1. DO NOT ORDER at any gestational age.
Prenatal Screening
Singleton Pregnancies
NIPS
Indications:
Any woman desiring screening for aneuploidy
Any woman who is high-risk:
Maternal age 35 years or older at delivery
Sonographic findings indicating an increased risk of aneuploidy
History of a prior pregnancy with one of the following: trisomies 13, 18, or 21, a sex-chromosome abnormality, or triploidy
Positive screening results for aneuploidy
Parental balanced Robertsonian translocation (involving chromosomes 13, 18, or 21)
Family history of a sex-linked disorder (ex. Duchenne muscular dystrophy)
Low-Risk Results
Routine Prenatal Care
High-Risk Results
Referral to MFM
Ultrasound
Diagnostic Testing
Traditional MSS
Any woman who is high-risk for ONTD, desiring screening for aneuploidy, if NIPS is not covered by insurance or out of pocket costs are too high, patients who have had this testing in previous pregnancies and prefer to stick with a familiar test. NT
Any woman desiring screening.
High risk for aneuploidy, family history of congenital heart defects. Can be used in conjunction with NIPS and traditional MSS.
Proceed with prenatal screening test of choice
High Risk Results
Do not order traditional 1st trimester MSS.
Twin Pregnancies
Harmony
(lab: Roche)
Patient will receive a single result for the pregnancy, rather than a result for each twin.
Gender is reported as presence or absence of the Y chromosome. If Y is absent, both fetuses are females, if Y is present at least one fetus is male.
Sequential, Integrated, Quad
Vanishing Twin
DO NOT ORDER at any gestational age.
Wait at least 4 weeks after the demise before ordering with 1st trimester screening (sequential, integrated) and at least 2 weeks before ordering with 2nd trimester screening (quad). Be sure to describe history of vanishing twin on requisition form.
Early Ultrasound to confirm EDD and look for multiples
Prenatal Screening - Algorithm