Multiple marker screening - eFTS/MSS

MMS Requisitions

These requisitions can be used to order enhanced first trimester (eFTS), maternal serum quadruple screening (MSS) in the second trimester, and maternal serum alpha-fetoprotein (MS-AFP) screening for open neural tube defects (only under certain criteria).

• Trillium Health Partners – Credit Valley Hospital requisition
• Mount Sinai Hospital requisition
• North York General Hospital requisition

Points to Consider

When completing the MMS requisition for your patient/client, it is important to consider the following:

1. The clinical information section is to be completed by the ordering provider prior to the bloodwork
2. The ultrasound information section is to be completed by:
   • When ordering eFTS – the sonographer/physician who is measuring the nuchal translucency should complete this section, along with their provider identifier to facilitate NTQA
   • When ordering second trimester MSS - the ordering provider should provide the ultrasound dating information.
3. Missing information decreases the quality of the screen and can potentially delay the results
4. Prenatal screening results will be reported to the ordering provider within 7-10 business days

 Non-invasive prenatal testing (NIPT)

Non-invasive prenatal testing (NIPT) is currently available to all pregnant individuals in Ontario. The funding for NIPT varies and will depend on the reason for testing.

NIPT Requisitions

OHIP-Funded NIPT

These requisitions are to be completed by a health care provider for those patients who meet the

Ministry of Health and Long-Term Care criteria for funding.

• Dynacare Lab (Harmony) OHIP requisition
• Lifelabs (Panorama) OHIP requisition

Patient-pay NIPT

If a patient does not meet the MOH criteria for OHIP-funded NIPT, there are two laboratories that perform NIPT in Ontario: Dynacare and LifeLabs. The cost of their test is between $500-$550. 

There are other labs who provide this type of screening outside of Canada, however Prenatal Screening Ontario does not have any oversight, data capture or quality role. These companies may require more involvement from the ordering provider (may require a few extra steps to obtain the kit for the testing, etc.). Please be aware that the samples would be analyzed outside of Canada.

• Dynacare Lab (Harmony) patient-pay requisition
• Lifelabs (Panorama) patient-pay requisition

Ministry of Health and Long-Term Care (MOHLTC) funding

If one of the following specific clinical criteria are met, NIPT will be funded by the Ontario Health Insurance Plan (OHIP).

Category I criteria: (can be ordered by any physician)

• a positive prenatal screening result from multiple marker screening (MMS) for this pregnancy
• the maternal age (or age of the egg donor) will be 40 years or older at the expected date of delivery
• the nuchal translucency (NT) measurement is ≥3.5mm
• there is a personal history of a previous pregnancy or child with a specific chromosome condition

Category II criteria: (must be ordered by a genetics or maternal-fetal medicine specialist)

• there are findings on ultrasound which are associated with an increased chance for trisomy 21, trisomy 18 or trisomy 13
• there is risk for a sex-linked genetic condition
• the ultrasound shows findings suggestive of a sex chromosome difference
• the ultrasound shows findings suggestive of a disorder of sex determination

Patients can be referred to a Regional Genetics centre for further information about the Category II criteria for funding and whether you meet the requirements.