GPs support pre-natal screening programme

The Medical Association backs a call for a national maternal screening programme to improve standards.

It is in response to Wellington obstetrician Jeremy Tuohy saying that poor monitoring of screening for foetal abnormalities risks another disaster similar to the Gisborne cervical cancer scandal, if a national programme is not set up.

Dr Tuohy said, in New Zealand Doctor magazine, that nuchal translucency screening, which tests for chromosomal aneuploidy, an indicator of Down's syndrome and other abnormalities, was not being carried out properly.

Results were being interpreted incorrectly, women were not always being counselled adequately before screening, and the level of expertise of some private radiologists was questionable.

Studies had shown only a 60 per cent accuracy rate for the test, which was carried out as part of an ultrasound scan between 11 and 14 weeks.

Dr Tuohy said he had dealt with some women who had had abnormal tests reported as normal, and vice-versa. Some had not wanted the test, and others were unaware that they were being tested during scans for other developments.

Medical Association chairwoman Dr Pippa MacKay said that carrying out a test on someone who was not aware of it was awful.

But alternatively, to do the test and not report the results would also make radiologists "highly culpable."

Dr MacKay said the problems with nuchal translucency testing stemmed largely from the rapid advance in technology.

"Those of us [doctors and midwives] who have organised the scans for other reasons are suddenly getting these results anyway.

"Technology has leapt ahead of us a bit ... but it's our role particularly to ensure patients are well-informed."

She said women had the right to be fully informed of the test, what it was for, its limitations (such as the possibility of false negative and false positive results) and implications.

This could be complemented by the development of a national pre-natal screening programme which ensured that testers were appropriately qualified, standards were established and results properly audited.

"It would be a massive thing, but that doesn't mean it shouldn't happen."

Health Funding Authority maternity manager Barbara Browne said it had been alerted to concerns about nuchal translucency testing.

This had prompted the authority to reconvene the maternity ultrasound committee to discuss such testing and the possibility of a national maternal screening programme.

Ministry of Health chief executive Dr Karen Poutasi agreed that the rapid advance of technology had resulted in testing being introduced without controls.

"When it's a big thing it does not get introduced immediately, but when it's something smaller, and an extension of something that already exists, like ultrasound, some of the people introducing it did not realise that this was new technology."

She said some specialists, who trained under British counterparts, had introduced the testing in a responsible way, with informed consent, appropriate counselling and quality assurance systems.

But others had started using the technology outside of that system.

"Now that it has been brought to our attention, we are discussing the best way of dealing with it to ensure that quality is built in wherever nuchal translucency is available."

- NZPA