Search

Objective : To delineate the indications, referral sources and outcomes of radical muscle dissection palate repair in the first 4 years of life for patients with submucous cleft palate (SMCP). Design : This study presents a retrospective analysis of a single surgeon's management. Setting : All children were treated at Great Ormond Street Hospital, United Kingdom. Patients : Twenty-three children with nonsyndromic SMCP were included in this study. Interventions : All participants underwent radical muscle dissection repair before their fourth birthday. Outcome Measured : Parameters analyzed included: referral sources, indications for referral, extent of anatomical abnormality, and postoperative outcomes. Results : Paediatricians provided the largest proportion of referrals to the cleft lip and palate clinic (39%) due to the presence of cleft lip/palate on prenatal scans or during neonatal examination. Over half (n = 12, 52%) of patients had severe anatomical anomalies being in grade IV (score 8-9), with the classical triad present to some extent in all but 2 of the patients. The main indication for surgery was nasal regurgitation of food and liquid (n = 9, 35%) followed by hypernasality (n = 6, 21%), difficulty feeding (n = 3, 8%), and severe anatomical defect (n = 2; 4%). Postoperatively, the presenting complaint improved in the majority of cases. Conclusion : Nonsyndromic SMCP is often missed, though may present with nasal regurgitation, feeding problems, and/or hypernasality, though may be missed in nonsyndromic children. Early radical muscle dissection repair in the first 4 years of life is safe and effective, facilitating normal speech development. [ABSTRACT FROM AUTHOR]

Background: Foetal alcohol spectrum disorders (FASDs) are one of the most common preventable forms of developmental disability and congenital abnormalities globally, particularly in countries where alcohol is considered socially acceptable. Screening for alcohol use early in pregnancy can facilitate the detection of alcohol-exposed pregnancies and identify women who require further assessment. However, only a small percentage of children with FASD are identified in the United Kingdom. This may be partly attributed to a lack of awareness of the condition by National Health Service (NHS) health professionals. Methods: We developed an online survey to determine health care professionals' (midwives, health visitors, obstetricians, paediatricians, and general practitioners) perceived knowledge, attitudes, and clinical practices relating to alcohol in pregnancy and FASD. Results: There were a total of 250 responses to the surveys (78 midwives, 60 health visitors, 55 obstetricians, 31 paediatricians, and 26 general practitioners). About 58.1% of paediatricians had diagnosed a patient with foetal alcohol syndrome (FAS) or FASD and 36.7% worried about stigmatisation with diagnosis. Paediatricians reported the highest levels of FASD training (54.8%), with much lower levels in midwives (21.3%). This was reflected in perceived knowledge levels; overall, only 19.8% of respondents knew the estimated UK prevalence of FASD for example. Conclusions: We identified a need for training in alcohol screening in pregnancy and FASD to improve awareness and recognition by UK professionals. This could improve patient care from the antenatal period and throughout childhood. [ABSTRACT FROM AUTHOR]

Within a century, congenital syphilis has been reduced from a major cause of morbidity and mortality to a condition rarely seen in the UK. Here, newly-derived literature and information searches were used to create a contemporary overview of the epidemic, including its epidemiology. Although constrained by high-quality healthcare services and with an incidence below the World Health Organization elimination threshold, congenital syphilis still has the potential to cause major consequences for the health and life chances of affected infants. If the complex challenges presented by this preventable disease are to be resolved, intervention strategies need to be optimised, rigorously assessed and extended across Europe. [ABSTRACT FROM AUTHOR]

Ultrasound is routinely used as a prenatal screening and diagnostic tool but has limitations. Some anomalies in the developing fetal brain can be difficult to detect, and in utero magnetic resonance imaging (iuMRI) is increasingly used as an adjunct to ultrasound. However, understandings of patient perspectives of iuMRI technology are still developing. Our qualitative study of 41 mothers who experienced iuMRI was embedded in a diagnostic accuracy trial and aimed to inform policy recommendations that might stem from the clinical findings. Our analysis suggests that iuMRI is seen as useful, offering valuable additional information and helping women make decisions about care options at a difficult time. However, patients’ experiences demonstrated the uncertainty and anxiety associated with the prenatal diagnosis (PND) process relating to brain anomalies including the challenges of their embodied contributions. Our findings suggest more could be done to reduce the impact on pregnant women during an already difficult, anxious period. [ABSTRACT FROM AUTHOR]

Several rare diseases are regularly identified during the prenatal and perinatal periods, including dysmelia. How these are communicated to parents has a marked emotional impact, but minimal research has investigated this. The purpose of this study was to explore parent experiences and preferences when their baby was diagnosed with dysmelia. Mothers and fathers were interviewed. Data were analyzed using thematic analysis. The overriding emotion parents experienced was shock, but the extent of this was influenced by several factors including their previous experience of disability. Four key needs of parents were identified, including the need for signposting to peer support organizations, for information, for sensitive communication, and for a plan regarding their child’s care. Parents wanted immediate information provision and signposting to peer support, and for discussions regarding possible causes of the dysmelia or termination (in the case of prenatal identification) to be delayed until they had processed the news. [ABSTRACT FROM AUTHOR]

The article described a study that evaluated the impact of screening for Down's syndrome on the prevalence of live births and antenatal diagnoses of Edwards and Patau syndrome. As mentioned, the study concluded that around 700 women per year had a pregnancy with Edwards or Patau syndrome, with over 90% of these pregnancies were detected antenatally, with the increased use of first trimester screening for Down's syndrome resulting in the reduction in the mean gestational age at diagnosis.

The article presents a study on the antenatal diagnosis of Down Syndrome on pregnant women. It mentions the quantification of its amelioration through estimating the number of women who took the tests per syndrome screening from 1991-2010. It notes the application of data on prenatal chorionic villus sampling (CVS) and amniocentesis samples to determine the rate of diagnoses of the disorder along with Edwards and Patau syndrome. It also points out its benefit in reducing foetal deaths.

While pregnant women’s views about antenatal screening have been widely researched, those of expectant fathers remain underexplored. Interviews were thus conducted with 12 men and 6 women, either during pregnancy or soon after birth. Findings suggested that the men started to construct a schema of their child and a paternal identity even before she/he was born. One of the paternal responsibilities men encountered was to participate in screening. However, men’s ideas, beliefs, and feelings about being a father and about the future child were challenged by the receipt of screening results. Their child-schema became splintered into a wanted, imagined child and the at-risk fetus. Moreover, their paternal identity became fragmented into genetic and social components. Screening thereby caused some disruption in men’s experience of impending fatherhood and of pregnancy, eliciting ambivalence and confusion. Further research is now required to explore the issues raised in the study. [ABSTRACT FROM PUBLISHER]

The article discusses a study which determined the proportion of cleft lip and/or cleft palate (CL±P) children diagnosed prenatally from 1999-2008 in patients referred to the Royal Hospital for Sick Children in Glasgow, Scotland (RHSC). The study also compared the percentage of children prenatally diagnosed in 2008 and those diagnosed in other cleft treatment centers in Great Britain. It notes that the percentage of CL±P incidences diagnosed prenatally increased from 1999-2008.

All pregnant women in the UK are entitled to antenatal care. In low-risk women, this is usually provided by the community midwife and the GP. GPs should therefore be aware of the structure and purpose of routine antenatal care and situations where referral to local obstetric facilities is necessary. Early pregnancy antenatal risk assessment is essential to identify high-risk women who will require obstetric-led care. [ABSTRACT FROM AUTHOR]

This article outlines the antenatal screening tests available to women as part of NHS maternity care. The tests are part of managed screening programmes which are overseen by the UK National Screening Committee (NSC) and underpinned by standards, education and quality assurance. [ABSTRACT FROM PUBLISHER]

This article reviews the development and organization of the Down's Syndrome Screening Policy by the National Screening Committee, outlining the implications for sonographer training and practice, and for antenatal ultrasound service provision. [ABSTRACT FROM AUTHOR]

Objective Antenatal screening for syphilis is well established in the United Kingdom. The prevalence of syphilis is now very low, prompting the question as to whether this screening programme is still necessary. This paper aims at identifying possible screening strategy options for the programme and comparing their effectiveness and cost effectiveness. Methods The cost of the screening programme in the United Kingdom was estimated. This was based on the cost of screening tests, treatment, and follow up of infected women and their infants. This information was obtained from laboratories, antenatal clinics, and genitourinary medicine clinics. Epidemiological data from a survey of women treated for syphilis in pregnancy were analysed to identify groups at increased risk of syphilis. Strategic options for the screening programme were then identified. The effectiveness, number needed to treat, and cost effectiveness of these options were compared. Results Antenatal screening in the United Kingdom detected at least 40 pregnant women who need treatment for syphilis every year. This means that 18 602 women are screened for every woman detected who needs treatment for syphilis. The marginal annual cost of this screening programme in the United Kingdom is £672 366. This is equivalent to 90p per woman screened, or £16 670 to detect one woman who needs treatment for syphilis. The screening programme could be targeted geographically at pregnant women in the Thames regions. This option has the potential to save £482 185. Other strategic options are to target pregnant women in non-white ethnic groups, or those born outside the United Kingdom. These targeted options would each detect between 70% and 77% of women needing treatment for syphilis. These options could potentially save £592 938 and £562 691 respectively. Conclusions Targeting or stopping the screening programme would save relatively little money. Although selectively screening groups by country of birth or by ethnic group could detect at least 70% of cases, this would be politically and practically difficult. Targeting by region would also be effective, but would pose similar ethical and medicolegal problems. These facts and the changing international epidemiology of syphilis lead us to recommend that the current universal antenatal screening for syphilis should continue. [ABSTRACT FROM AUTHOR]

The article discusses the study on mother-to-child transmission of HIV infection conducted in Great Britain. It focuses on the effect of place of antenatal interview and the time of uptake on the acceptance of testing. Moreover, it also examines the cost effectiveness of the alternative antenatal screening practices. Factors affecting the HIV transmission, importance of transmission timing on the intervention and the HIV seroprevalence in London are also presented.

The article comments on issues concerning the lack of medical screening in Great Britain. It is estimated that 40% of the decline in the prevalence rate of neural tube defects (NTD) in Britain was due to antenatal screening. However, despite the availability of a highly effective and simple method of prevention, women continue to have pregnancies with NTD, because screening is not enough. With this regard, immediate implementation of national fortification programs is recommended.