Provider Tools
Point of care tools, patient leaflets, slide deck and other resources
Performance of traditional multiple marker screening (eFTS/MSS) and NIPT in Ontario
Locations of genetics centres in Ontario, and when to consider a referral
COVID-19 and Prenatal Genetic Screening
Update (January 12, 2021) - The temporary measures outlined below came into effect on April 6, 2020 and have been extended to June 30, 2021.
Ontario currently uses a two-step prenatal screening system, with enhanced First Trimester Screening (eFTS) generally being the first step. However, at the onset of the COVID-19 pandemic, the delivery of prenatal screening services in Ontario was impacted:
- Some diagnostic imaging centres were not offering dating and NT ultrasounds
- Community blood collection services were being consolidated to a smaller number of labs
- Pregnant individuals in self-isolation were missing the NT ultrasound window
Temporary changes were recommended by PSO and endorsed by the Ontario Ministry of Health on April 6, 2020 to provide patients with alternative pathways for obtaining robust government-funded screening in the event that a NT ultrasound is missed. These measures have been extented until June 30, 2021.
Prenatal Screening Ontario (PSO), supported by the Ministry of Health, is endorsing the following measures:
Singletons: NT ultrasounds should be offered to all pregnant individuals whenever possible. If an NT ultrasound cannot be done, order the MSS.
- MSS is the only validated serum screen in Ontario that can be used without ultrasound information, and can be done from 14 weeks to 20 weeks 6 days gestation.
- A concurrent change in the screening cutoff for MSS occurred, moving it from 1:200 to 1:350 (bringing the screening performance to a similar level as eFTS).
- PSO cannot endorse first trimester serum-only screening because provincial data collected by BORN Ontario has insufficient numbers to allow for quality assurance.
Twins: Prioritize NT services. The Ministry of Health will temporarily fund NIPT for all twin pregnancies if a NT ultrasound is not available OR if maternal age is 35 or older at expected date of delivery. In these circumstances, NIPT can be ordered by any physician or nurse practitioner (effective April 6, 2020 until June 30, 2021).
- NT ultrasounds are essential for twin pregnancies as serum screening alone is NOT possible for twin pregnancies (i.e. MSS is not a validated option). The value of NT ultrasounds extends beyond screening for Down syndrome and trisomy 18.
Higher-Order Multiples: The only option continues to be an NT ultrasound.
- For triplets, quadruplets, or more, the only option is NT ultrasound (eFTS, MSS and NIPT cannot be done).
- Serum screening alone is not possible for higher-order multiples (i.e. MSS is not a validated option for twin pregnancies).
Additional Resources
Screened Conditions
Further information and resources on the screened conditions:
Practice Guidelines / Position Statements
| Society of Obstetricians and Gynaecologists - Prenatal Testing Guidelines |
| Public Health Agency of Canada - Maternity Guidelines (Loss and Grief) |
| Chapter 7: Loss and grief - guidance on how to support families through perinatal loss |
| Canadian Down Syndrome Society |
| Prenatal Position Statement |
Other Prenatal Resources
| Genetics Education Canada - Knowledge Organization (GECKO) |
| Guide to understanding prenatal screening tests |
| OMama |
| OMama is a website and app that connects you to trusted, evidence-informed pregnancy, birth, and early parenting information (focusing on resources in Ontario, Canada) |
| PregnancyInfo.ca |
| PregnancyInfo.ca is an initiative of the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the content on this websiteis based on SOGC guidelines |
| Centre for Effective Practice |
| Primary care resources for your practice |
| Canadian Association of Genetic Counsellors |
| List of contact and referral information for Canadian genetic clinics |
| Best Start / Health Nexus |
| The Best Start Resource Centre supports service providers who work in preconception health, prenatal health and early child development |
| Pregnancy and Infant Loss Network (PAIL) |
| Pregnancy and Infant Loss Network provides support to families across Ontario who experienced the loss of a pregnancy or infant. |
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