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Obstetrics & Gynecology 2008;112:218-222
© 2008 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

First-Trimester and Second-Trimester Screening at a Community Hospital

Experience From the First Year of Implementation

Elliot H. Philipson, MD, Michelle Callahan, RN and J. Eric Jelovsek, MD

From the Department of Obstetrics and Gynecology, Cleveland Clinic Lerner College of Medicine, Hillcrest Hospital, Mayfield Heights, Ohio.

OBJECTIVE: To review the first-year experience implementing a new early screening during pregnancy program for aneuploidy in a community hospital and compare this program with the screening program immediately preceding its implementation.

METHODS: The electronic medical records of all pregnant patients referred from May 17, 2005, through December 31, 2006, for genetic counseling were reviewed for maternal characteristics, indication for referral, a priori and adjusted risk of aneuploidy, and patient choice for screening or testing. The new early screening program (nuchal translucency group) consisted of additional educational materials, nuchal translucency, serum biochemical analytes, quad screening, and invasive testing when indicated. This cohort was compared with the patients who received traditional genetic screening or testing (pre–nuchal translucency) immediately preceding the nuchal translucency program.

RESULTS: A total of 101 patients were included in the pre–nuchal translucency group compared with 359 patients in the nuchal translucency group. The most common reason for referral was advanced maternal age; there were no differences in the maternal characteristics between the two groups. Forty-six percent of patients in the early screening program underwent an invasive procedure compared with 76% in the pre-nuchal translucency group (odds ratio 0.26, 95% confidence interval 0.15–0.42; P<.001).

CONCLUSION: Early screening programs in a single community hospital are feasible and appear to result in a significant reduction in the number of invasive procedures with excellent patient satisfaction and acceptance.

LEVEL OF EVIDENCE: II






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