Second Trimester Absent or Hypoplastic Nasal Bone: Counseling and Management
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 absent hypoplastic nasal bone 2. Explain the association of isolated absent or hypoplastic nasal bone with Trisomy 21
Estimated time to complete activity: 0.5 hours
Ashley Comfort, MD, FACOG is the Director of Medical Content, 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: Ashley Comfort, MD, has a financial interest in Pfizer and has no other conflicts of interest to disclose.
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 Nov 24 2021 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 0.5 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 0.5 contact hours.
The nasal bone is imaged on prenatal ultrasound in the second trimester of pregnancy, evaluated perpendicular to the longitudinal axis of the nose, in the mid sagittal plane of the fetal face. A hypoplastic nasal bone can be defined as a ratio against the biparietal diameter, by absolute length, by gestational age-based percentiles or by multiples of the median. If absent or hypoplastic nasal bone is suspected, next steps should include detailed anatomic evaluation and aneuploidy testing. SMFM considers an absent or hypoplastic nasal bone a “soft marker” which is a “minor ultrasound finding” associated with an increased risk of aneuploidy.
Isolated Ultrasound Finding
Offer aneuploidy testing
NIPS or quad screening if NIPS is unavailable or cost-prohibitive or
Diagnostic testing via amniocentesis
If negative quad serum screening
Offer counseling to estimate the residual risk of Trisomy 21 to inform discussion of following options
No further evaluation | cfDNA | Diagnostic testing
If negative NIS screening
No further evaluation is recommended
Absent or hypoplastic nasal bone occurs in 0.1 to 1.2% of euploid pregnancies. It is associated with trisomy 21, especially when occurring with other structural anomalies or soft markers. If screening is low risk for aneuploidy, this finding is of little clinical significance and most likely a normal variant.
Trisomy 21 risk is increased by a factor of 6.6 when isolated absent or hypoplastic nasal bone is seen
No further additional antenatal ultrasound or fetal surveillance is recommended with negative NIPS screening
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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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