If a woman does not qualify for IPS (for eg. she is under age 35) but wishes to pay privately, is this service available?
(MSP covered) NT ultrasound is reserved for those women who are at an increased risk for chromosomal aneuploidy. In BC, women age 35 and older are eligible for the NT ultrasound as part of IPS. Women age 34 and younger are eligible for SIPS (2 part serum only) which offers a comparable detection rate and false positive rate for their age group.
In some parts of the province, NT ultrasound measurement is available on a private pay basis. If a woman wishes to pay privately for the NT and have the SIPS done through the public system, the NT measurement can be used in the risk calculation if the NT was measured by a provider who is accredited by the Fetal Medicine Foundation (provincially-recognized quality control organization). In such cases, the provider ordering the prenatal screen should send a copy of the NT ultrasound report to the Prenatal Biochemistry Laboratory at BC Children's and BC Women's at fax number 604-875-3008. Please mark on the Part 1 Prenatal Biochem Lab Req that an NT ultrasound is being done/ planned (see clinical information question #3 on the lab req). The (privately paid) NT ultrasound measurement will then be incorporated with the (publically offered) SIPS result to provide the woman with an IPS result.
If a woman wants to know her risk of Down syndrome in the first trimester, is that an option?
- Yes, First Trimester Screening (PAPP-A + free beta-hCG serum biochemistry + NT ultrasound) is done between 11-13w6d gestation and provides an immediate risk for Down Syndrome. It is not available through the public system.
- First Trimester Screening (FTS) is available on a private pay basis (approx. $500) in some parts of the province (Burnaby, Victoria, Kelowna). FTS is a screening test, measuring different serum analytes, other markers on ultrasound, and using different technology to analyze results. It is NOT the same as ordering Part 1 serum (of IPS or SIPS) and an NT ultrasound through the public system.
- If a woman is looking for a private pay service for First Trimester Screening, consider the following to ensure a reliable result:
- Ensure that the provider who takes the ultrasound measurements is accredited by the Fetal Medicine Foundation (provincially-recognized quality control organization).
- Ensure that the serum biochemistry tests (PAPP-A + free beta-hCG) are performed in a DAP – accredited laboratory or a laboratory that has accreditation by a comparable organization.
- Note that the First Trimester Screen does not screen for open neural tube defects (NTD). The second trimester detailed fetal ultrasound scan is therefore required to properly screen for NTDs.
If my patient has had private pay First Trimester Screening (FTS), should I order IPS/SIPS through the public system?
No. Only one screen should be ordered in the pregnancy. Since the screens measure different markers and use different technology, two results can be contradictory and overall increase the false positive rate.
What should I do if the woman has had private pay FTS but I have already ordered IPS/SIPS through the public system?
The IPS/SIPS should be cancelled. Two contradictory results can be generated for the same pregnancy. This will be confusing for the patient.
What should I do if my patient shows me her private pay FTS result after I receive her IPS/SIPS report?
You and your patient will need to discuss the results of both tests. A referral to Medical Genetics can be helpful to sort out the overall meaning of the two reports for this pregnancy (Vancouver 604-875-2157 and Victoria 250-727-4461).
What is Non-Invasive Prenatal Testing (NIPT) and how does it compare to all the other screening tests?
NIPT is a new non-invasive blood test that measures the quantity of cell-free fetal DNA that is normally found circulating in maternal blood. NIPT can be performed anytime after 10 weeks gestation. It is considered a very accurate, safe, and non-invasive screen which has an increased detection rate for Down syndrome (>99%) and trisomy 18 (>98%) with a lower false positive rate (<0.3%) compared to the other offered blood screening tests. NIPT, therefore, is likely to reduce or even prevent the need for a lot of women to have to undergo the invasive amniocentesis procedure as the next step after a positive IPS/SIPS/Quad screen.
Effective November 2015, provincial funding is available for particular high-risk pregnancies. NIPT is a funded option for women who meet one of the following criteria:
- first screen positive on IPS/SIPS/Quad;
- a pregnancy/family history of trisomy 21/18/13; or
- pregnancy with both a screen result and ultrasound markers of aneuploidy which increases the risk to 1/300 or more.
Visit our NIPT page for more information on NIPT, how it compares to amniocentesis, and BC locations offering funded NIPT.
Women who are considered at lower risk for chromosomal aneuploidy (or none of the above eligibility requirements apply) should still continue to be offered IPS or SIPS. If a lower risk woman wants to consider NIPT as a first tier screen instead of doing SIPS/IPS, and is willing to pay, there are many private locations in BC offering self-pay NIPT. See our NIPT page for self-pay NIPT locations.