and isolated choroid plexus cysts, we recommend no further aneuploidy
Increased monitoring for these complications is suggested but has not been shown to improve outcomes.22.
False Negative NIPT - DC Urban Mom Placenta. Hurt, L, Wright, M, Dunstan, F, Thomas, S, Brook, F, and Morris, S (2016). Faculty: Susan J. if cell-free DNA is unavailable or cost-prohibitive (GRADE 1B); (3) for
Proposal of a simple clinical summary for management of specific soft markers in pregnancies. In stepwise sequential screening, first-trimester combined screening (PAPP-A, hCG, and nuchal translucency) results are given to the patient if positive so that she may be offered early invasive diagnostic testing. The PIM planners and others have nothing to disclose. Prevalence of defined ultrasound findings of unknown significance at the second trimester fetal anomaly scan and their association with adverse pregnancy outcomes: the Welsh study of mothers and babies population-based cohort. The Cochrane database was also searched. Hey mamas,I wanted to share my story in hopes that it may help others out there in a similar situation. Thank you so much to anyone who answers and to those who like me read these posts to feel less lonely. Prenat Diagn. It is essential . She didnt give us much info and said I could see a genetic counselor. 2 soft markers at 20 weeks but negative NIPT. postnatal evaluation (GRADE 1B); (6) for pregnant people with negative
[30], isolated shorted HL and FL in second trimester demonstrated higher rates of preterm delivery and preeclampsia. CPC is found in approximately 2 to 4% of fetuses at 16 to 24 weeks of gestation usually as an isolated finding in otherwise normal low-risk pregnancy [1,20]. Stefanovic, V (2015). https://www.psychosocialresearchgroupunsw.org/decision-aids.html, Systematic reviews and meta-analyses of high-quality diagnostic accuracy studies; NIPT performs similarly in high- and low-risk populations, although positive predictive values are lower in low-risk populations, Meta-analysis of diagnostic accuracy studies with limitations; detection rates are lower in twin pregnancies, Expert consensus guidelines; no screening test, including cell-free DNA, is considered diagnostic. They are found in about 3 to 4% of normal fetuses and in about 25% of those with trisomy 21 [6,41]. Right now you're just in the dark and that's the worst. Therefore, we are not responsible for the content or availability of this site. Rodriguez, R, Herrero, B, and Bartha, JL (2013). Cue to yesterday at 31 weeks I had the follow up. Midtrimester isolated short femur length as a predictor of adverse pregnancy outcome. The Pregnancy Meeting is a Trademark of the Society for Maternal-Fetal Medicine. Choroid Plexus Cysts When is it Time to Worry? Shortened humerus length (HL) and femur length (FL) was observed in 0.4 to 3.9% of normal fetus [26]. Understanding what the NIPT test results mean. Diagnosis of toxoplasma and CMV infection is based on positive specific immunoglobulin M results with confirmatory immunoglobulin G avidity test. Please keep us updated . Ultrasonographic fetal soft markers in a low-risk population: prevalence, association with trisomies and invasive tests. for fetuses with an isolated single umbilical artery, we recommend no
This educational content is not medical or diagnostic advice. It seems impossible to have so many soft markers and for the baby to be healthy. clinical circumstances and patient preference (GRADE 1B); (4) for
J Ultrasound Med. Im very upset that for some reason I was not told about this second marker, as I definitely would have requested an amnio but it wasnt offered to me nor did they make any mention of the abnormalities both being markers. Women with positive aneuploidy screening results should be offered referral to maternal fetal medicine and genetic counseling to discuss invasive diagnostic testing with chorionic villus sampling or amniocentesis. Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. Negative NIPT but 2 soft markers seen on ultrasound I am anxious, terrified, confused, just hoping for good news. Signorelli, M, Cerri, V, Taddei, F, Groli, C, and Bianchi, UA (2005). Short Femur on the Second Trimester Ultrasound Report: What to Include in the Management Plan? They told me because my NIPT was negative that the chance of the reasoning behind the thickened nuchal fold being down syndrome is 1 in 10,000 but the chance of miscarriage after the amniocentesis is 1 in 1,000. Now at my 20 week scan friday everything looked good except the nuchal fold is still thickened. Sonographic findings with little or no pathological significance, known as soft markers, are often found in aneuploidy fetuses. pregnant people with no previous aneuploidy screening and isolated
for noninvasive aneuploidy screening with cell-free DNA or quad screen
Some recent data indicate a positive association between NF measurement and congenital heart defects, with reported adjusted odds ratio of 14.8 (95% confidence interval [CI], 5.440.1). Prenat Diagn. While most commonly fetal pyelectasis is a transient physiologic state, it can be a marker for aneuploidy and be a precursor of potential urinary tract pathology [3]. The following two strategies were included: (I) NIPT screening in which the mothers were first screened with NIPT, and those with high-risk NIPT screening results underwent genetic counseling and concurrent amniocentesis; (II) serological screening, in which the mothers were first screened serologically, and those at high risk for aneuploidy Ill begin by saying I had the Maternity 21 test done at 10 weeks and everything was negative. Use of this site is subject to our terms of use and privacy policy. Community for those with abnormal or discordant Noninvasive Prenatal Testing (NIPT/NIPS) screening results: FALSE POSITIVE, FALSE NEGATIVE, TRUE POSITIVE & those stuck in limbo. I had the NIPT @ 12 weeks and everything came back as normal 99% negative for Down Syndrome. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. Multiple soft markers were associated with an increased risk of congenital anomalies and preterm birth [3,6,1215]. We found out we have eif and pyelectasis, My daughter was born 2.5 weeks ago.. she had two soft markers.. bilateral choroid plexus cysts and dilated kidneys.. all testing came back negative.. she does not have either of the trisomies. Previous studies reported isolated echogenic bowel was associated with an increased risk of congenital anomalies, and preterm birth. My question that I had for my doctor that she could not answer and I was wondering if you guys could help was-. However, at my 20 week anatomy ultrasound the identified 2 "soft markers" for DS. Goetzinger, KR, Cahill, AG, Macones, GA, and Odibo, AO (2011). Cookie Notice 2015. Scala, C, Familiari, A, Pinas, A, Papageorghiou, AT, Bhide, A, and Thilaganathan, B (2017). Ahman, A, Axelsson, O, Maras, G, Rubertsson, C, Sarkadi, A, and Lindgren, P (2014). obstetrical ultrasound examination. Patient information: See related handout on fetal aneuploidy. Create an account or log in to participate. Privacy Policy. Absent fetal nasal bone: what does it mean for the euploid fetus?. I am anxious, terrified, confused, just hoping for good news. These activities will be marked as such and will provide links to the required software. previous aneuploidy screening were low risk or testing was declined. However, the majority of fetuses with trisomy 18 have multiple other defects. Fetal Diagn Ther. Group Black's collective includes Essence, The Shade Room and Naturally Curly. Looking for anyone with a similar experience- at 10 weeks my NIPT results came back negative for trisomy 21, 13, and 18, and we were told we were having a healthy baby BOY. Second-trimester ultrasonography has limited utility in aneuploidy screening in women who have already been screened with a first- or second-trimester serum test. Clinical experience of laboratory follow-up with noninvasive prenatal testing using cell-free DNA and positive microdeletion results in 349 cases.
Low risk NIPT but soft marker in ultrasound - January 2021 Birth Club The American College of
Learn more about, Learn About What to Expect's Pregnancy & Baby App, My story: High risk and THREE soft markers. How did everything turn out for you?! With rapid implementation of NIPT as a new method of prenatal testing for Down syndrome or other common aneuploidies in the first trimester, it became easier to deal with soft markers. think twice before sharing personal details, foster a friendly and supportive environment, remove fake accounts, spam and misinformation, delete posts that violate our community guidelines, reviewed by our medical review board and team of experts. CPC is not considered a structural nor functional brain abnormality [4]. This is a question for a genetic counsellor, but I heard that its more likely to have a false positive.
Clinical significance of sonographic soft markers: A review It may be performed as primary screening or as a follow-up test to abnormal findings on first- or second-trimester screenings. Ultrasound Obstet Gynecol. Magnetic resonance imaging can be used for further elucidation of cases with ventricular enlargement [18]. Copyright 2020 by the American Academy of Family Physicians. think twice before sharing personal details, foster a friendly and supportive environment, remove fake accounts, spam and misinformation, delete posts that violate our community guidelines, reviewed by our medical review board and team of experts. Physicians should counsel pregnant women on available screening and diagnostic tests for aneuploidy.8 Counseling should be nondirective, with the physician supporting the autonomy of the woman and her partner in choosing whether to be screened. Semin Fetal Neonatal Med. First one is a "bright spot" on the heart and the second is one slightly enlarged kidney. First-trimester combined screening is designed to report 5% of all results as positive, most of which will be false positives. SMFM has addressed the topic, with a focus on how to integrate these findings within current screening programs (NIPS and serum marker screening), Society for Maternal-Fetal Medicine Consult Series #57: Evaluation and management of isolated soft ultrasound markers for aneuploidy in the second trimester, Get specially curated clinical summaries delivered to your inbox every week for free, Already an ObGFirst Member?
Soft Markers, Neg NIPT - expecting 2nd child - What to Expect After completing this activity, the participant should be better able to: 1. Information from prenatal aneuploidy screening facilitates anticipatory planning and may affect the decision to continue an established pregnancy. At 17 weeks I went for an early anatomy scan and told everything fine except they saw an EIF on baby's heart. Group Owners uphold the core values of the brand by reporting content that violates the community guidelines. Obstet Gynecol Sci. When abnormal NIPT screening is discordant with (normal) invasive diagnostic testing, it may be attributable to placental mosaicism, maternal aneuploidy, or sometimes occult maternal malignancy. Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. Also, looking for soft markers of trisomy 21, should not be performed in women with a normal NIPT result due to its high false-positive rate and poor positive predictive value [ 11 ]. No other abnormalities or concerns were found. Eur J Obstet Gynecol Reprod Biol.
PDF Soft Markers Identied on Detailed Ultrasound Therefore, a comprehensive examination and evaluation for CMV infection is suggested, in addition to correlation with aneuploidy testing results. 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. Ultrasound Obstet Gynecol. Mi Sun Kim, Sukho Kang, and Hee Young Cho, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea. NICHOLAS M. LEFEVRE, MD, AND RICHARD L. SUNDERMEYER, MD. Learn more about, Learn About What to Expect's Pregnancy & Baby App. These no-call results may indicate an increased risk of aneuploidy.33 Of those women with no-call results, 50% to 80% will receive a reportable result on a repeat test.7,34 Low fetal fraction is more common in pregnant women who are obese, with 7% of women weighing more than 100 kg (220 lb, 7 oz) and 51.1% of women weighing more than 160 kg (352 lb, 12 oz) receiving fetal fractions too low to report at 11 to 13 weeks' gestation.35, Any NIPT test may have a false-positive, false-negative, or no-call result. Therefore, karyotyping should be offered when thickened NF is observed [10].
PDF Clinical significance of sonographic soft markers: A review - ResearchGate NIPT and invasive prenatal testing are acceptably offered in high risk population (advanced maternal age, abnormal FTS results, history of fetal aneuploidy, known balanced translocation, or other chromosomal rearrangements in one of the parents) with soft marker and those with any combination of two soft markers [4,6]. We strive to provide you with a high quality community experience. Nyberg, DA, Souter, VL, El-Bastawissi, A, Young, S, Luthhardt, F, and Luthy, DA (2001). Two-third of them was detected during the first and the second trimesters with the prevalence ranging from 0.2 to 1.8%. Wax, JR, Donnelly, J, Carpenter, M, Chard, R, Pinette, MG, and Blackstone, J (2003). The risk of fetal aneuploidy rises with increasing maternal age. Keep me posted!! Most doctors do an ultrasound early in the second trimester between 16 and 20 weeks. Kim, HJ, Kim, JH, Chay, DB, Park, JH, and Kim, MA (2017). Relationship of isolated single umbilical artery to fetal growth, aneuploidy and perinatal mortality: systematic review and meta-analysis. They usually say worst case scenario.
P16.10: False-negative NIPT and the role of placental mosaicism Create an account or log in to participate. Use of the soft markers may increase the positive predictive value in patients with first trimester combined screening (FTS) (combination of maternal age, biochemical screening tests of free -hcg and PAPP-A, and nuchal translucency) [7]. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. serum or cell-free DNA screening results and isolated fetal echogenic
It is essential to provide information to the parents about the observed soft markers and its potential impact on prenatal and postnatal life. that has been identified in the absence of any fetal structural anomaly,
If you feel a message or content violates these standards and would like to request its removal please submit the following information and our moderating team will respond shortly. Echogenic Intracardiac Focus What is the Clinical Significance? .
Patients with intermediate risk are offered second-trimester quad screening to refine risk estimates. Malinger, G, Lev, D, and Lerman-Sagie, T (2011). third-trimester ultrasound examination for reassessment and evaluation
have greatly evolved in the last 2 decades, the relative importance of
I've been seeing a few posts on soft markers so I'm hoping this may make you feel a bit more at ease about it. In a 2015 randomized controlled trial comparing NIPT with first-trimester combined screening, NIPT detected 100% of trisomy 21 cases (false-positive rate of 0.06%) and 78.9% of trisomy 18 cases (false-positive rate of 0.01%).24 A 2017 meta-analysis reported that NIPT had a detection rate of 99.7% for trisomy 21 and 97.9% for trisomy 18, with a false-positive rate of 0.04% for both17 (Table 417,21). An Essential Evidence Plus summary of patient-oriented evidence that matters was reviewed. My partner and I both have severe anxiety. Second Trimester Nuchal Fold What Does It Mean? Acta Obstet Gynecol Scand. However, fetus with structural abnormality by ultrasound should be offered diagnostic testing with chromosomal microarray because there is a substantial risk that a chromosomal abnormality other than trisomy 21, 18, and 13 is present in the fetus which will not be detected by NIPT [9]. The absence of a fetal nasal bone warrants a detailed evaluation of fetal anatomy. Physicians should communicate test results in a timely manner and discuss the likelihood that a positive result is a true positive. A Group Leader is a What to Expect community member who has been selected by our staff to help maintain a positive, supportive tone within a group. How did everything turn out for everyone? Prenat Diagn. Soft markers for aneuploidy following reassuring first trimester screening: what should be done?. Risk of chromosome abnormalities in the presence of bilateral or unilateral choroid plexus cysts. I think Im most concerned about the nuchal fold, especially because it was never measured in the first trimester and now I wish I would have pushed for that. Thank you for responding. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. Pretest counseling should include a discussion of baseline age-dependent risk, the potential for false-negative and false-positive results, the difference between screening and diagnostic tests, and what types of follow-up testing to expect.9 The use of decision aids (examples are available at https://www.psychosocialresearchgroupunsw.org/decision-aids.html) may improve a woman's ability to make an informed choice.10 All prenatal aneuploidy screening tests optimize detection rates (high sensitivity) and test for relatively uncommon conditions, resulting in high negative predictive values but low positive predictive values. In this low risk population, soft markers were found in 5.9% of fetuses at second trimester ultrasound; markers were isolated in 5.1%, multiple in 0.7%, and combined with anomalies in 0.1% [1]. Jelliffe-Pawlowski, LL, Walton-Haynes, L, and Currier, RJ (2009). A historical and practical review of first trimester aneuploidy screening. A meta-analysis found that a thickened nuchal fold is the only soft marker associated with increased risk of trisomy 21.40 When soft markers are isolated, reassurance can be offered to most women after negative quad screening or NIPT testing. After normal screening for the aneuploidy in first trimester, there are no uniform recommendations regarding when to disregard or put on clinical significance in isolated soft markers. Two markers were identified at your 24-week scan: mild pyelectasis and an intracardiac echogenic focus. discussion of options for noninvasive aneuploidy screening through
For fetuses with urinary tract dilation
SUMMARY: Soft markers are ultrasound findings that do not represent a structural anomaly, may be a normal variant, but have been associated with increased risk for fetal aneuploidy. Should Amniocentesis or Chorionic Villus Sampling Be Offered to All Pregnant Women?
Negative NIPT, but 2 soft markers found - Reddit Karyotyping of fetuses with isolated choroid plexus cysts is not justified in an unselected population. Prenatal diagnosis and management of mild fetal pyelectasis: implications for neonatal outcome and follow-up. Thanks in advance. However, the introduction of noninvasive prenatal testing (NIPT) with cell-free fetal DNA from maternal plasma may enabled to deal with soft markers as indicators of fetal chromosomal abnormalities [1,4,7]. Female fetus. Soft markers are ultrasound findings that do not represent a structural anomaly, may be a normal variant, but have been associated with increased risk for fetal aneuploidy. It's much more likely that you have a false positive from soft markers than a false negative from the NIPT, but it can happen. A Group Owner is a member that has initiated the creation of a group to connect with other members to share their journey through the same pregnancy & baby stages. Echogenic bowel on second-trimester ultrasonography: evaluating the risk of adverse pregnancy outcome. soft markers has shifted. of growth (GRADE 1C). It is superior to first- or second-trimester serum screenings with fewer false positives and higher positive predictive values for trisomies 18 and 21. Hurt, L, Wright, M, Brook, F, Thomas, S, Dunstan, F, and Fone, D (2014). (2) for pregnant people with no previous aneuploidy screening and
indication for fetal echocardiography, follow-up ultrasound imaging, or
Group Black's collective includes Essence, The Shade Room and Naturally Curly. Jung, E, Won, HS, Lee, PR, and Kim, A (2007). IEF is defined as an echogenic small spot inside the heart having brightness equivalent to that of the bone. Aneuploidy is the presence of one or more extra chromosomes or the absence of one or more chromosomes. Controversially, the meta-analysis of Voskamp et al. Ultrasound Obstet Gynecol. Association of isolated single umbilical artery with perinatal outcomes: systemic review and meta-analysis. Risk of amniocentesis is not justified if CPC is an isolated finding and amniocentesis is only acceptable if other major anomalies are present [6,21]. Soft markers were originally introduced to prenatal ultrasonography to
Prenat Diagn. Cookie Notice Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s).
Negative NIPT but 2 soft markers? : r/NIPT - Reddit This activity is intended for healthcare providers delivering care to women and their families. Use of this site is subject to our terms of use and privacy policy. Feel free to buy additional CME hours or upgrade your current CME subscription plan, You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. I just had my appointment with a Genetics Counselor where they offered for me to do an amniocentesis (after an echocardiogram next week & a growth scan right before my MFM appointment) to look for other things. to estimate the probability of trisomy 21 and discussion of options for
By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. However, a few studies have suggested that diffuse echogenicity in the fetal heart, especially when the right ventricle is also involved, may signal a poor prognosis and deserves a further search for associated pathologies [27,28]. Because fetal aneuploidy can affect any pregnancy, all pregnant women should be counseled and offered aneuploidy screening regardless of age. Large randomized controlled trials will be needed in management of thickened NF. Group Owners uphold the core values of the brand by reporting content that violates the community guidelines. Isolated sonographic markers for detection of fetal Down syndrome in the second trimester of pregnancy. Fetal cell-free DNA testing (noninvasive prenatal testing), which is generally performed at or after 10 weeks' gestation, can be used to determine the likelihood of trisomies 21, 18, and 13, as well as fetal sex and sex chromosome aneuploidy. Lancet. It has been estimated that between 0.5 to 2.8% of euploid fetuses will have images consistent with delayed ossification of the nasal bone in either first-or second trimester sonography [23]. I know the amnio is scary, but these days it's very safe. Do not order serum aneuploidy screening after noninvasive prenatal testing has already been performed. It is performed any time after 15 weeks' gestation; earlier amniocentesis has higher complication rates.44 Both tests carry a risk of pregnancy loss, with an estimated risk of one in 455 for chorionic villus sampling and one in 900 for amniocentesis.1,45 The laboratory tests performed depend on the indication for the diagnostic procedure but may include karyotyping, chromosomal microarray, or fluorescent in situ hybridization. During the period from 10/21/2021 through 10/21/2023, participants must read the learning objectives and faculty disclosures and study the educational activity. Your post will be hidden and deleted by moderators. If no screening has been http://creativecommons.org/licenses/by-nc/4.0/, Detail evaluation for other markers of aneuploidy, Evaluation of fetal heart, consider fetal echocardiography, 32-week ultrasound to assess growth and to rule out certain skeletal dysplasia, Undergo targeted anatomical survey (level II ultrasound). Thickened NF is defines as, thickening of the skin and the subcutaneous tissues on the posterior aspect of the fetal neck measuring 6 mm or greater before 20+6 weeks gestation. with negative serum or cell-free DNA screening results and an isolated
In about 90% of cases they resolve by the third trimester of pregnancy [6]. A retrospective analysis demonstrated associations between abnormal quad screening markers and adverse pregnancy outcomes.13,22 Women with abnormal quad screening results without subsequent evidence of aneuploidy or neural tube defect may have increased risk of adverse pregnancy outcomes, including preterm birth, fetal growth restriction, preeclampsia, and fetal loss. If you wish to receive acknowledgment for completing this activity, please complete the test and evaluation. to estimate the probability of trisomy 21 and a discussion of options
first-trimester screen, integrated screen, sequential screen, contingent
If there are no other anomalies and normal karyotype, it is reasonable to reassure that the likelihood of a good neonatal outcome is high. echogenic bowel, we recommend an evaluation for cystic fibrosis and
Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis. This paper will review recent literatures about the most common second trimester sonographic soft markers and propose a simple clinical guideline for management of specific soft markers in pregnancies (Table 1) [3,6,10,1236].
Negative NIPT but 2 soft markers seen on ultrasound : r/NIPT - Reddit Norton, ME (2013). Low risk NIPT but soft marker in ultrasound : Hi ladies I had the Harmoney test done at 11 weeks and it came back 1 in 10,000 so low risk however At my recent ultrasound a soft marker was found. Hi all, I had my NIPT testing done at 12 weeks and it all came back negative/low risk. All Rights Reserved. Studies advocate serial fetal growth assessment when isolated echogenic bowel was detected at the first and the second trimester because it is associated with FGR and increase in intrauterine fetal demise (relative risk [RR] 1.6 for FGR and 8.6 for intrauterine fetal demise). Obstet Gynecol. options. Regarding the location, 88% are found in the left ventricle and 5% in right ventricle. Furthermore, more studies are needed to establish standard guidelines and to facilitate the application of soft markers to the clinical practice in Koreans. presented in this activity is not meant to serve as a guideline for patient management. fetal cytomegalovirus infection and a third-trimester ultrasound
These doctors see this all the time and I dont think they would give us false hope. Please try to speak to a genetic counsellor. She also told me the MFM clinic I'm going to does a lot of amnios and has never had a loss, and modern day risk averages 1:1000. Any NIPT test may have a false-positive, false-negative, or no-call result. The genetic counselor said she was most concerned about Down syndrome, so thats definitely encouraging now that that is ruled out. The impact of isolated single umbilical artery on labor and delivery outcome. Its prevalence varies between 0.3 and 1.5 per 1,000 births [16]. SUA is characterized by absence of one of umbilical arteries and it occurs in 0.5 to 5% of pregnancies. I just had my anatomy scan today and the midwife said I have 2 soft markers (EIF and CPC). The amnio is diagnostic and also tests for other genetic problems not tested by the NIPT (1-2% risk in each pregnancy). Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. I then paid for the harmony test and it came back low risk. Please update us when you know more. CPC is a small sonographically discrete fluid-filled space 5 mm within the choroid plexus and CPC is seen as black echo-free areas. First-trimester combined screening consists of ultrasound testing of fetal nuchal translucency, maternal serum pregnancy-associated plasma protein A (PAPP-A) levels, and free or total human chorionic gonadotropin (hCG) levels obtained between 10 0/7 and 13 6/7 weeks' gestation.1,18,19 Nuchal translucency alone should not be used to screen for trisomy 21 in singleton pregnancies.