Intro
- Wash hands, introduce self, check patient name and DOB, explain role/interview and gain consent
Check situation
- History of the current pregnancy
- Was it planned?
- When was the LMP? or How far along are you?
- Are you wanting to keep the pregnancy?
- Have there been any problems during this pregnancy so far e.g. bleeding, pain etc?
- What is the social situation?
- NB Ideally, the partner would also be present. Check whether the partner is involved/supportive if not
- Are you working? Who’s at home with you? (social support etc)
- At this point it would also be a good idea to take a full obstetric history (previous pregnancies) +/- gynaecological history (as appropriate)
Check understanding
- What do you know about Down’s syndrome and how it can be tested for?
Explain the tests
- If <14 weeks
- Combined test
- Nuchal translucency (more fluid between body and neck in DS)
- Measured at scan
- β-HCG (low in Down’s)
- PAPP-a (Pregnancy associated plasma protein alpha)
- Woman’s age
- Nuchal translucency (more fluid between body and neck in DS)
- Combined test
- If >15 weeks
- Triple
- Maternal AFP; unconjugated oestriol and β-HCG
- Quadruple
- +Inhibin A
- Triple
- These are used to calculate the chance of having Down’s syndrome
- If >1/250, this is ‘positive’
- Further diagnostic tests used
- ONLY if the patient is considering TOP (often risk of these procedures outweighs their benefits where this is not the case)
- Further diagnostic tests used
- If >1/250, this is ‘positive’
- Invasive tests
- If <15 weeks- chorionic villous sampling (risk of abortion 2%)
- If >15/16 weeks- amniocentesis (risk 1%)
Explain about Down’s
- People with Down’s syndrome often have characteristic appearance (e.g. low set ears and wide-set eyes); they also quite often have mild learning disabilities (although IQ is often >80).
- Also associated with some serious heart defects
- May cause problems early or later in life
- Can be treated surgically but often a large operation
- There is an increase in mortality in the first year of life (five times increased risk- NB STILL SMALL absolute risk of ~1%)
- Most will now live into late 50s-60s
- There are many services available to help with care (both health and social)
- Answer any questions the patient may have as they ask them. Give time after chunks of information to do this.
Abortion/TOP and Down’s
- As with other TOPs, a reason must be specified. In the case of possible Down’s pregnancy, the category is
- “to prevent grave permanent injury to the physical or mental health of the pregnant woman”