Prenatal Screening in New Brunswick On April 1, 2024, we transitioned our prenatal screening to the North York General Hospital in Ontario. The IWK Health Centre MSS requisitions will no longer be accepted. Please download the new requisition here: Requisition to use It is recommended that all pregnant individuals are offered a multiple marker screening test for aneuploidy screening. This test consists of a single blood test as outlined below. Further patient resources and pamphlets will be available here soon. Further details on the multiple marker screen are available on the Prenatal Screening Ontario website. Please remember that not all that information applies to the current state of prenatal screening in New Brunswick. Please do not hesitate to contact us if you have questions. Ordering eFTS Who and how to order: Enhanced First Trimester Screening (eFTS) is a screening test for trisomy 21 and trisomy 18, consisting of a nuchal translucency (NT) ultrasound (US) and bloodwork in the first trimester of pregnancy (before 13weeks 6days). In New Brunswick, NT is not universally available. This US must be performed by Fetal Medicine Foundation (FMF) certified practitioners. Women > 35 years as well as those with select indications should be referred to a Maternal Fetal Medicine Unit. Please inform yourself of the indications specific to your Zone. The eFTS can only be ordered with the NT. The requisition must contain the NT information when the blood sample is obtained. If your patient will not have the NT ultrasound, please DO NOT send for eFTS (see STS bellow). Please see the example (Sample copy requisition for MFM (to include NT) which highlights the fields to be filled on the requisition. Please ensure you complete the requisition correctly and include all the information in order to obtain the highest quality results. Missing information will decrease the quality of the screen and potentially delay the results. Receiving the report: You will receive the report in 3-5 business days. If you do not receive the report, please contact the North York General Hospital Laboratory directly. Please review the report for accuracy and reach out to them if you note discrepancies. The cut-offs: The test has a cut-off of 1 in 350 for trisomy 21 and a cut-off of 1 in 200 for trisomy 18. Negative Screening Results: A negative screening result is reassuring, but it does not guarantee that the baby will be born without any health concerns or other genetic conditions. No additional aneuploidy testing would be required, and the patient should be booked for the routine anatomy scan. Positive Screening Results: Since the patient was most likely seen in an MFM unit already for the NT ultrasound, they will get the result as well. Depending on their local practice, they may contact the patient directly to review the results and offer more counselling and testing. If the patient was not seen in an MFM unit, please consider referring them. Open Neural Tube Defects: Maternal serum alpha-fetoprotein (MS-AFP) is no longer necessary to routinely screen for open neural tube defects (ONTD), unless there is a barrier to a good quality ultrasound evaluation. The risk for ONTD will not be reported in the eFTS. Your patient, however, had a high quality NT US and the fetal spine was evaluated then. The fetal spine will be evaluated again at the time of the routine anatomy. Ordering STS Who and how to order: Second Trimester Screening (STS) is a screening test for trisomy 21 and trisomy 18 offered in the second trimester (14 weeks 0 days to 20 weeks 6 days). Screening for Open neural tube defects (ONTD) will only be included after 15 weeks. Maternal serum alpha-fetoprotein (MS-AFP) is no longer necessary to routinely screen ONTD, unless there is a barrier to a good quality ultrasound evaluation. You may consider ordering STS for your patients > 15 weeks if you wish for this information to be included in the report. All pregnant individuals who did not have eFTS or other forms of prenatal screening (e.g., non-invasive prenatal screening) should be offered STS. Please see the example (Sample copy requisition for obstetricians and general practitioners) which highlights the fields to be filled on the requisition. Please ensure you complete the requisition correctly and include all the information in order to obtain the highest quality results. Missing information will decrease the quality of the screen and potentially delay the results. Receiving the report: You will receive the report in 3-5 business days. If you do not receive the report, please contact the North York General Hospital Laboratory directly. Please review the report for accuracy and reach out to them if you note discrepancies. The cut-offs: The test has a cut-off of 1 in 350 for trisomy 21 and a cut-off of 1 in 200 for trisomy 18. Negative Screening Results: A negative screening result is reassuring but it does not guarantee that the baby will be born without any health concerns or other genetic conditions. No additional testing would be required for aneuploidy, and the patient should be booked for the routine anatomy scan. Positive Screening Results: A positive screening result can be quite stressful for you and your patient. Remember that this is a screening test only and does not mean the baby is affected. Please refer your patient to your regional MFM unit, and they will assist you with further counselling and testing. Other screening options on the requisition You will note 2 other tests available on the requisition. Vanishing twin: If your patient has a dating ultrasound report suggestive of a vanishing twin, please refer for nuchal translucency (NT) in an MFM unit. Your patient will be counselled and the NT + STS will be ordered. Please allow the NT provider to provide the requisition, as the NT information is mandatory to obtain quality results. Maternal Serum AFP only: Maternal serum alpha-fetoprotein (MS-AFP) is no longer necessary to routinely screen ONTD, unless there is a barrier to a good quality ultrasound evaluation. This test should not be ordered as per the above recommendation. Please see the explanations below: If your patient had eFTS + NT, there is no indication to do the MS-AFP alone. The request will be declined by the receiving laboratory (North York General Hospital) and there will be no results reported. If your patient had STS between 15weeks 0days and 20 weeks 6 days, the result for ONTD is included in the report. If your patient had STS between 14weeks 0 days and 14 weeks 6 days there will be no results for ONTD. Please consider ordering the STS > 15 weeks if you wish for this information in the report. Other available screening options – private pay NIPS Non-invasive Prenatal Screening (NIPS) is an optional test that provides information on the risk of certain chromosome differences. It is available from several private vendors across the province. Examples of private companies include Natera, Harmony and Prenato. Please contact the companies directly for more information and location of collection sites. The NIPS should be performed after 10 weeks. It does not include an ultrasound, thus it is important to have prior confirmation of a viable pregnancy. If your patient chooses to have NIPS, you should not order eFTS, STS or AFP. In other words, the screening is complete. Some patients may still need to be referred for a NT US depending on their risks. Please discuss with your regional MFM Unit. Twins and multiples Neither the eFTS nor the STS provide aneuploidy information for twins or multiples. Please refer to a MFM unit for NT US and risk calculation and counselling. Twin pregnancies could have NIPS while higher order multiples (triplets and more) cannot. This information will be covered in the routine MFM counselling.