Regional variations in prenatal screening across Australia: Stepping towards a national policy framework

Abstract

A relatively few centres across Australia provide screening tests for maternal serum markers or ultrasound measurement of fetal nuchal translucency to assess risk of fetal anomalies such as Down syndrome. While providers engage in external accreditation and quality assurance programs, state and federal governments have been slow to formulate relevant policies and standards. In this paper we review the current practices across Australian states and territories and propose recommendations for developing a national policy framework. Data on the number and types of screening tests provided as well as state policies, where they are available, were obtained from government reports and supplemented by a mail survey to selected stakeholders in each state or territory. At a jurisdictional level, our results highlight the need to integrate the collection and monitoring of antenatal population-screening programs to assess clinical effectiveness and program performance (detection and screen-positive rates, uptake of diagnostic tests as a result of screening). Women's expectations and satisfaction with the information they are provided should be evaluated and used to adjust education resources. At a local level, collaboration between providers of the separate tests, both public and private, would enable the ascertainment of outcomes of integrated screening programs. To complete the cycle, these data should inform decisions to improve antenatal screening programs at a national level. A primary goal at a national level would be to develop a consensus on key performance indicators for programs that clarify best practice guidelines and establish optimal performance and accreditation standards.