Referral practices of obstetricians in response to ACOG Bulletin number 77: Screening for fetal chromosome abnormalities

Background. Recent studies have shown much lower loss rates from amniocentesis. These studies prompted The American College of Obstetricians and Gynecologists (ACOG) to publish guidelines advising that a woman's decision of whether to have screening, an amniocentesis, or chorionic villus sampling (CVS) should be based on many factors. These factors include the risk that the fetus will have a chromosomal abnormality, the risk of pregnancy loss from an invasive procedure, and the consequences of having an affected child. The decision to perform invasive testing should take into account personal preferences and should not be based solely on age, as it has been in the past. Objective. This study attempted to determine if physicians have adopted the ACOG recommendations and explore what specific obstacles, if any, exist to the implementation of the guidelines. Methods. A 14-item questionnaire was administered to obstetricians, focusing on referral practices regarding genetic services to determine if they have incorporated the new guidelines set by ACOG, and factors that affect this process. Results. There were 18 respondents that participated in this study. The percentage of respondents that have incorporated the recommendation was 78% of those who had not incorporated the recommendation, 75% stated their reasons as availability of services and billing obstacles. There were no significant relationships between practice type, length of time in practice, the percentage of patients referred to genetic services in a given year, and the implementation of the guidelines. Conclusion. Obstetricians state they have included the ACOG guideline in their clinical practice, informing patients of changes to the availability of testing options not previously indicated. Obstacles that impact the ability of a minority of obstetrical practices to implement the guidelines should be taken into consideration to facilitate this process.Keywords. Prenatal, ACOG, obstetricians, amniocentesis, CVS.