LAUSR

Introduction There is no national Australian antenatal haemoglobinopathy screening policy and a previous Australian study of antenatal haemoglobin electrophoresis requests highlighted poor patient selection. Whilst benefits of screening have been well demonstrated, adherence to selective screening protocols in low prevalence populations has not been well described. Objectives This study aims to assess adherence to an established selective antenatal screening policy within a low prevalence Australian population. Methods This single-centre retrospective cohort study identifies all women attending for routine public antenatal care with estimated due date between 1st January 2014 and 31st December 2016 who meet criteria for selective screening on the basis of established guidelines. The primary outcome was the proportion of eligible women who were appropriately screened. Secondary outcomes included rates of partner testing and rates of specialist referral where fetal risk was identified. Results A total of 11,709 births were recorded during the study period. Eligibility for screening was identified on the basis of ethnicity in 1076 (9.1%), abnormal red cell indices in 427 (3.6%) and known personal or family history in 77 (0.6%). 158 (10%) had haemoglobin electrophoresis results documented during the antenatal course with 64 (4%) initiated by obstetric staff during the index pregnancy at a median gestation of 22 weeks. Partner testing was documented in 140 (88.6%) of “at risk” pregnancies and of these, appropriate specialist referral was indicated in 28 (20%) but occurred in only 17. Discussion This is the first Australian study to describe the rate of pregnancies meeting established criteria for selective screening in a low prevalence population. This data demonstrates poor identification of “at risk” patients leading to limitation of informed choice for affected families. The demonstration of poor adherence within the clinical setting supports arguments for universal screening which becomes increasingly cost effective as the selective screen failure rate rises.