The BC Perinatal Health Program has unveiled its new Prenatal Genetic Screening Program, with mailings of an algorithm and pamphlets to be handed out to patients.

The program is very good, with an algorithm that is clear and easy to follow. The recommendation with nuchal translucency (NT), however, I believe, puts us practitioners in a very awkward medicolegal position. The protocol directs that NT be recommended for pregnant women aged 35 to 39 “if available.” However, when a requisition is submitted under such circumstances to either the BC Wo­men’s Hospital or Surrey Memorial Hospital (I have not canvassed other hospitals), the requisition is rejected citing “clinical situation does not meet criteria.” I understand that NT need not be offered if the test is not available. However, in such instances, the aforementioned hospitals should issue statements that NT is not available. Otherwise, the implication is that it is available. In such a case, for us to not recommend it would expose us to medicolegal difficulties in the unfortunate (albeit maybe rare) circumstance that a positive case is not picked up by a Serum Integrated Prenatal Screen. On the other hand, if we choose to protect our own behinds by submitting requisitions, fully expecting rejections, the patients would get confused and worried that they are missing out on a test that is recommended by the powers that be!

—Peter Yeung, MD
Surrey