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Nine Months : Down's syndrome

Mothers-to-be are being offered a 'one-step' testing service on the NHS that will identify whether they are at high risk of having a Down's syndrome baby. It can check women at around 11 weeks of pregnancy - two months earlier than under standard Health Service screening.

Women at high risk can then have immediate follow-up tests which give them the chance to opt for an abortion much sooner in their pregnancy.

The program called Oscar - the one-stop, counselling, assessment and risk clinic - is being pioneered at an NHS clinic at Harold Wood Hospital, in Romford, East London. But experts hope that promising results mean it will eventually become standard procedure and reduce the trauma facing women who have to decide whether to terminate a pregnancy.

There is widespread dissatisfaction about the existing serum screening for Down's and other chromosomal abnormalities. The blood test is taken at the 16th week of pregnancy with the results coming through two weeks later when women at higher risk may need a more invasive test called amniocentesis, which has a risk of miscarriage.

Kevin Spencer, the consultant biochemist at Harold Wood who developed the Oscar program with specialists at King's College Hospital in London, said conventional testing meant some women had to decide as late as 21 weeks whether to terminate their pregnancy.

The new program allowed screening at 11 weeks and a simpler, quicker procedure to confirm the diagnosis. If the woman chooses termination it can be carried out a week later. Dr Spencer said: 'Psychological trauma and potential risks to the mother are greater at 21 weeks. Some women refuse to be screened for religious, ethical or moral reasons. They may decide that even if a baby is affected by Down's, as far as they are concerned, that is not a significant reason to have a termination.

The program uses several tests to check for potential chromosomal disorders, including analysis of the levels of a compound called free beta HCG in the placenta and checks for pregnancy-associated plasma protein A. Another procedure is called nuchal fold scanning, which tests a fluid-filled area at the back of an unborn baby's neck.

The results can be discussed with counsellor-midwives within an hour rather than having to come back for another appointment. Parents can then make a decision on termination within a few days.

About 13,000 women have been through this program over the last three years with 50 identified as being at risk of a chromosomal disorder. All chose termination. The system is believed to be picking up 90 per cent of unborn babies with these disorders rather than 70 per cent under existing tests. Dr Spencer said the program was rapid but doctors did not want women to feel pressurised. 'The mother does not have to keep coming back two, three or four times,' he said. 'We are trying to build into the system the possibility for them to say "Stop. I want to think about it.", a place where if they think they are on a railtrack, they can get off.

This article by Jenny Hope has been selected from the Daily Mail - May 29, 2001






               

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