MSS2 is an optional test and should be offered to all women except where:

• an earlier scan has shown an anomaly which is being separately investigated.
• the woman has a genetic or chromosomal condition. In this case, refer to specialist obstetric care for advice. 
• there is a multiple pregnancy of triplets or higher.

The LMC or doctor ordering the test must ensure that:

• written information should be offered to the woman and she must be supported to obtain further information if required. 
• informed consent, which may be verbal, must always be obtained prior to testing and this should be documented in the woman’s notes.
• there should be agreement about how the results will be communicated to the woman and by whom.

Please see the Referral Guidelines for further information.

Most women access the nuchal translucency (NT) scan in their first trimester. As specified in Section 88 the NT scan must only be undertaken by sonographers that are accredited to perform this test. At present NT scan measurements are often provided to women as a single risk assessment of fetal anomaly. 

These measurements from the NT scan can also be combined with the MSS2 measurements to provide a more accurate risk assessment. In order to minimise the confusion about the risk results, women who are also having MSS2 should only be given one combined result. We are therefore requesting that sonographers provide women with the scan report, but do not discuss the measurements of the NT scan. This information will be provided to LMCs by the Laboratory, combined with the MSS2 result to give a risk estimate. The Lead Maternity Carer is in the best position to communicate the risk estimate to the pregnant woman.

MSS2 is a blood test of maternal serum to screen for increased risk of fetal anomalies for trisomy 13, 18, 21, neural tube defects and other biochemical markers indicative of fetal compromise and at risk pregnancies. The test, also known as the triple test, is comprised of measurements of alpha feta protein (AFP), Beta hCG (βhCG) and unconjugated eostriol (uE3). The sample can be taken between the 14th –20th week of pregnancy. Prior to 15 weeks the sample will not contain adequate amounts of AFP to safely measure the risk of neural tube defect. After 18 weeks the reliability of the test begins to decline. The optimum period to test is 15-18 weeks of pregnancy. 

Ordering MSS2

To support the ordering of MSS2 the following resources are available:

• Laboratory form pad: the top cover provides the referral guidelines and information to help when completing the laboratory form
• Consumer information sheets to support the discussions practitioners have with women when offering screening. 

The forms and sheets can be downloaded as PDF files. 

Laboratory Form

Consumer Information Sheet

To order a pad of 50 sheets please contact:

LabPLUS 
Level 3,
Building 31
Gate 4
Auckland Hospital,
Grafton Road
Auckland.
Enquiries: 09 307 4949 Extn 6729.

What Other Quality Improvements Are Planned?

Other quality improvements planned by the NationalSU which will be implemented by mid 2009 include the development of:

• a range of screening tests/pathway options that can be accessed by women who present in the first and/or second trimester
• information for pregnant women and their partners
• information and standards for practitioners on appropriate screening tests and protocols
• standards for ultrasound services and laboratories
• improved access to counselling, support services and genetic services
• monitoring of laboratories, ultrasound services and pregnancy care providers.

Feedback about the Forms and Documentation

Your comments and feedback are very important to us. You can help improve the content of the consumer pamphlets, laboratory forms and referral information by emailing your comments to MSS2literature@moh.govt.nz.
 
With any other enquiries, please feel welcome to contact Nicola Deveraux, Programme Manager Antenatal Screening, on (09) 580 9243 or email nicola_deveraux@moh.govt.nz