BACKGOUNDInvasive prenatal diagnosis (PND) through amniocentesis and chorionic villus sampling (CVS) can detect Down syndrome. Pregnant women usually experience a variety of psychological responses associated with invasive PND. This study is intended to assess depression, anxiety and stress levels and the factors related to their psychological responses in pregnant women with invasive prenatal diagnosis of Down syndrome. METHODSA cross sectional study was conducted at Kandang Kerbau Women's and Children's Hospital, Singapore. The psychological responses of 70 women undergoing PND were assessed by Depression Anxiety Stress Scale 21 (DASS 21) questionnaire. A multiple linear regression analysis was used to analyze association between knowledge and perceived risk with psychological responses (CI 95% and significance value p<0.05). RESULTSMore than half of the participants had normal anxiety (55.7%), stress (72.8%), depression levels (65.8%). The results revealed significantly higher level of anxiety in women with gestational age >13 weeks who had pursued amniocentesis. Women with no previous children had higher levels of depression and stress. Women who pursued amniocentesis had significantly higher anxiety scores compared to women undergoing CVS (p=0.015). CONCLUSIONS

We are heartened to read that the authors found our commentary insightful.(1) There is currently a myriad of prenatal tests available to patients, and in order for clinicians to help patients make a truly informed decision about their test options, it is integral that they have thorough knowledge of the details of the tests and how they compare with each other.We strongly feel that the authors' view that "additional benefits such as identifying cardiac defects in the foetus may be a bonus"needs to be addressed. It is widely known that congenital heart defects are the most common type of congenital malformation, with an incidence of 1 in 100 to 1 in 150. (2) Compared to the 1 in 700 birth incidence of Down syndrome (DS) and the 1 in 7,000 to 1 in 10,000 birth incidence of Trisomy 18 (T18), (3)(4)(5) congenital heart defects are 7-100 times more prevalent and hence a greater cause of concern for the general population. Given such high frequencies, efforts taken to identify heart defects during pregnancy is not simply 'a bonus'.Early screening for possible cardiac defects will only be for the benefit of patients, as it will prompt clinicians to be more vigilant in their care -either by recommending a foetal echocardiogram, or at least by paying careful attention to the foetal heart during the routine 20 weeks ultrasound scan.Although the authors explained that the purpose of their paper was "to offer informed choices in the prenatal testing for foetal aneuploidy", (1) we find that it is crucial that we address the definition of informed choice. We agree with the authors that decisions about testing should be made autonomously by the patient, but readers should be reminded that patients are only able to make an informed choice if they have sufficient information in hand about their test options, including details of the conditions covered by the test, and understand the risks, benefits and limitations of the tests they are considering. The role of genetic counselling in noninvasive prenatal testing (NIPT) has been addressed by many concerned parties. (6)(7)(8) The National Society of Genetic Counselors (NSGC), for example, recommends that "pretest counseling for NIPT include information about the disorders that it may detect, its limitations in detecting these conditions, and its unproven role in detecting other conditions".(9) It has been clearly understood that although the detection for DS and T18 using NIPT is higher than that of first trimester screening (FTS), NIPT will not detect any other abnormalities that would have been suggested in FTS. In fact, the American College of Obstetrics and Gynecology guidelines emphasise that "counseling regarding the limitations of cell free fetal DNA testing should include a discussion that the screening test provides information regarding only trisomy 21 and trisomy 18 and, in some laboratories, trisomy 13". (10) Like the FTS, NIPT is a screening tool for DS, T18 and perhaps even T13. Unfortunately, unlike FTS, NIPT is unable to reveal any insight into other concerns abou...

Introduction: Now, male partners’ involvement in prenatal screening and diagnostic testing for Down syndrome is becoming increasingly recognized as well to ensure that parents are well informed of the risks and benefits of screening. The aim of study was to understand the degree of male partners’ involvement during pregnancy in Singapore population. Methods: A cross-sectional survey of male partners’ attending prenatal counseling was performed. The instrument used to measure the level of involvement is a self-assessment questionnaire that identifies the role of male partners with a Likert scale. Descriptive statistics was used to analyze data gained. Result: A total of 107 participants completed the questionnaire. Sixty-seven percent of male partners were found to have a highlevel of involvement while 32.7% was found to have a medium level of involvement. Most of them stated that women can pursue prenatal testing without their permission. Male partners found it more important for them to accompany their spouse to amniocentesis or CVS than to the Down syndrome screening test. When participants were asked about how much information about Down syndrome they sought prior to the appointment, how much discussion they had with their spouse about Down syndrome testing, and about whether they or their spouse should be the first person to receive test results, most stated that they were undecided. Conclusion: These results revealed that male partners were very well involved in the Down syndrome testing during pregnancy and future studies should assess possible underlying factors that influence male partners’ involvement.

Objective To investigate preferences of pregnant women for the characteristics of prenatal testing, and to quantify their willingness‐to‐pay (WTP) for non‐invasive prenatal testing (NIPT) as first‐line screening for Down Syndrome. Method A cross‐sectional discrete choice experiment survey including five testing attributes was administered to 192 pregnant women (≤14 weeks' gestation) who were aged ≥21 years in Singapore. We calculated marginal WTP for improvements in testing characteristics and NIPT. Results We identified two groups of women with distinct preferences for prenatal testing. Women aged ≥35 years, with at least a university education, and with intention to terminate pregnancy of an affected fetus were more likely to be in the group with higher WTP for improvements in test characteristics. While participants valued increased detection rate and lower screen positive rate associated with NIPT, they also valued no risk of test failure and ability to test for birth defects using standard testing. The participants, on average, were not willing to pay for NIPT over the standard testing as a first‐line screening test. Conclusions As a first‐line screening, NIPT was not preferred over standard testing. The prenatal consultations should focus on each testing characteristic equally as our findings show diverse preferences for testing characteristics.

Poster discussion hub abstracts diaphragmatic hernia, omphalocele, gastroschisis, megacystis, limb abnormalities and hydrops. At this gestational age, we found 17 cases (1.2%) with major heart defects. Conclusions: Ultrasound screening at 11-13 weeks is a feasible and effective method to detect chromosomal abnormalities and fetal structural low-risk pregnancies. P16.08 Non-mosaic Trisomy 21 from CVS and subsequent normal karotype from amniocentesis: a rare case of fetoplacental discordance

Introduction: Aneuploidy screening is widely practised in the field of obstetrics in current times. This study thus aims to gain an insight on pregnant women’s knowledge and risk perception of Down syndrome and first trimester screening (FTS), as well as their views on various potential pregnancy outcomes and how these may affect their decision-making processes. Materials and Methods: A cross-sectional questionnaire-based qualitative study of consecutive 50 women choosing to undergo FTS at KK Women’s and Children’s Hospital (KKH), Singapore was conducted. The women completed a questionnaire after their FTS pretest counselling session. Basic knowledge of Down syndrome and FTS as well as participants’ risk perception with regards to various cut-off values used in FTS were examined. Patients’ views of various potential pregnancy outcomes were also studied. Results: Most patients had good retention and comprehension of what FTS entailed after a FTS counselling session at the KKH Antenatal Monitoring Clinic. However, knowledge of the risks of invasive diagnostic testing was poor. Patients also did not possess an adequate understanding of FTS risk values. With regards to risk perception, patients had very different views on acceptable pregnancy outcomes and what constituted a high-risk FTS value to them personally. A significant number of women were concerned even at medically low-risk values of 1:500 and 1:1000 in FTS. The majority of patients viewed highest detection rate followed by a lowest false positive rate as the more important factors impacting their choice of a Down syndrome screening test. Conclusion: This study demonstrates the diversity of pregnant women’s risk perception, risk aversion and participation in decision processes when there are 2 different values in competition. The study also highlights our patients’ gaps in knowledge and lack of understanding of risk values used in FTS. Key words: Choice, Decision-making, Pregnancy, Prenatal test, Risk assessment