title: Direct access midwifery booking for prenatal care and its role in Down syndrome screening.
abstract: OBJECTIVE
  To compare the uptake of Down syndrome screening by women following referral by direct access and general practitioner (GP) modes.
  
  
  METHODS
  The method of referral by either GP or direct access, for women who booked into prenatal care in Hull and East Yorkshire in 2010, was analysed using data collected from the Protos database at the Women and Children's Hospital, Hull. Subsequently, the uptake of first and second trimester screening for Down syndrome was reviewed by combining the Protos database to the screening data collected by the Clinical Biochemistry Laboratory at Hull Royal Infirmary, Hull.
  
  
  RESULTS
  Women booked into prenatal care significantly earlier when referred by GP in comparison to direct access with a significant difference in screening uptake of 49.5 and 42.7%, respectively. The ratio of uptake between first and second trimester screening was not significantly different.
  
  
  CONCLUSIONS
  Further research on the new direct access method of referral is required, as it may have a role in the uptake of prenatal screening for Down syndrome. More time is needed to show a definitive effect.
authors.affiliation: Hull York Medical School, University of Hull, Kingston upon Hull, UK.
authors.forename: Tariq S
authors.initials: TS
authors.lastname: Nawaz
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Tringham
authors.forename: Stephen
authors.initials: S
authors.lastname: Holding
authors.forename: Jane
authors.initials: J
authors.lastname: McFarlane
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Lindow
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D004314:Down Syndrome / Q000097:blood / Q000175:diagnosis*; D005260:Female; D058005:General Practitioners; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008485:Medical Audit; D048208:Nuchal Translucency Measurement; D009721:Nurse Midwives; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood; D011262:Pregnancy Trimester, Second / Q000097:blood; D011295:Prenatal Care / Q000379:methods*; D012017:Referral and Consultation; D012189:Retrospective Studies; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: C097353:AFP protein, human; D015415:Biomarkers; D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins