The principles of screening tests as applied to obstetrics and gynaecology

Screening in reproductive healthcare in the UK has expanded rapidly since the introduction of cervical screening by the NHS in 1981. Women are offered comprehensive antenatal care screening for a range of pregnancy complications, now including pre-eclampsia and gestational diabetes, with the aim of early disease detection and management. With the advances in molecular medicine in recent years, novel biomarkers are being developed that have the potential to accurately predict these diseases long before their clinical onset. Likewise, non-invasive testing in fetal medicine for a variety of genetic conditions may supersede traditional first trimester screening. In oncology, new tools for population screening for ovarian cancer are being sought via prospective samples stored in biobanks. Tracking serial measurements from each patient may optimize the current use of CA125 rather than using predetermined thresholds. These developments highlight the move towards more personalized medicine. However challenges in implementing new screening will include cost efficacy and ethical considerations such as informed consent.