Oxford Handbook of Midwifery by Janet Medforth, Sue Battersby, Maggie Evans, Beverley Marsh, Angela Walker Page B

include:
Chlamydia
Endocervical swab
Self-taken swab
Urine test (first catch).
TAKING A SEXUAL HISTORY
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Gonorrhoea
Endocervical swab: high vaginal swab: candidiasis (‘thrush’), Trichomonas vaginalis , bacterial vaginosis
Viral culture swab: herpes, HPV.
Blood testing
Syphilis
HIV
Hepatitis A
Hepatitis B
Hepatitis C.
Other
Cervical screening:
Has the woman been called for screening at all? This will depend on the country she resides in and the age at which the screening programme commences.
If appropriate, has she been screened at all and when was her last test?
Has she ever been asked to attend for repeat testing within the
normal recall time and has she ever had an abnormal result?
Has she had a colposcopy examination and, if so, what was the outcome?
1 Health Protection Agency (2010). Health Protection Report: HIV/Sexually Transmitted Infections . Available at www.hpa.org.uk/hpr/infections/hiv_sti.htm (accessed 2.4.10)
CHAPTER 4 Antenatal care
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Principles of antenatal screening
As science and technology advance, we are able to elicit more information about pregnancy, the mother, and the fetus than ever before. The scru- tiny with which we examine every aspect of pregnancy has never been more detailed. It is very likely that further advances in these techniques will expose women to increasingly difficult choices and dilemmas. The midwife will need to be well prepared and informed to guide her clients through this process.
A range of activities come under the banner of ‘antenatal screening’. Certain activities are a fundamental part of midwifery practice, e.g. measuring the fundal height, listening to the fetal heart, and the routine blood tests, including full blood count, group and Rh factor, and maternal serum for rubella antibodies. We may classify these as low intervention, unlikely to cause any ethical concern. Other types of screening, such as those undertaken to detect fetal abnormality, can lead to much moral difficulty.
The aims of screening
The whole pregnant population is screened because, although collectively
this population has a low risk of abnormality, screening aims to iden- tify those at a higher risk, so that more specific diagnostic tests can be applied.
Benefits of screening and diagnosis
Reduce fetal abnormality.
Reduce genetic reoccurrence.
Reduce the incidence of mental handicap.
Reduce the burden on family and society.
Increase resources for those disabled individuals who are not detected before birth.
Adverse effects of screening and diagnosis
Anxiety provoked by screening procedures.
Psychological sequelae for parents.
Risks of diagnostic tests to woman and fetus.
Risks to the woman of a late termination of pregnancy.
Risk of aborting a normal fetus.
Long-term effects on society’s attitude to the disabled.
Implications
Inadequate counselling at the time of the test could mean that clients are not prepared for adverse outcomes, such as being recalled with a high-risk result, or giving birth to an affected child after having a low- risk result from the screening test. 1
No matter how good a test is technically, screening uninformed, unsupported clients by unprepared staff is a recipe for, at best, confusion and, at worst, great distress. This is avoidable. 2
PRINCIPLES OF ANTENATAL SCREENING
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Consent and counselling
Screening tests other than those performed in normal midwifery care are likely to reveal information that parents need to be prepared
for, and to result in decisions being made about the future of the pregnancy.
If, on consideration, parents decide not to take up the offer of tests, then this should be respected.
In practice, it is difficult to ensure that clients are aware of all the ramifications of tests, especially when so many are on offer.
Where informed consent has not been obtained, and a positive result to a screening test is returned, the practitioner is vulnerable to litigation.
If a client’s language barrier or intellect makes understanding