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The FMF-Germany runs theoretical courses, attendance of which leads to the award of a Certificate of Competence entitling to perform first-trimester screening (11-14 wks).
Follow-up ultrasound training can be recognised as a theoretical course in this sense if it is held at one of the recognised training centres of the FMF-Germany. Alternatively, any course in this field can be authorised by the FMF-Germany on condition that this has been so agreed with the officiating president of the FMF-Germany in due time before the course is held, and provided that attendance of a sufficient number of qualified lecturers is ensured.
All medical doctors working in the field of prenatal diagnosis and obstetrics are invited to participate in one of the theoretical courses on the 11-14 week ultrasound scan. The minimum duration of such courses must not be less than 6 hours. The fee should be as low as possible and should cover the price of the book.
The following list is designed to provide an overview of topics to be covered in the course: Principles of screening examinations, background risk of chromosomal abnormality, risk calculation procedure, invasive diagnostic testing, measurement guidelines for the nuchal translucency scan, diagnosis of fetal malformation in the first trimenon, multiple gestation in the first trimenon, assessment of biochemical parameters, free beta-hCG and PAPP-A. The respective focus may be modified and varied, and should always be consistent with the current state of the art.
The course should involve both a demonstration of nuchal translucency measurement and a live demonstration of risk calculation. The possibility to complete practical examinations can, but need not be, provided to the course participants.
  Principles of screening examinations:
Data distribution, normal, abnormal, cut-off, false-positive rate, false-negative rate, probability quotient (abnormal/normal), principles of risk modification through multiplication by probability quotient
  Screening based on maternal age:
Maternal age distribution, age of 35 (rising risk with increasing age)
Background risk of trisomies 21, 18 and 13
Background risk of sex chromosome disorders, Turner syndrome, triploidy
Background risk and gestational age (decreasing risk with rising number of weeks)
Risk in the case of previous histories of trisomy 21, 18, 13 (background +0.75%)
Risk in the case of previous histories of sex chromosome disorder, Turner syndrome, triploidy (background +0%)
  Measurement guidelines for the nuchal translucency scan:
11+0 until 13+6 weeks of gestation
45-84 mm crown-rump length
Mid-sagittal section, neck position parallel to transducer head
Image magnification (the fetus should occupy at least 75 % of the image, maximum interval spacing of measurement 0.1 mm)
Neutral position (flexed, hyper-extended, umbilical cord)
Largest distance between the two lines, in right angle (90°)
Placement of calipers on the lines, in as close a position as possible to translucency
  Percentile curves:
Crown-rump length
Nuchal translucency
  Nuchal translucency studies:
Snijders Study (n = 100 311, T21 = 326)
(T21 NT = 95th percentile 72%, normal 5%, T21 risk = 1:300 82%, normal 8.3%)
Zoppi Study (n = 12 499, T21 = 64)
(T21 NT = 95th percentile 80%, normal 5%)
The German-language study (n = 23 805, T21 = 210)
(T21 NT = 95th percentile 83%, normal 8%, T21 risk = 1:300 87, 6%, normal 13%)
Meta-analysis (n = 86 012, DR = 79%, FPR = 3%)
  First-trimester serum biochemistry:
Which serum picture matches which chromosomal disorder
Free beta-hCG: increased in trisomy 21
PAPP-A: decreased in trisomy 21
Trisomies 18 and 13, Turner syndrome, triploidy (both forms)
OSCAR principles (one-stop clinic for assessment of risks)
patient information: 85-90% sensitivity, 5% false positive
nuchal translucency measurement, serum analysis
result disclosure: demonstration of findings (FMF software)
decision-making
possible invasive testing
follow-ups as an integral part of quality assessment
  Ductus venosus:
Matias study: reverse flow, normal: 3.1% (13/423), chromosomally abnormal: 57/63 (91%)
  Nasal bone:
Cicero study: NB (-): T21 73% (43/59, LR 146), normal 0.5% (3/603, LR 0.27%)
  Statistical models on various combinations of non-invasive diagnostic testing:
Age, NT, NB, biochemistry, ductus venosus
NT followed by second-trimester serum biochemistry
NT followed by second-trimester ultrasound
  Invasive diagnostic testing:
 Indications, point of time, rates of miscarriage, leakage, method, mosaics (CPM)
Chorionic villus sampling (from 11+0 weeks of gestation onward): direct preparation, long-term cultivation
Amniocentesis (from 16+0 weeks of gestation onward): FISH
Amniocentesis (from 14+0 weeks of gestation onward)
Cordocentesis (from 20+0 weeks of gestation onward); Rh incompatibility, alloimmune thrombocytopenia, parvovirus B19
Studies: Nicolaides, Sundberg, Tabor, Canadian
  Malformations in the first trimenon:
Increased NT and normal karyotype
genetic syndrome: Souka studies
skeletal anomalies: extracellular matrix (genetic table)
cardiac defects: Hyett studies
CNS anomalies: acrania/exencephaly/anencephaly, encephalocele, Meckel-Gruber syndrome, hydrocephalus/hydranencephaly, Dandy-Walker malformation, holoprosencephaly, iniencephaly, spina bifida
Abdominal wall defects, omphalocele, gastroschisis
Urogenital malformations: renal aganesis (bilateral), infantile polycystic renal disease, multicystic dysplastic renal disease, hydronephrosis, megacystis
Skeletal anomalies: caudal regression syndrome
  Multiple gestations:
Zygosity, chorionicity, amniocity
Miscarriages, premature deliveries, perinatal mortality, IUGR
TTTS: diagnostic criteria, conservative/surgical treatment
Death / Structural anomalies of the fetus and pertinent management
Chromosomal disorders: choice of invasive diagnostic method (AC versus CVS)
Reduction of multiple pregnancies and embryo reduction
The content of the course is also dealt with in the book "The 11 - 14 Week Scan: The Diagnosis of Fetal Abnormalities", KH Nicolaides, NJ Sebire, RJS Snijders, Parthenon".