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Objective:This study investigated women’s experience of care when undergoing termination of pregnancy for fetal anomaly (TOPFA) with a view to assisting healthcare professionals in providing optimum care to women.Background:Technological developments in antenatal screening and testing mean more women are given a prenatal diagnosis of fetal anomaly and confront the possibility of terminating the pregnancy. TOPFA is a psychologically significant life event, but there is limited evidence on how women perceive their termination care.Methods:A cross-sectional online survey was used to elicit qualitative data as part of a study examining women’s experience of the TOPFA procedure, in particular the choice of method. Women were asked to comment on what they had found helpful and unhelpful in their termination care. Participants were recruited from a national support organisation. A total of 361 women offered qualitative comments, which were analysed using thematic analysis.Results:Women’s experience of termination care varied. Five themes were identified as underpinning what women considered ‘good care’: being cared for in a timeframe and environment that feels right; receiving the right level of care; the role of healthcare professionals and support organisations; acknowledging women’s particular circumstances; and enabling women to make choices. Regarding the last theme, women particularly valued being offered a choice of termination method.Conclusions:The findings suggest that many women undergoing TOPFA perceived their care as lacking in some way. Recommendations on improving practice are made and areas of further research are suggested, which may deepen knowledge on how best to care for these women. [ABSTRACT FROM PUBLISHER]

This study aimed to investigate the relationship between attitudinal ambivalence towards Down’s syndrome (DS) and prenatal testing and termination intentions. Intentions towards using a screening test, a diagnostic test and termination of pregnancy for DS were collected from 140 pregnant women along with their attitudes and attitudinal ambivalence towards the condition. Women who were unsure about diagnostic testing and termination were more likely to hold ambivalent attitudes towards DS than were women who gave a definite yes or no response. In particular, a higher level of ambivalence about how a child with DS might impact on parental quality of life was significantly associated with an uncertain attitude towards termination of pregnancy. Qualitative data suggested that ambivalence towards DS was associated with a desire to make diagnostic testing and termination decisions with a significant other. The findings from this study inform debate on the link between ambivalence and informed choice and have implications for supporting prenatal testing decisions in women who hold ambivalent attitudes towards parenting a child with DS. [ABSTRACT FROM PUBLISHER]

The purpose of this study was to examine (a) the incidence of liver disease diagnosed in our antenatal population, (b) the diagnostic value of initial symptoms and liver function tests (LFTs), (c) the adequacy of investigation and management of the liver disorder and (d) the obstetric and neonatal outcome in this group of patients. Women with abnormal LFTs that delivered at our hospital over a 2-year period were identified from computerised hospital records and data was obtained from chart review. Forty-six out of a total of 13 181 (0.35%) women had liver disease diagnosed in pregnancy: Diagnoses included intrahepatic cholestasis of pregnancy (13), pre-eclampsia and the HELLP syndrome (eight), acute fatty liver of pregnancy (three), hyperemesis gravidarum (one), hepatitis C (13), B (four) and hepatitis A (one), cholelithiasis (two) and hepatitis of unknown aetiology (one). Symptoms at presentation were more predictive of the final diagnosis than the initial LFT profile. Investigation of the liver disorder was incomplete in 50% of cases.One mother required intensive care for 6 weeks postpartum and three others had significant postpartum haemorrhage. There was one neonatal death and 24 neonates were admitted to the special care baby unit. Eighteen women attended for their postnatal check up at 6 weeks. Eight of these women were referred to a hepatologist. Detection of liver disease in pregnancy identifies a group at risk of poor neonatal and maternal outcome. Structured guidelines should be implemented in obstetric units to facilitate appropriate investigation, treatment and referral patterns for these women. [ABSTRACT FROM AUTHOR]

The object of this study was to assess the resource use, feasibility, uptake and consumers' perspective of introducing routine named human immunodeficiency virus (HIV) testing into an inner city hospital antenatal clinic (St Thomas Hospital, part of Guy's and St Thomas Hospital Trust). Following the introduction of a new service offering routine named HIV testing at booking appointments, the length of the appointments were recorded over a three-month period and compared with appointment lengths in the previously existing service. Women being offered routine named HIV testing were asked to complete a questionnaire before and after their appointment to assess knowledge, attitudes and acceptability of HIV testing. Subjects were three-hundred-and-eighty-one pregnant women attending the antenatal clinic for their booking appointment. There was no significant difference in the length of the booking appointments following the introduction of offering routine named HIV testing. One-hundred-and-fifty-eight women (42%) consented to testing with no positive results detected. There was a significant rise in the uptake of the test over the three-month period. No other variables (demographics, perceived risk, having read the leaflet) were predictive of uptake. Anxiety scores were significantly less after the booking appointment. Routine named HIV testing was feasibly introduced into a hospital antenatal clinic with minimum resource implications. Further study is needed to monitor the ongoing uptake rate and identification of HIV-positive women before a decision can be made as to the long-term benefit of this new service. Women considered it acceptable to be offered the HIV test and were less anxious after their appointments. [ABSTRACT FROM AUTHOR]

The article reports on an early diagnosis of a complete hydatidiform mole in a twin pregnancy with a viable fetus by researchers from Worthing, England. The incidence of complete or partial hydatidiform moles is 1 per 714 live births in Great Britain. However, the incidence of a hydatidiform mole co-existing with a viable fetus is a much rarer event. The plausibility for a first trimester diagnosis of gestational trophoblastic neoplasia in a twin pregnancy is very rare, even with improved imaging. Researchers recommend referral to national centers for a successful management.

Concepts allied to ethnicity are increasingly coming under question as legitimate variables for use in health research. A randomised controlled trial of two ethnicity screening questions for ascertaining risk of carrying genes associated with sickle cell and thalassaemia illustrates the challenges and limitations of assessing an association of social constructs and genetic statuses. Objectives . To evaluate two candidate ethnicity screening questions in antenatal screening programmes in low, mixed and high sickle cell prevalence areas, and to identify time taken in administration of the questions by use of the following measures: Proportions of respondents with missing ethnicity data and/or significant changes in ethnic/family origins upon re-interview. Numbers of carriers of clinically significant haemoglobin disorders missed by ethnicity screening questions. Time taken to explain screening question for sickle cell disease (SCD)/thalassaemia and obtain ethnic/family origins. Proportion of clients providing usable ethnic/family origins data. Reported ethnic/family origins in pregnant women at first booking with midwife. Design . Ten-month (September 2002–June 2003) questionnaire study with random allocation to two self-administered ethnicity questions, comparison with laboratory results and results from re-interview. The settings were antenatal booking clinics in four geographical areas of England of varying expected foetal prevalence of SCD: very high (29.75 per 10,000 pregnancies); high (8.2); mixed high and low (1.29); and low (0.18). The subjects were 4,559 pregnant women at first booking with midwife. Results . Proportions of respondents with missing ethnicity data and/or significant changes in ethnic/family origins upon re-interview were 4.33% (CI 2.63–6.68%) for a category-based question and 9.45% (CI 6.86–12.61%) for a binary plus open-ended question. Proportions of carriers missed were 5.74% (CI 2.34–11.46%) and 9.71% (CI 4.75–17.13%) by category-based and binary plus open-ended questions, respectively. Average time taken to ascertain ethnic/family origins for screening was between 2.17 and 5.12 minutes in different areas, and up to 15 minutes at the 95th centile. Usable ethnicity screening data was missing in 2.94% of instances. Errors in interpretation or missing data were 3.2% for a category-based question and 4.71% for a binary plus open-ended ethnicity question. Ethnicity Question A produces fewer cases of missing or misinterpreted data (p < 0.001) 10.1080/13557850500460348 X25233W81G641Q7P 169 189 Routledge, part of the Taylor & Francis Group CETH Ethnicity and Health 1355-7858 http://taylorandfrancis.metapress.com/link.asp?target=journal&id=102212 11 2 Number 2/May 2006 X25233W81G641Q7P.pdf http://taylorandfrancis.metapress.com/link.asp?target=contribution&id=X25233W81G641Q7P http://taylorandfrancis.metapress.com/link.asp?target=issue&id=M4567VT81122 Simon Dyson Lorraine Culley Cynthia Gill Stephanie Hubbard Ann Kennefick Patsy Morris David Rees Faye Sutton Patricia Squire Ethnicity Sickle Cell Thalassaemia Screening [ABSTRACT FROM AUTHOR]

An abstract of the article "Antenatal detection of aneuploidy in Merseyside and Cheshire," by G. Edwards and Z. Alfirevic is presented. The audit herein aims to review all cases of aneuploidy reported to the Merseyside and Cheshire Congenital Anomaly Survey and evaluates the effectiveness of antenatal screening policies. It was discovered that detection of aneuploidies in the Mersey Region in 1997 was less than the expected standard.