Antenatal screening by history taking--a missed opportunity

In order to determine how effectively obstetricians and midwives identify and manage women at increased risk of fetal abnormality a case note review was undertaken. Two district general hospitals in each of two health regions and their tertiary referral centres making seven hospitals in all were studied. Women booked for antenatal care over a one-year period were included (19 895) which was estimated to be 75% of the total. Significant numbers of women at high risk because of age, past obstetric, medical or family history were not offered appropriate tests such as detailed scanning, carrier status testing, amniocentesis or chorion villus sampling. Asian women were less likely to be offered screening compared with Caucasians. Women at low risk were subjected to inappropriate tests such as amniocentesis. Ultrasound departments were rarely informed that a woman had had a previous baby with a structural abnormality. In conclusion the quality of booking histories was poor allowing important information about past medical, family or obstetric history to be overlooked. Maternity units should use carefully structured forms taking when booking histories and all staff must have regular training on risk factors.