further investigations as required
ANC to inform woman via
Community Midwife
Hb < 10.00gms after 36/40 - G+S in
labour
Taken at booking
Repeated at 28-34 weeks and as
required
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
9
ABO GROUP AND RUBELLA RESULTS
If Rubella non-immune
discharging midwife is
responsible for offering
/arranging postnatal period
vaccination
Must not be given within 3
months of Anti-D
Full / shared Care
Results to ANC
Filed + documented in
hospital notes
Copy to GP
Taken at Booking
Community Care
Results to GP
Filed / documented in
patient-held records
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
10
KLEIHAUR RESULTS AND POSTNATAL FULL BLOOD COUNT
Results reported
to maternity unit
for action by
midwives.
Document
results in notes
and care plan
Taken on day 3 if –
Low Hb in
pregnancy
Caesarean
Section
As required if –
PPH
Results returned to
maternity unit for action
Midwives refer to
obstetric team for
treatment
Community midwife
informed
Taken in pregnancy if sensitising
episode suspected in Rh Neg
women
Taken within
48hrs of delivery
for Rhesus
Negative
women
Results to maternity unit for
action. Treatment arranged
by midwives as required
Results documented in notes
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
11
RHESUS STATUS and ANTIBODY SCREEN RESULTS
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
12
Taken at Booking
Repeated at 28 weeks
Rh Negative
Results to ANC + added to Register
Woman informed by community
midwife and information leaflet given
Results to GP
Rh Positive + no
antibodies
Results filed in
notes and
documented in
patient-held
records
Rh Positive –
with antibodies
Community or
ANC midwife will
refer woman to
Consultant
Antibody screen repeated @ 28
weeks prior to prophylactic Anti-
D (if accepted)
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
13
SYPHILIS / HEPATITIS / HIV RESULTS
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
14
Taken at Booking
Community Care
Results to GP
Negative results filed and recorded in
patient held records
Positive results to GP
Woman referred to
GUM / HIV midwife
for counselling and
treatment
Treatment coordinated
by GP+ midwife
Midwife to document
results in patient-held
records + inform ANC
Hospital care
Results to ANC
Negative results filed with
copy to GP
Positive results to ANC
Woman referred to ANC at next
appointment for discussion
Referred to GUM Clinic / HIV
Midwife for counselling
Treatment coordinated by
Consultant + ANC midwife
ANC midwife files results in
notes with copy to GP
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
15
ULTRASOUND SCAN RESULTS
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
16
Routinely performed at:-
8 - 15 weeks – dating
USS
20 weeks – anomaly
USS
Serial / Random
Community Care
All USS
Normal result
Copy to woman
for patient-held
notes
Abnormal result
Referred directly to
ANC by Sonographer
Referred to Obstetrician
by Midwife in ANC
GP / MW informed
Consultant / Shared Care
All USS
Normal result
Copy filed in notes
Copy to woman for patient-
held records
Abnormal results
Referred back to ANC by
Sonographer
Seen by named Obstetric
Team
Copy of results to GP
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
17
MATERNAL SERUM SCREENING RESULTS
Early screening for Downs Blood
at 10-14 weeks
(date confirmed after USS when date
given to woman for test)
Later Screening for Downs Blood
at 15-20 weeks
Consultant / Shared Care and
Community Care
ANC liaises with Community
Midwife to give result or woman
informed directly by telephone
Amniocentesis arranged via ANC
within 1 week
LOW RISK
RESULTS
HIGH RISK
RESULTS
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
18
AMNIOCENTESIS RESULTS
Community Midwife
gives results to woman
and informs ANC
No Action – Results
filed in notes
Woman informed either
by letter or via
Community Midwife
No Action – Results filed
in notes
Community Care
Result to GP
Consultant / Shared Care
Result to ANC
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
19
Performed between 16 and 24 weeks
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
20
Results faxed to Obstetric
Consultant’s Secretary
Normal Karotype
Woman informed by
letter / telephone
within 2 weeks via
the consultant
secretary
Results filed in notes
Abnormal Karotype
Consultant informed
ANC informed
Consultant Secretary ANC Midwife will
contact woman and arrange an
appointment with the consultant asap to
discuss plan of care
If difficulty contacting woman the ANC
will contact woman’s community
midwife to make contact with the woman
ASAP
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
21
RANDOM TEST RESULTS ( SEE MATRIX)
TAKEN AT ANY
TIME DURING
PREGNANCY
Community Care
Any tests taken by the GP or
Midwife the results will be
sent to GP surgery for
actioning
This may involve referral to
consultant
It is the responsibility of the
community midwife to file or
documented the results in
Consultant / Shared Care
Results of tests performed at the
request of the obstetric team will
return to the ANC or Maternity unit
or FAU
It is the responsibility of the
midwifery / obstetric team in either
area to ensure they are actioned and
filed in the notes and the woman
informed as required
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
22
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
23
INR /APPT RESULTS
IN PREGNANCY
Woman usually an in-
patient and test taken as a
diagnostic test as part of
PIH screen, Haemorrhage or
anticoagulant therapy
Results returned to
maternity unit –
for referral by midwives to
obstetric team for action
may require input of
haematologist
POSTNATAL
May be in-patient but may
have been discharged
home
Results returned to maternity unit for
action –
results referred to obstetric
team
may require haematologist
input
if not in-pt woman should be
contacted at home with results
+ instructions on treatment if
required (eg when changing
from heparin to warfarin)
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
24
GLUCOSE TOLERANCE TEST RESULTS
Results filed in notes when
actioned and results added
to investigation result sheet
Results should be filed in
notes after actioned and
warfarin book completed ad
appropriate
Copy to GP if woman in
community
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
25
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
26
POSTNATAL
FU screening at 6 weeks
postnatal in women who
developed Gestational Diabetes
Test taken in FAU – woman
given a date for the test prior to
discharge home – entered into
FAU diary with a completed
pathology form
IN PREGNANCY
May be taken at any time after 28
weeks if Gestational Diabetes is
suspected
Women usually attend FAU for test
Results returned to FAU or
maternity unit if FAU closed
Midwife informs obstetric team of
results – if high informs ANC
midwife to arrange FU appt with
Obstetrician and DSN
Midwife informs woman of results
and any FU required eg. appt with
DSN / Joint Diabetic Clinic
Results directed to GP and
Diabetologist for
information and action
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
27
CORD BLOOD RESULTS ( Rh STATUS AND COOMBES)
Cord bloods taken at delivery from
Rh Negative women or women
with antibodies
Woman’s name entered into
Rhesus book on maternity ward
after delivery
Results phoned to maternity ward
by pathology
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
28
Midwife on ward enters results in
Rhesus book and informs woman
of results
If baby Rh positive Anti-D
ordered and administered by
midwife
Positive Coombes tests are
reported to Paediatrician for
action
Results entered into notes, care
plan and baby notes
If woman has been discharged
the ward midwife informs
community midwife and
records results in woman’s
notes
Ward midwife orders anti-D
Community collects and
administers anti-D and records
results in personal care plan
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
29
NEONATAL SERUM BILIRUBIN RESULTS
Taken for investigations of neonatal
jaundice Coombes +ve babies
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
30
Taken as in-patient
on maternity ward
Taken at home by
community
midwife
The community midwife will obtain
results from the Indigo results system
If results elevated community midwife
will discuss with paediatrician
Community midwife will inform
mother and advise her of recommended
treatment from the paediatrician
Results returned to maternity ward for action
Midwife on ward will inform paediatric SHO of
results
Midwife or SHO will inform mother of results and
treatment as required
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
31
NEWBORN BLOOD SPOT RESULTS
Taken from baby on day 5
Test performed by
community midwife
The bloods are sent to Willink Laboratory by the
community midwife within 48hrs of taking sample
Details should be entered in the Child Health
Records ( Red Book) and the personal care plan
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
32
MSSU RESULTS / HVS RESULTS
The mother is informed that the
Health Visitor and GP will
receive the results within 6 weeks
Positive results will be sent to the
Community Child Health Team
for follow-up arrangements
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
33
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
34
Taken in the
community
Result to ANC
Copy to GP
Results to GP
ANC will inform GP for
action if treatment required
and will inform woman
Results filed in notes
Taken as in-patient
Taken as out-patient
in ANC
Results to
maternity ward
Ward midwife informs
doctor if treatment
required and informs
woman
Midwife will file
results in notes and
document on summary
sheet
GP will action if
treatment required.
Surgery will inform
woman
Community midwife
will document in
patient-held records
at next visit
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
35
POSITIVE GROUP B STREP RESULTS MUST BE HIGHLIGHTED IN THE APPROPRIATE SECTIONS OF THE PT-HELD AND
HOSPITAL NOTES FOR MANAGEMENT IN LABOUR ( YELLOW STICKER TO NOTES)
INVESTIGATIONS FOLLOWING A STILLBIRTH / FETAL ABNORMALITY
All Core and Optional Blood Tests /
swabs taken from mother and baby
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
36
Results of tests given to
parents at pre arranged
postnatal appointment
Results sent to maternity ward
if still in-pt or to the secretary
of the named consultant who
will keep health records
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
37
ULTRASOUND SCANNING PATHWAY
Document
History done
Ultrasound discussed
Scan leaflet given
Woman selected for appropriate
pathway of care
Community care
Community midwife and/or GP completes
ultrasound request “yellow” form → maternity
general office to ultrasound
Appointment made, sent to
woman by post
Dating scan @ 8-16 weeks
Normal
Report printed in
hand held notes
Verbal report to
parents
Yellow form by
sonographer to
ultrasound
department to
generate 20 week
scan appointment
Consultant care
Prior to ANC appointment
scan performed white form
complete
Dating scan
Dating abnormal
At scan appointment
transfer or continue
consultant care
Immediate consultant
Normal
Consultant booking
appointment.
Consultant signs form
for 20 week scan
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
38
SERUM SCREENING FOR DOWNS SYNDROME AND NEURAL TUBE DEFECTS
History taken
Discuss screening test
Leaflet given
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
39
Accept Screening Test Decline Screening Test
Screen Negative
A screen negative result
No Action is Recommended
A Screen negative result. Women informed by letter and a copy
filed in their notes
Screen Positive Fax from Birmingham to the ANC. Women informed by the ANC midwife or the CMW is asked to visit women at home.
Discuss the results with the family and offer appointment to discuss
future management. Contact name given. Increased risk of Downs Syndrome
Amniocentesis
offered,
Appointment
booked. Given
verbally to the
woman.
Raised AFP.
Verbal
invitation to the
Fetal Medicine
Clinic.
Action
Declined
Scan
Normal Scan shows
NTD
Accept Diagnostic
Test
Discuss the test results.
Verbal results by phone by FM Midwife.
Appointment to see
consultant.
Unaffected Pregnancy
Affected pregnancy Discuss options with the
consultant.
Termination of pregnancy Continue with the
pregnancy
Offer D/E or induced abortion
Consider need for fetocide
Women who … or are eligible for
a diagnostic test
Abnormal ultrasound scan
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
40
NEWBORN BLOOD SPOT SCREENING DRAFT 1
Baby Born
No Complications To NNU
Leaflet given to parents
prior to day of testing
Home Post delivery Newborn blood spot test
taken on day 1
Repeated on day 5 or 5
days after blood
transfusion
Re-admitted to NNU or ward,
check if it has been taken Newborn Blood spot taken on
day 5 ideally. Not on Saturdays
Day 5-9 taken by Community
Midwife or Midwife on the
ward.
All screening cards to the central point.
Checked against birth register. Record all
samples sent to GOS
Send to GOS in pre-paid envelopes
List of all received by GOS sent to the L&D
If the sample is poor or borderline results Name of samples to be repeated to L&D.
Follow up by Community Midwife
Parents decide not
to take up offer of
newborn
screening.
Appointment to
be made to
discuss with
Paediatrician
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
41
CF Newborn Screening Algorithm for a baby born at the
Royal Lancaster Infirmary (RLI) Westmorland General Hospital
(WGH)
Furness General Hospital (FGH)
In
(5 day limit)
If Dr Peckham is unavailable .i.e. on annual leave patient then to be referred to Royal
Manchester Children's Hospital for sweat test and diagnostic visit. Telephone number of
Regional CF screening Nurse:
Link Health Visitors – South Cumbria - Jane Scattergood telephone – 01229
827317
Lancaster and Morecambe – Julie Myers telephone 01524
405709
Dr Peckham’s Secretary telephone – 01524 583598
Date: October 2006
To be reviewed October 2007
Positive Screening Result
Information to be conveyed to Dr Peckham secretary or e-mail
*Local screening HV, Jane Scattergood and Julie Myers to visit home with leaflet and date and time to attend
children’s day care unit RLI the next day for sweat test am and appointment with Dr Peckham pm for diagnostic
visit and to meet with physio, dietician and Sister Fran Campion in next 48-hours
Follow up with Dr Peckham and meet regional team
If 2nd
IRT blood
spot needed
NB* sweat test can only be done Tuesday – Friday
Named nurses for doing sweat tests:
Fran Campion, Tracey Denny, Debra Dunk
Named clinician: Dr Clare Peckham
Named laboratory for processing: RLI Clinical
Chemistry – Consultant Dr Richard Neary
*HV visit to do
2nd
blood spot
test. If positive
result go to
algorithm as
above
Carrier result – link HV informs family – GP referral if clinical concerns
concerns
Refer to respiratory clinic Dr Peckham as new patient
patient in 2 to
University Hospitals of Morecambe Bay NHS Trust
Women’s Health Directorate
42
Document The management of Screening and Diagnostic Test Results During Pregnancy, Childbirth and the Puerperium
Purpose To give guidance to staff on the correct mechanism for reporting test results to ensure appropriate actions are taken
Location of document Maternity Risk manager
Version 2
Status Approved
Author Jeanette Parkinson, Sue Knowles and the Maternity Risk management Group
Approving Officer Maternity Risk Management Group
Approval Date June 2007
Commencement Date June 2007
Review Date June 2010