Dear Sue,
 
We analyse samples for two groups of patients - for the majority of
Cornwall, except the east whose ladies go to Plymouth for their A/N care,
and for the east of Cornwall and area around Plymouth - we have different
procedures for each group.
 
For the majority of High Risk (>1:250) Cornwall ladies, most of whom will
now have had an early dating scan, an information leaflet and initial
counselling about the test, we arrange an appointment for counselling for
amniocentesis at the next available clinic (we have 5 O&G consultants doing
clinics at 8 different sites) - this information is then phoned through to
the woman's GP surgery, along with the risk, and the surgery are requested
to get the GP or midwife to contact the patient to give them the result and
counselling prior to this appointment - this is very GP/midwife dependent!
Having attended the clinic the Consultant requests an amniocentesis, if the
patient decides on this option - these are currently done in two sessions a
week at the main hospital in Truro.  
If the patient has not had an early dating scan then we arrange an
appointment, via our Ultrasound (U/S) department, and phone this information
through to the GP surgery, who act on it in a similar way - we try to
coincide the scan, where possible, to an available clinic.  U/S then contact
us immediately the patient has been scanned so that we can amend the
gestation and risk, if necessary - if the patient is still High Risk she is
either sent straight to the clinic for counselling or we arrange a clinic
counselling appointment straight away and tell the patient of this whilst
she is still in the U/S department.  
We operate the same procedure for all 5 consultants.  In view of recent
mailbase correspondence we would like to point out that we do not give out
results to the patients themselves, as we do not have all the patient's
details, eg cycle length, to hand and we are not trained counsellors - but,
then, are Consultants, other A/N medics, GP's and midwives?  It does concern
us, at times, at the appalling information that appears to be passed on to
patients!
 
For the east of Cornwall and Plymouth patients the result is phoned, then
faxed, through to the Antenatal Sister at Derriford Hospital, Plymouth, who
arranges a hospital appointment and then contacts the GP/community midwife.
This appointment incorporates a dating scan, if the patient hasn't had one,
counselling and amniocentesis, if required.  Amniocentesis is performed
every day (?including Friday) at Plymouth.
 
These procedures have worked extremely well since we started screening in
December 1992, and made much easier since routine early dating scans (EDS)
were introduced for the Cornish ladies between September last year and
January this year - currently around 75% of our pregnant population are
having an EDS, bearing in mind the geography of Cornwall and the fact that,
at present, they have to travel to Truro for this to be done.
 
Hope this will help your cause.
 
Angela Mallard, Senior Biochemist
Bruce Daniel, MLSO2
Department of Clinical Chemistry,
RCHT (Treliske Hospital),
Truro,
Cornwall
TR1 3LJ

-----Original Message-----
From: Sue Walker [mailto:[log in to unmask]]
Sent: Thursday, July 20, 2000 17:25
To: acb mailgroup
Subject: Serum Screening/Downs - contacting/counselling high risks


Could any colleagues involved with serum screening for Downs please tell me
your policy/actual procedure for contacting high risk/positive women to get
them to attend for further counselling etc.  Also who does that further
counselling?  Is it uniform or do you have variations depending on origin of
sample (eg another hospital/district) or particular consultant
obstetricians?  The reason I ask is that we have different procedures for
different obstetricians and I would like to collate consensus/best practice
to take to discussions with obstetrics and midwifery colleagues. Any
information would be gratefully received. Thanks, Sue Walker, Salisbury UK



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