O&G Cases · Antenatal care — screening and prenatal diagnosis
Screen-positive result — counselling and diagnostic decision station
Simulated-patient counselling station on a screen-positive cfDNA result: explaining that cfDNA is a screening test, naming the diagnostic pathway (CVS), putting the risk in context, supporting a shared decision, and acknowledging the emotion. Includes assessor timeline, marking domains, assessor key and fail criteria.
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Target exams
Station brief
Format. Simulated-patient communication station, approximately 12 minutes. A trained actor plays the patient. The assessor observes and feeds one piece of new information. There is no examination and no procedure. [2]
Candidate instruction. Explain the result honestly, correct the misunderstanding that cfDNA is definitive, put the risk in context, explain the diagnostic test (CVS) and its risk, and support a shared decision. Verbalise everything. [2]
Her context. She is 38, first pregnancy, conceived naturally. She paid privately for cfDNA after a normal combined screen. She has read that cfDNA is "over 99 percent accurate" and has interpreted that as definitive. [1]
References4ShowHide
- [1]Gil MM, Accurti V, Santacruz B, et al. Analysis of cell-free DNA in maternal blood in screening for aneuploidies: updated meta-analysis Ultrasound Obstet Gynecol, 2017.PMID 28397325
- [2]American College of Obstetricians and Gynecologists Screening for Fetal Chromosomal Abnormalities: ACOG Practice Bulletin, Number 226 Obstet Gynecol, 2020.PMID 32804883
- [3]Beta J, Zhang W, Geris S, et al. Procedure-related risk of miscarriage following chorionic villus sampling and amniocentesis Ultrasound Obstet Gynecol, 2019.PMID 30977213
- [4]Scheffer PG, Wirjosoekarto SAM, Becking EC, et al. Association between low fetal fraction in cell-free DNA testing and adverse pregnancy outcome: A systematic review Prenat Diagn, 2021.PMID 34350596