Download & Sign – Down Syndrome Screening Consent Form

You have received informational materials and discussed the Multiple Marker Screen being offered to you. As you know, the laboratory uses blood to measure the levels of specific chemicals or markers for certain birth defects of the brain and spinal cord (known as neural tube defects) and for Down Syndrome. This test can help your health care provider and you to determine if further evaluation of your pregnancy is indicated for these or other defects.

As with all screening procedures, complete certainty is impossible. However, after extensive research, this test has been shown to be a substantially reliable indicator of whether or not there is an increased possibility of these birth defects affecting your pregnancy. In the majority of cases, the test results indicate the absence of an increased risk of these defects. In all cases, the test results are communicated to your health care provider.

If you choose to have this test, a blood sample will be taken from you between the 15th and 20th weeks of pregnancy. The risk of this procedure to you or your fetus is not greater than that involved with routine blood samples regularly taken during pregnancy. After performing the blood tests, the lab will report to your health care provider. This process usually requires up to a week.

Some anxiety or other emotional upset may be associated with understanding the results of a test of this kind. It is important for you to remember that even if the test results are abnormal, it does not mean that your fetus has a birth defect. Abnormal test results only suggest that further evaluation of the pregnancy is indicated. This may include another blood test, genetic counseling, ultrasound examination of the fetus and/or biochemical analysis of the fluid surrounding the fetus (amniocentesis) by a perinatologist, a specialist in maternal-fetal medicine and high risk pregnancies.

Please print the attached form and return on your next visit.