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CMECNE

SMFM Guidance – The Role of Prenatal Ultrasound and NIPT

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. Restate the SMFM recommendations for the role of ultrasound in the era of non-invasive prenatal screening for fetal aneuploidy
2. Incorporate proper terminology when documenting a ‘soft marker’ finding

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

SUMMARY:

SMFM has released, as part of their Consult Series, a document on the role of prenatal ultrasound in the context of cfDNA screening. The summary recommendations are as follows:

Negative cfDNA at 11-14 weeks: (evidence level 1B)
- First trimester ultrasound only for NT measurement not recommended
Negative cfDNA and isolated ‘soft marker’: (evidence level 2B)
- Diagnostic testing is not recommended solely for this indication
- Describe ‘soft marker’ finding as ‘not clinically significant’ or ‘normal variant’
Negative 1st or 2nd trimester screen and isolated ‘soft marker’: (evidence level 2B)
- Describe ‘soft marker’ finding as ‘not clinically significant’ or ‘normal variant’
Structural abnormality on ultrasound (evidence level 1A)
- Offer diagnostic testing using microarray
Do not offer routine screening for microdeletions using cfDNA (evidence level 1B)

Key Points:

Examples of ‘soft marker’ include echogenic intracardiac focus or choroid plexus cysts
‘Isolated’ implies a single finding and the absence of any other pathology
If multiple ‘soft markers’ are identified
- Refer for genetic counseling, consideration of diagnostic testing
- prenatal risk assessment should be limited to expert centers and individuals

Levels of Evidence:

1A: Strong recommendation; high-quality evidence
1B: Strong recommendation; moderate-quality evidence
2B: Weak recommendation; moderate-quality evidence

Learn More – Primary Sources:

SMFM Consult Series #42: The role of ultrasound in women who undergo cell-free DNA screening

ACOG Committee Opinion 682: Microarrays and Next-Generation Sequencing Technology: The Use of Advanced Genetic Diagnostic Tools in Obstetrics and Gynecology

ACOG Practice Bulletin 226: Screening for Fetal Chromosomal Abnormalities

ACOG Practice Bulletin 162: Prenatal Diagnostic Testing for Genetic Disorders

ACOG Practice Bulletin 175: Ultrasound in Pregnancy

Locate a Genetic Counselor or Genetics services:

Genetic Services Locator-ACMG

Genetic Services Locator-NSGC

Genetic Services Locator-CAGC

Locate a Maternal Fetal Medicine Specialist

Maternal Fetal Medicine Specialist Locator-SMFM

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