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 Recently the America College of Obstetricians and Gynecologists
(ACOG) released guidelines for first trimester screening.
It recommended first trimester screening for genetic defects
as an option for pregnant women, but only if certain criteria
is met by the medical facility. In keeping with these guidelines,
New Jersey Perinatal Associates, encompassing the Division
of Maternal Fetal Medicine at Saint Barnabas Medical Center,
has one of the longest running comprehensive prenatal screening
programs in New Jersey and the northeast region.
"There are very few facilities in the country that
are certified by the Fetal Medicine Foundation," say
Richard Miller, M.D., perinatologist and Associate Director
with New Jersey Perinatal Associates. "Our certification
reflects our status as one of the most experienced teams available
for pregnant women and their partners. We also are one of
the only sites to provide the counseling options and early
diagnostic capabilities recommended by ACOG."
The new ACOG Committee cautions that sonographer training
and ongoing quality assurance are essential if nuchal translucency
(NT) is used as a first trimester screening method. Small
differences in NT measurements can have a large impact on
the risk prediction of Down syndrome, the Committee reports.
Research has shown an association between fetuses with certain
chromosomal abnormalities and ultrasonographic findings of
an abnormally increased NT between 10 and 14 weeks gestation.
Although first-trimester screening is an option for some
women, ACOG recommends that it should only be offered if the
following criteria are met by the medical facility:
- Appropriate ultrasound training and ongoing quality monitoring
programs are in place.
- There are sufficient resources to provide
comprehensive counseling to women regarding the different
screening options and limitations of these tests.
- Access to an appropriate diagnostic test is
available when screening tests are positive.
"Our ultrasound
readings are performed by experienced perinatologists, and
patients can receive counseling and early diagnostics depending
on the results," reports Dr. Miller.
"For our patients, first-trimester screening offers
several potential advantages over second-trimester screening.
When test results are negative, the information may help reduce
maternal anxiety earlier. If results are positive, women can
take advantage of prenatal diagnosis by chorionic villus sampling
or amniocentesis. Detecting problems earlier in the pregnancy
can allow a woman to prepare for or make decisions regarding
a child with health problems."
There are also new technologies for second and third trimester
screening that require appropriate ultrasound training and
expert skill. Last year New Jersey Perinatal Associates introduced
new ultrasounds with 4-D capability.
Physicians have an enhanced view of fetal development, which
may aide in the evaluation of babies with conditions such
as cleft lips or spina bifida. The new system can provide
a more complex view of the major blood vessels of the heart.
It also allows the physician to view all sides of the spine,
or any organ, and twist the picture for a 360-angle inspection.
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