title: Emerging issues in invasive prenatal diagnosis: Safety and competency in the post-NIPT era.
abstract: BACKGROUND
  Numbers of invasive prenatal procedures are declining in response to improved aneuploidy screening methods.
  
  
  OBJECTIVE
  To assess current practice and attitudes of clinicians performing invasive prenatal diagnosis in regard to patient consent and safety, maintaining procedural competence and uptake of chromosomal microarrays (CMAs).
  
  
  METHODS
  Anonymous online survey of the Australian Association of Obstetrical and Gynaecological Ultrasonologists conducted in March 2015.
  
  
  RESULTS
  The survey had a 45% response rate with 59 respondents from Australia. Of these, 34 were subspecialists in maternal fetal medicine or obstetric and gynaecological ultrasound. Fifty-six (95%) currently performed amniocentesis or chorionic villus sampling. Of these, 14 (25%) performed <25 procedures and 8 (14%) performed >150 annually, with most respondents (60%) proposing 10-25 amniocenteses/year as adequate activity to maintain their skills. The majority neither expected referrers to provide results of hepatitis B and HIV serology, nor followed up missing results. There was uncertainty regarding the procedure-related vertical transmission risk of HBV in women with high viral load, with most respondents stating they were either unsure of the risk (22%) or that the risk was unknown (30%). Fifty per cent of practitioners routinely ordered CMA after invasive testing; all recommended CMA following a diagnosis of structural abnormality.
  
  
  CONCLUSIONS
  In a period of declining testing, many Australian specialists are performing <25 procedures annually. Consideration of the potential risks of bloodborne viruses is limited. CMAs are rapidly being incorporated into clinical practice. These data have implications for patient consent and safety, and workforce training and practice.
authors: Maternal Fetal Medicine, Department of Perinatal Medicine, The Mercy Hospital for Women, Heidelberg, Victoria, Australia.|Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.|Public Health Genetics, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
authors: Lisa
authors: L
authors: Hui
authors: Australian Association of Obstetrical and Gynaecological Ultrasonologists, Sydney, Australia.|Women's and Children's Health, Westmead Hospital, Westmead, New South Wales, Australia.
authors: Stephanie
authors: S
authors: The
authors: Maternal Fetal Medicine, Department of Perinatal Medicine, The Mercy Hospital for Women, Heidelberg, Victoria, Australia.|Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.
authors: Elizabeth A
authors: EA
authors: McCarthy
authors: Perinatal Medicine, The Mercy Hospital for Women, Heidelberg, Victoria, Australia.|Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.
authors: Susan P
authors: SP
authors: Walker
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D000649:Amniocentesis / Q000009:adverse effects / Q000706:statistics & numerical data*; D001291:Attitude of Health Personnel; D001315:Australia; D015193:Chorionic Villi Sampling / Q000009:adverse effects / Q000706:statistics & numerical data*; D002983:Clinical Competence; D020732:Cytogenetic Analysis / Q000706:statistics & numerical data; D005260:Female; D006176:Gynecology / Q000706:statistics & numerical data; D015658:HIV Infections / Q000635:transmission*; D006509:Hepatitis B / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D009774:Obstetrics / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000009:adverse effects / Q000379:methods; D011795:Surveys and Questionnaires; D014463:Ultrasonography / Q000706:statistics & numerical data
keywords: amniocentesis; aneuploidy; chorionic villi sampling; hepatitis B; prenatal diagnosis; risk