Supporting patients after disclosure of abnormal first trimester screening results

The clinical value of first trimester aneuploidy screening is well established internationally. The implementation of a more effective testing protocol has led to an increase in 'abnormal' or worrying findings that are disclosed to women relatively early in their pregnancy. It is timely, therefore, to explore the support needs of women who are told during the first trimester that their screening result has increased their risk of fetal anomaly.

A Medline search uncovered numerous papers in the review period on first trimester screening regimens, and the efficacy of particular screening markers, but very little on the psychosocial sequelae for women receiving abnormal results. Therefore, this study takes what can be gleaned from the available literature, augmented by the author's experience in an independent UK charity providing nondirective support and information to parents through prenatal screening and its consequences. [Antenatal Results and Choices (ARC) was established as a UK charity in 1988. The organization provides nondirective information and specialized support to parents throughout antenatal testing and its consequences, dealing with approximately 8000 contacts a year. ARC also provides training programmes for providers in communication skills and supporting decision-making. www.arc-uk.org.]

With the shift in timing of screening programmes, there has been an emphasis in the literature on concerns about the provision of pretest information and counselling rather than what women find beneficial when dealing with results. The emotional impact of worrying news will always be significant and the ensuing decisions complex. The challenge for providers is to have a flexibility of approach that enables women and couples to be supported to understand the possible clinical implications of a screening result and what this might mean to them in the context of their individual lives.