research day - University of Toronto Department of Obstetrics and ...

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ABSTRACT #O2
WHAT WOMEN WANT: PATIENTS’ PREFERENCES ABOUT REPORTING OF
ULTRASOUND SOFT MARKERS
Rebecca Cash [R](1), Myuri Manogaran (2), Hana Sroka (3), Nan Okun (4)
(1) Department of Obstetrics and Gynaecology, University of Toronto, (2) University of Toronto,
(3) Department of Genetics, Mount Sinai Hospital (4) Maternal Fetal Medicine Division,
Department of Obstetrics and Gynaecology, Mount Sinai Hospital
Objective: The Society of Obstetricians and Gynecologists of Canada (SOGC) recommends
routine use of a single ultrasound at 18-20 weeks in all pregnancies. New guidelines from the
SOGC , the American College of Obstetrics and Gynecology (ACOG) and the American College
of Medical Genetics recommend that all pregnant women, regardless of their age, be offered
screening for Down syndrome. Soft marker screening at the time of anatomical ultrasound has
been incorporated into the multitude of genetic screens available to pregnant women. The process
of informed consent for ultrasound screening has been shown to be grossly inadequate. To date,
there are no studies that examine women’s views on the examination for, and reporting of
ultrasound soft markers. We conducted a survey of women’s prior knowledge and opinions on
ultrasound soft markers.
Methods: A prospective survey of 263 women undergoing18-20 week anatomy ultrasound at
Mount Sinai Hospital, a level three perinatal referral center for a multiethnic population of
approximately 2.5 million, after ethics approval.
Results: Prior to reading an information pamphlet provided in the context of this survey, 30 %
(79/263) of women reported having heard of the term soft marker and 59% (47/79) of these women
had discussed soft markers with their caregiver. 85% of women attending a midwife who had heard
of the term soft marker reported having discussed this with that caregiver compared to 54% of
comparable women attending an obstetrician. The latter group more commonly reported their
source of information to be from a genetic counselor or from the internet. Of women who were
familiar with the term soft marker 25% attended an obstetrician, 35% attended a family doctor and
68% attended a midwife for prenatal care. Of all respondents, 53% preferred that soft marker
findings should be reported routinely, 20% said they should be reported if the caregiver thought it
was required and 23% preferred they be reported only after discussion prior to the ultrasound
exam. A minority of respondents (8%) had not participated in prenatal screening for aneuploidy.
Of these women, all preferred that soft markers should only be reported after prior discussion.
Conclusions: The study demonstrates that a majority of women have received little to no
counseling regarding routine examination for soft markers at second trimester ultrasound. Only 8%
of our study population had not participated in genetic screening in the first trimester of her
pregnancy. Of these women, all stated that they believed soft markers should only be reported after
prior discussion. These findings validate and emphasize the importance of counseling our patients
appropriately and attaining adequate informed consent for genetic screening not only conducted in
the first trimester but also at the time of second trimester ultrasound scan.