Commentary: Important role for primary care in ensuring informed choice and timely screening and care

摘要

Sickle cell disease is now as common as cystic fibrosis in England and is one of the commonest reasons for admission to hospital in London.1,2 The paper by Dormandy and colleagues reports that a cohort of women in a deprived inner-city setting confirmed their pregnancy early on (median gestation 7.6 weeks).3 Despite this early confirmation, antenatal sickle cell and thalassaemia testing did not occur for many weeks (median gestation 15.3 weeks). These results raise two problems. First, services in their present form are falling a long way short of the NICE guidelines that to achieve truly informed choice women should be offered antenatal sickle cell and thalassaemia screening by 10 weeks gestation; and second, the failure to test early in pregnancy results mostly from an NHS failure to deliver early testing rather than from women failing to report their pregnancy early.