basis of these previous studies and studies by other workers using triple test procedures. Many health authorities make such decisions without carrying out their own studies or evaluations, as was the case when Alison Round and Willie Hamilton's health authority (Exeter) introduced screening on the basis of our protocol in September last year. With respect to the uptake of screening, we have been screening for neural tube defects since 1979. Our screening programme has continually achieved uptake rates in excess of 80% since then. We and our antenatal clinics provide information leaflets about the tests on offer, the consequences of the various conditions, and how women identified as being at increased risk may need follow up, whether it be to consider ultrasound dating of the pregnancy, detailed scanning of the spine, or amniocentesis. We believe that the patients served by our service are given sufficient information to make an informed choice whether to have the tests or not. Five of the seven fetal deaths that we identified in association with an increased risk of Down's syndrome occurred at or before the time of screening. In two cases fetal death was identified some seven days after biochemical screening. None of the seven women in these cases had amniocentesis, and we reported in our paper that one fetal death occurred within 28 days of amniocentesis. It is conceivable, but highly unlikely, that the seven fetal deaths may have been associated with increased maternal anxiety.