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The Genome
CMECNE

Second Trimester Nuchal Fold – What Does It Mean?

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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. Define thickened nuchal fold
2. Explain the relationship of a thickened nuchal fold and Trisomy 21

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

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 Dec 31 2021, 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.

Read Disclaimer & Fine Print

CLINICAL ACTIONS:

The nuchal fold (NF) thickness is a measurement performed on prenatal ultrasound, and is the distance from the outer edge of the occipital bone to the outer edge of the skin in the midline. While both measurements are at the level of the fetal head or neck, a nuchal fold thickness, which is only performed in the second trimester, should not be confused with a first trimester nuchal translucency (NT) measurement.

If an enlarged second trimester nuchal fold measurement is obtained, next steps should include:

  • Detailed anatomic study
  • Refer for genetic counseling and consideration of diagnostic testing options if not previously performed
  • ACOG guidance recommends offering prenatal screening for aneuploidy or invasive, diagnostic testing for all pregnant women regardless of age
    • ACOG guidance recommends offering invasive testing using microarray in the setting of fetal structural anomalies seen on prenatal ultrasound

SYNOPSIS:

Second trimester thickened nuchal fold has a high specificity for aneuploidy.  ACOG defines an abnormal nuchal fold as ≥ 6mm in the 2nd trimester (typically performed between 15w0d and 22w6d).  The SOGC (Society of Obstetricians and Gynecologists of Canada) considers a nuchal fold to be abnormal when the measurement is ≥ 5 mm at 16-18 weeks, or ≥ to 6 mm at 18-24 weeks.  It is the most powerful second trimester sonographic marker for Trisomy 21 / Down syndrome.

KEY POINTS:

  • Can be differentiated from a cystic hygroma by the lack of fluid filled loculations
  • Trisomy 21/Down syndrome risk is increased by a factor of 17 when the nuchal fold is thickened
  • Can also be associated with single gene abnormalities

Learn More – Primary Sources:

ACOG Practice Bulletin 226: Screening for Fetal Chromosomal Abnormalities

SOGC: Fetal Soft Markers in Obstetric Ultrasound

ACOG Practice Bulletin No. 162: Prenatal Diagnostic Testing for Genetic Disorders

Locate a genetic counselor or genetics services:

Genetic Services Locator-ACMG

Genetic Services Locator-NSGC

Genetic Services Locator-CAGC

Take a post-test and get CME credits

TAKE THE POST TEST

2nd Trimester Ultrasound Reference Library, Now Available on Your Phone with ObGFirst

Learn More  »

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Related ObG Topics:

Genetic Counseling: Who to Refer and What They Should Expect
Down Syndrome / Trisomy 21: Clinical Findings and Prenatal Considerations
Practical obstetrics info for your women's healthcare practice
Cystic Hygroma: Definition, Genetics and Prognosis
Practical obstetrics info for your women's healthcare practice

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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.

Disclaimer

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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