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Example clinical scenario

A couple have opted to have non-invasive prenatal testing (NIPT) following a combined screening result that gave an increased chance (1 in 20) of Down syndrome (trisomy 21). The couple have just been given the results of that NIPT which show a higher chance of trisomy 21, which are in keeping with their combined screening results.

When to consider genomic testing

  • All women who have a higher-chance NIPT result should be offered the option of diagnostic genetic testing.
  • If the first NIPT sample gives no result, or the sample is rejected, the patient should be offered either a further NIPT sample or diagnostic genetic testing.
  • If the second sample also fails to give a result, the patient should be given the option of diagnostic genetic testing.

What do you need to do?

  • Refer to local guidance regarding higher-chance NIPT discussion and fetal medicine referral.
  • Referral to clinical genetics is not routinely indicated for a higher-chance NIPT result. A review by fetal medicine teams will determine whether genomic testing is appropriate, and referral to clinical genetics can be considered in certain circumstances.
  • The relevant team will refer to the NHS England National Genomic Test Directory eligibility criteria to determine which tests are available for your patient. The directory itself provides a list of all available tests.
  • Decide which testing is most suitable for the specific clinical scenario and for your patient.
  • For DNA-based tests (including all the above tests), an EDTA sample is required. For many of the tests (particularly whole genome and exome sequencing), parental samples are also needed or are helpful. Please refer to your local Genomic Laboratory Hub for details of test request forms and where to send samples.
  • Information about patient eligibility and test indications was correct at the time of writing. When requesting a test, please refer to the National Genomic Test Directory to confirm the right test for your patient.

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  • Last reviewed: 10/09/2024
  • Next review due: 10/09/2025
  • Authors: Dr Laura Parnell
  • Reviewers: Jo Hargrave, Dr Jessica Woods