Routine

Anaemia
Mahomed K.
Iron supplementation in pregnancy (Cochrane Review).
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract.

A review of 20 trials concluded that routine iron supplementation prevented low haemoglobin at birth or 6 weeks post partum. There was little information about pregnancy outcomes for mother and baby.

Rh Negative
RCOG Green Top Guideline No. 22 Anti-D immunoglobulin for Rh prophylaxis
http://www.rcog.org.uk/guidelines.asp?PageID=106&GuidelineID=45
Evidence based review of monitoring and prophylaxis necessary for the prevention of Rhesus disease.

HIV
Brocklehurst P.
Interventions for reducing the risk of mother-to-child transmission of HIV infection (Cochrane Review).
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract.

Zidovudine, Caesrean section and Nivirapine have been shown to reduce vertical transmission.

Dunn 1992 Dunn D, Newell M-L, Ades A, Peckham C.
Risk of human immunodeficiency virus type 1 transmission through breast-feeding.
Lancet 1992; 40:585-8, Abstract.

Observational studies have reported a doubling of mother to child transmission following breast feeding. The WHO has therefore recommended that where safe alternatives to breast feeding exist, they should be implemented.

Syphilis

Walker GJA.
Antibiotics for syphilis diagnosed during pregnancy (Cochrane Review).
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract.

Review concludes that antibiotics are effective at treating syphilis in pregnancy and preventing congenital syphilis although the best treatment regime remains to be proven.

Hepatitis B
Andre F E, Zuckerman A J.
Review: protective efficacy of hepatitis B vaccines in neonates.
Journal of Medical Virology 1994, 44(2), 144-151, Abstract

Haemoglobinopathies
www.wmpi.net/reviews
Reviews: Haemoglobinopathies
Review of sickle cell disease with special emphasis on its management within pregnancy.

Infections

Chicken Pox

RCOG Green Top Guideline No13.
http://www.rcog.org.uk/guidelines.asp?PageID=106&GuidelineID=7
Evidence based review, which includes: risks to mother and baby, prevention, management of the pregnant woman who has a chickenpox contact and management of the pregnant woman with chickenpox.

Toxoplasmosis

Peyron F, Wallon M, Liou C, Garner P.
Treatments for toxoplasmosis in pregnancy (Cochrane Review).
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract.

As of the trials studied met the inclusion criteria, the review was unable to conclude whether the treatment of toxoplasmosis for women who seroconvert in pregnancy is beneficial. However a review of current studies and information is presented.

Screening Tests

Neural Tube Defects
Morrow RJ, McNay MB and Whittle MJ.
Ultrasound detection of neural tube defects in patients with elevated maternal serum AFP levels.
Obstet Gynecol 1991; 78:1055-7, Abstract.

In a study of 905 pregnant women with raised alpha feto-protein, ultrasound scanning had 98% sensitivity and 100% specificity for the detection of neural tube defects. The positive predictive value was 100% and the negative predictive value 99.9%.

Down's Syndrome

National Screening Committee
http://www.nsc.nhs.uk/antenatal_screen/antenatal_screen_ind.htm
Provides current recommendations for antenatal screening.

Serum Screening
Gilbert RE, Augood C, Ades AE, Logan S, Sculpher M, van Der Meulan JH.
Screening for Down's syndrome: effects, safety and cost effectiveness of first and second trimester strategies.
BMJ 2001; 323: 423-5, Abstract.

This study considered the safety, outcome and cost effectiveness of first and second trimester Down's screening.

Nuchal Translucency
Snijders RJ, Nobel P, Sebire N, Souka A, Nicolaides KH.
UK multicentre project on the assessment of risk of trisomy 21 by maternal age and fetal nuchal translucency thickness at 10-14 weeks of gestation.
Lancet 1998; 352(9125):343-6, Abstract.

Multicentre study of 96127 women, investigated for their risk of Trisomy 21 by a combination of maternal age and nuchal translucency thickness at 10-14 weeks gestation. Risk was calculated by maternal age, gestational-age-related prevalence and multiplied by a likelihood ratio derived from the deviation from normal of the Nuchal translucency measurement. The sensitivity of a cut off risk of 1 in 300 was investigated. Phenotype was derived from fetal karyotype or clinical examination of liveborn infants. The estimated Trisomy 21 risk was > 1in 300 for 8.3% of normal pregnancies, 82.2% of those with Trisomy 21 and 77.9% of those with other chromosomal defects. 80% of affected pregnancies were identified using the above screening method to determine -those offered invasive testing.

SURRUS- The Serum, Urine and Ultrasound Study

This 5 year national study is due to report in autumn 2002. It will examine the effectiveness of the range of antenatal screening methods available in the United Kingdom. It is expected to influence future recommendations for practice via the National Screening Committee and National Institute for Clinical Effectiveness.

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