More recently, guidelines from the American College of Obstetricians and Gynecologists (ACOG, 2007) and the American College of Medical Genetics (ACMG) (Palomaki et al, 2007) state that all women, regardless of age, should have the option of invasive testing.
#Sequential testing pregnancy vs quad screen plus
The serum tests performed in the second trimester are either a "triple" screen" (maternal age plus maternal serum alpha-fetal protein (MSAFP), unconjugated estriol, and free or total beta-hCG) or a "quad" screen (maternal age plus MSAFP, estriol, free or total beta-hCG, and dimeric inhibin A). Invasive genetic testing, either amniocentesis or chorionic villus sampling (CVS), were offered to women who would be older than age 35 at the time of delivery with singleton pregnancies. Second trimester maternal serum testing ("analyte testing") was offered to women younger than 35 years at time of delivery with singleton pregnancies, or those older than age 35 but who decline invasive testing. Historically in the United States, risk assessment for Down syndrome (DS) and other fetal chromosomal abnormalities had varied by maternal age. CPB 0464 - Serum and Urine Marker Screening for Fetal Aneuploidy.CPB 0358 - Invasive Prenatal Diagnosis of Genetic Diseases, and.CPB 0106 - Fetal Echocardiography and Magnetocardiography,.CPB 0047 - Prenatal Care Provided by Primary Care Physicians,.Note: All screening schemes that involve NT testing are considered medically appropriate only when performed in a setting of demonstrated ultrasound credentialing and ongoing quality monitoring. Ultrasound evaluation of the right subclavian artery (RSA)įootnotes*For purposes of this policy, these various forms of hCG are considered interchangeable: free beta subunit of hCG, total hCG, or hyperglycosylated hCG (also known as invasive trophoblast antigen ).Maternal fetal-derived circular RNA (circRNAs).First-trimester maternal serum placental growth factor level.First-trimester maternal serum anti-Mullerian hormone level.First-trimester maternal serum A disintegrin and metalloprotease 12 (ADAM12-S) level.First-trimester maternal plasma levels of follistatin-related gene protein.First-trimester ultrasound assessment of the nasal bone.First-trimester serum analyte testing (hCG footnotes* and PAPP-A) alone without NT measurement.First-trimester NT measurement alone (without first-trimester serum analyte testing) in the absence of fetal cystic hygroma in singleton pregnancies.See CPB 0464 - Serum and Urine Marker Screening for Fetal Aneuploidy and CPB 0787 Comparative Genomic Hybridization (CGH).Īetna considers other noninvasive screening schemes for fetal aneuploidy to be experimental and investigational, including the following because their effectiveness has not been established: Measurement of cell-free fetal nucleic acids in maternal blood when criteria are met in CPB 0464 - Serum and Urine Marker Screening for Fetal Aneuploidy.Īetna considers the above-listed screening tests for fetal aneuploidy not medically necessary for women who have previously had a microarray or non-invasive prenatal testing (NIPT) with cell-free DNA during the current pregnancy.Serum integrated screening for pregnancies where NT measurement is not available or can not be obtained: First-trimester (PAPP-A plus hCG footnotes*) plus second-trimester quad (MSAFP, uncongugated estriol, inhibin A, and hCG footnotes*) screening or.Second-trimester serum analyte screening (see CPB 0464 - Serum and Urine Marker Screening for Fetal Aneuploidy) or.Integrated, sequential, or contingent screening: First-trimester triple test (NT, PAPP-A, and hCG footnotes*) plus second-trimester quadruple test (maternal serum alfa-fetoprotein (MSAFP, unconjugated estriol, inhibin A, and hCG footnotes*) screening or.First-trimester NT measurements results combined with the results of first trimester serum analyte tests that include pregnancy-associated plasma protein A (PAPP-A) plus beta-human chorionic gonadotropin (hCG) footnotes* or.First-trimester nuchal translucency (NT) testing alone (without serum analyte screening) for multiple gestations or.Aetna considers the following noninvasive screening schemes for fetal aneuploidy medically necessary:
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