PCRM is excited to offer a comprehensive prenatal screening program that combines Non-Invasive Prenatal Testing (NIPT), First Trimester Screening (FTS), and Pre-eclampsia (PE) screening.  By the end of the first trimester, TriO enables pregnancy evaluation for:

  • Chromosome differences
  • Early growth and anatomy
  • Placental disorders
  • Severe open neural tube defects
  • Markers of heart defects
  • Pre-eclampsia risk

How is TriO done?

TriO begins with an appointment at around 11 weeks of pregnancy for blood work.   A woman’s blood will be drawn for NIPT genomic assessment and for FTS measurement of two placental proteins (PAPP-A and PlGF) and a pregnancy hormone (hCG). NIPT results typically take 5-7 days.  As soon as these results are available, the genetic counselors contact you to review the results and arrange follow-up if necessary.

Then, between 11 and 14 weeks, the FTS ultrasound with PE screening is performed.   The ultrasound is performed by Dr. Seethram and results are discussed in real-time.  During the visit, the woman’s blood pressure will also be measured. After this is completed, the genetic counselors input the data from the ultrasound, determine the FTS blood work results, and discuss with you the final, combined results. You will be provided with a report to take home with you.

The Evolution of Screening – Why is FTS with PE screening plus NIPT the most comprehensive fetal and maternal screen?

What is NIPT?

You can read more about NIPT by linking to PCRM’s webpage: http://www.pacificfertility.ca/first-trimester/nipt.  NIPT determines with high accuracy the presence or absence of the most common chromosome differences: Down syndrome, trisomy 18, and trisomy 13.  Although the technology behind NIPT is remarkable, it cannot assess the pregnancy for conditions other than specific chromosome differences.   Thus, results from NIPT can be reassuring, but can still leave many questions about the baby’s health left unanswered.

What is FTS?

You can read more about FTS by linking to PCRM’s webpage: http://www.pacificfertility.ca/first-trimester.   FTS determines with high accuracy the presence and absence of the same chromosome differences evaluated by NIPT.   The difference is this:  FTS involves an ultrasound to assess fetal well-being and development and maternal serum measurement of a placental protein (PAPP-A) and a pregnancy hormone (hCG).

Because of its more broad approach to screening, FTS is able to detect concerns beyond the chance of fetal chromosome differences. FTS ultrasound, especially between 12 and 14 weeks, provides a good overview of the baby’s physical development and can detect birth defects unrelated to chromosome differences.

First trimester blood work gives insight into how the placenta is functioning. Maternal serum screening can be used to assess risks of complications related to the placenta that occur much later on in pregnancy. Intrauterine growth restriction, maternal hypertension, and pre-eclampsia are some of the conditions that have been associated with abnormal FTS blood work. At the beginning of 2020, additional markers and risk factors were incorporated to improve pre-eclampsia screening.

What is PE screening?

Pre-eclampsia (PE) is a multisystem disorder that typically affects 2%–5% of pregnant women and is one of the leading causes of maternal and fetal morbidity and mortality, especially when the condition is of early onset. Globally, 76,000 women and 500,000 babies die each year from this disorder. PE gives high blood pressure and signs of damage to organ systems, usually the liver and kidneys. Due to scientific advancements, it is now recommended that all pregnant women should be screened for PE at 11 to 13+6 weeks gestation using a combination of maternal risk factors, ultrasound, blood pressure measurements and blood test markers.

The benefits of TriO

The primary benefit of TriO is to have comprehensive and accurate screening information available early in the pregnancy.  MSP-covered screens (IPS, SIPS, and Quad screening) require second trimester information to calculate the chance of a chromosome condition.   Through TriO, a comprehensive picture of the pregnancy’s health will be available by the end of the first trimester.

To have screening results earlier in pregnancy has both emotional and medical benefits.   In the very likely event of normal results, early reassurance is provided.  In cases of positive or abnormal results, you can access diagnostic procedures earlier or seek specialty consultations or treatment earlier.

PCRM offers several options for prenatal screening, including first trimester screening (FTS), non-invasive prenatal testing (NIPT), pre-eclampsia screening (PE), and a combination of the three (TriO). The following table summarizes what each prenatal screening option offers.

 

TriO

NIPT only FTS & PE only
Singleton Twins Standard NIPT (singleton or twins)

Standard NIPT + 8 Microdeletion Syndromes (singleton only)

First Trimester Screening

Abdominal ultrasound: viability, growth, early anatomy, markers of chromosome differences (NT, FHR, DV, NB)*

Maternal serum: PAPP-A and hCG

 

Pre-Eclampsia Screening

(maternal blood pressure, serum PlGF, PAPP-A, history questionnaire)

 

NIPT: Chromosome differences -Trisomy 21 (Down syndrome), Trisomy 18, Trisomy 13

 

NIPT:  Sex chromosome differences (X, XXY, XXX, XYY)

 

(optional)

Not available (singleton only)

NIPT: Fetal sex(es)

(optional)

(optional)

NIPT:

Microdeletion Syndromes

6 (optional)

22q11.2 del syndrome
Cri-du-chat syndrome

1p36 deletion syndrome

Prader-Willi syndrome

Angelman syndrome

Wolf-Hirschhorn syndrome

Not available  

8

 

22q11.2 del syndrome
Cri-du-chat syndrome

1p36 deletion syndrome

Prader-Willi syndrome

Angelman syndrome

Wolf-Hirschhorn syndrome
Jacobsen syndrome**
Langer-Giedion syndrome**

 

Cost (CAD- no tax)

$1000

$1250*** $650 $950

$650

*NT = nuchal translucency, FHR = fetal heart rate, DV = ductus venosus flow, NB = nasal bone

**All microdeletion syndromes are rare, these two syndromes are very rare

***If you want to know the sex of both babies, the cost is $1250. If not, the cost is $1000.