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The Genome
CMECNE

SMFM Guidance – The Role of Prenatal Ultrasound and NIPT 

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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. 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 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.

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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Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

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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