On April 1, the State of California implemented a change in the Prenatal Screening Program that is being offered to obstetric patients.  The goal has been an improved population-based screening program to aid in the early detection of some genetic diseases.  This program offers three options, based on when a patient enters into prenatal care, the availability of testing in a region, and the particular screening desires of a patient.  ACOG understands the population advantages to a comprehensive prenatal program.  Half of the deliveries in the state are Medi-cal.  We support the concept of population-based screening that follows ACOG guidelines.  Change is difficult but essential in medical care, but wise implementation of practice guidelines is critical to success.  We all understand that the goal of prenatal genetics testing is to offer our patients tests with high detection rates combined with low false positive rates.  In January 2007, ACOG produced a Practice Bulletin on Screening for Fetal Chromosomal Abnormalities.  This bulletin summarized the research on aneuploidy screening, and specifically reviewed the evidence for ultrasonic measurements and serum markers.  They made sure to point out that screening strategies depend on the availability of nuchal translucency and chorionic villi sampling in a geographic area.

The American College of Obstetricians and Gynecologists represents over 5000 physicians providing medical care for the women of California.  It is our mission to improve health care for women and to improve access to care.  At any point in time we are balancing the needs of patients for appropriate medical evaluations and access to care which can be impacted by insurance, physical and social constraints, and by proximity to testing.

The new program offers:

Quad Marker Screening: one blood test drawn between 15 weeks - 20 weeks.

Serum Integrated Screening: combines first trimester blood results with second trimester blood test results.

Full Integrated Screening: combines Nuchal Translucency results with first and second trimester blood test results.

Some facts:

·         The Prenatal Screening Program will offer follow-up services at State-approved Prenatal Diagnostic Centers for women with screen positive results in the first or second trimesters.

·         There will be one Program participation fee (currently $162) whether the Program receives one or two blood specimens.  Medi-Cal is expected to pay for NT ultrasounds performed by credentialed practitioners.

·         The regional Prenatal Screening Program Coordinators are offering “in-services†to clinicians and their staff to explain the new Integrated Screening Program.

·         The State of California made a decision that prenatal screening can only be performed by the state program.

ACOG believes we can best help our Fellows in this time by working with the state on implementation strategies and by providing patient handouts that assist in the decision-making process.  Kaiser Permanente voluntarily implemented this Prenatal Screening Program earlier than the rest of the state.  Dr. Don Dyson, Associate Executive Director of The Permanente Medical Group and a perinatalogist has made three critical patient summaries available to the obstetric providers in California.  We are sharing these summaries here, will place them on our website and have asked the state to share the information on their website.  We believe that we can assist you most effectively by helping your practice implementation.

HANDOUT ONE:  This patient algorithm addresses the decision-making process in prenatal screening.

HANDOUT TWO:  This chart summarizes the five testing choices and assists in effective comparisons

HANDOUT THREE: This valuable website allows a clinician to input the EDD and then the dates of every test date can be printed out for the patient and as documentation in the clinical record.  Dr Marc Schiff and Jimi Fox reformatted this so all obstetricians in the state would have access.

Please, help us understand how the implementation of this program is going and let us know what changes need to happen to improve patient care

Jeanne A. Conry, MD, PhD

Chair, ACOG District IX

Click HERE to access Handout One.

Click HERE to access Handout Two.

Click HERE to access Handout Three.