Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss how NT measurement is best performed 2. Describe the relationship of an enlarged nuchal translucency with fetal abnormalities
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Nuchal translucency (NT) is a fluid-filled space normally seen behind the fetal neck on ultrasound performed in the first trimester of pregnancy
A precise measurement of this space is used in first trimester aneuploidy screening in combination with levels of maternal serum markers [free or total hCG and pregnancy-associated plasma protein A (PAPP-A)] to provide an adjusted risk for fetal aneuploidy
Measurements should be performed between 11w0d and 13w6d weeks of pregnancy
ISPD suggests 12 weeks may be superior because
Patient scheduling may be easier and fetal anatomic visualization is better compared to 11 weeks
Screening performance is superior compared to 13 weeks
Determination of whether or not a measurement is normal requires an accurate measurement of fetal size using a crown rump length (CRL) measurement
Programs exist for credentialing purposes to provide education and ongoing mechanism for quality review and is a necessary requirement for optimal screening performance
A fetal measurement >3.0 mm is an independent risk factor for fetal abnormalities and requires referral and further follow up
More commonly associated with aneuploidies such as Down syndrome and Turner syndrome, but may also be associated with other genetic syndromes, such as skeletal dysplasias
Larger NT may be associated with Noonan syndrome, especially in the context of other structural anomalies such as cardiac and renal findings
Approximately 10% risk with NT >3.0 mm and normal chromosomal complement
Fetal structural anomalies, including cardiac, abdominal wall and diaphragmatic defects, must be assessed by anatomical fetal ultrasound and fetal echocardiography
If the NT is sufficiently large to extend the length of the fetus with visible septations, this is called a ‘cystic hygroma’ and risk of aneuploidy is 50%
Other genetic syndromes and structural anomalies may be present even in those with normal karyotype
normal outcome may be <20%
Refer for high risk OB consultation and genetic counseling, and consider prenatal diagnostic testing
ACOG guidance recommends offering invasive testing using microarray in the setting of fetal structural anomalies seen on prenatal ultrasound
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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