Prenatal Diagnosis Clinic (PND)

At the PND Clinic, we offer consultation services to pregnant patients and their support people regarding a number of different issues in pregnancy.

Our goal is to provide you with accurate information regarding any issues in pregnancy, or family history concerns that you may be experiencing. In order to do that, we will ask you questions about your medical, pregnancy and family histories. We will also go over the results from any important testing or ultrasounds you may have had. In some cases we will talk about other testing options, or other specialists who might be helpful. We believe in two way communication, and so please ask any questions that may come to mind during our consultation. You may find it helpful to write down questions you have before meeting with us.

The PND team includes:

• High Risk Obstetricians (MFMs)
• Genetic Counsellors
• Genetic Assistants
• Business Clerks

Some other healthcare specialists you may meet at the clinic

• Ultrasound technicians
• Social Workers
• Other specialist doctors such as Heart Specialists (Cardiologists) or Brain Specialists (Neurologists)

What is a High Risk Obstetrician? (also known as Maternal Fetal Medicine or MFM Specialists)

MFM Specialists are Obstetrician physicians who have extra training in looking after complicated pregnancies. This may include health concerns for the pregnant person, for the fetus, or both. MFMs have special expertise in understanding ultrasound findings, and providing procedures such as amniocentesis or CVS. Learn more about MFMs.

What is a Genetic Counsellor?

Genetic Counsellors are specially trained Healthcare Professionals who provide information and support to patients and families regarding different genetic conditions. In the PND Clinic, Genetic Counsellors have experience dealing with a number of issues related to risks of genetic syndromes specifically within pregnancy. For more information about Genetic Counsellors:

• National Society of Genetic Counselors
• Canadian Association of Genetic Counselors

Please fill out the PND Clinic questionnaire, and send it back to us before your appointment time. The information you give us is very helpful for us to learn more about you, any additional risk factors for your pregnancy, and to understand your questions. We will also be going through the questionnaire with you during your consultation so don’t be worried if you’re not sure how to answer all of the questions.

Please find a link here to our information booklet. For some, but not all of our patients, we may use this booklet to help us to explain certain topics. The booklet also includes our contact information. You may find it helpful to have the booklet with you for your consultation with us. Feel free to read through the booklet before your consultation, but be aware that not all of the information in the booklet may apply to you.

We understand that being referred to our clinic may cause some anxiety. Please know, that when we meet with you, we will spend as much time as you need to understand why you were referred to us, and what your options are. We are also here to support you and your decision making.

Indications for referral:

• In the PND Clinic, pregnant patients are seen for a number of reasons, including the following:
  • Prenatal screening (eFTS/MSS/NIPS) positive, atypical/inconclusive or high risk
  • Family history of a baby born with specific birth defects or chromosomal or genetic syndromes
  • Previous child or pregnancy with specific birth defects or chromosomal or genetic syndromes
  • One or both parents are carriers of a specific chromosomal or genetic syndrome
  • Maternal health concerns that may increase risks in pregnancy
  • Previous ultrasound findings of concern
  • Certain exposures which may be associated with risks to the pregnancy
• We do not offer Adult or Pediatric Genetic Counselling services.
  • You may wish to contact the Clinical Genetics service (F: 905-521-2602), the Neurogenetics clinic (F: 905-521-2638), the Cardiogenetics clinic (F: 905-577-8037), or the Cancer Genetics Clinic (F:905-575-6316) if those may be more appropriate services to refer to.
• We do not offer preconception counselling, paternity testing, or fertility related counselling
  • If you have a patient who would benefit from these services, we recommend referring to a Fertility specialist.

How to refer:

External referrals

• Please fill out a copy of our referral form and fax to the PND Clinic at 905-521-4955.
• Please ensure the required documentation is included, that there is a valid dating ultrasound, and that the reason for referral is clearly stated on the referral form.
• Any referrals sent with incomplete information will be declined, and a new referral will be required.
• If you have questions about the appropriateness of a referral, please contact the PND Clinic front desk (905-521-2100 ext. 73135) and ask to speak to one of the Genetic Counsellors. Please note, it is helpful for us to be able to review the available documentation in these cases, so it may be more efficient to send the referral and indicate that you have specific questions.

Internal referrals

• Send a referral through EPIC using the code REF203
• If the referral is urgent, you may wish to contact the front desk and ask to speak to the Triage Genetic Counsellor

Referral Form – Prenatal Diagnosis (PND) Clinic

Will I have to pay for anything in the PND Clinic?

• Most services and tests offered through the PND Clinic are covered by OHIP if you have a valid health card, a TPA agreement with a Midwifery Group, or Federal Interim health coverage. Some tests may have to be paid for in certain situations, but your Genetic Counsellor will go over all available options with you and let you know if there are any associated costs.
• There is a fee to park in the hospital parking lot and unfortunately we are not able to help with those costs.

Can I bring support people to my appointment?

• You are welcome to bring a support person with you to your in person appointment, and it is often helpful to bring a partner if you have one. One support person is preferred, especially given Covid protocols. You may choose to bring additional support people if needed, but we may not be able to accommodate more than 3 people in a clinic room at a time.
• You may have as many people with you for your virtual appointment as you would like. We can also virtually connect with a support person if they are not able to physically be with you at the time of your appointment, and you would like them to attend.
• You may have ONE support person with you for any ultrasounds you may have at McMaster Hospital. They must remain outside of the room until the ultrasound tech has finished taking the pictures they need. Then your support person can be invited into the room to see some pictures of the pregnancy.
• Please keep in mind, that as part of our consultation we ask health and pregnancy questions. If you have any concerns about the confidentiality of your own health information, you may wish to consider this when deciding which support people to include.
• Please also be aware that the pregnant person is legally our patient, and we are not able to discuss their medical information with anyone else unless they give us express permission to do so.

Are children allowed in my appointment?

• We understand that it can be hard to find childcare. However, we strongly recommend not bringing children to your appointment. The visits can be very long and difficult for children to wait through. Some of our patients hear very upsetting information, and that can be more difficult with children to attend to. If young children become fussy, it can also be hard for the parents to be able to listen to the information being given to them. If you must bring your children with you, it is helpful to bring another support person who may be able to look after your children when you’re meeting with the team.

My screen was positive for Down syndrome, but my NIPS (NIPT) came back low risk. Do I still need to come to my appointment?

• It is completely up to you if you want to attend your PND consultation or not in this situation. However, we do have additional information and options to discuss with you, and so we do strongly recommend that you keep your appointment. If you do decide to cancel, please let us know as soon as possible by calling the front desk (905-521-2100 ext. 73135) so that your appointment time may be used for someone else. We also recommend that you speak to your doctor or midwife to let them know if you decide not to come to the PND Clinic.

How do I find information out about my PND appointment?

• The best way to find out information about your appointment is to make sure you have a MyChart account. If you are not able to access your MyChart account, you can call your doctor or midwife, or call the PND Clinic front desk at 905-521-2100 ext. 73135

I don’t know why I’ve been referred. What should I do?

• The PND Clinic is not able to talk to you about the reason you were referred to us until we have our appointment. If you have questions about why you are being referred to us, please contact your doctor or midwife to get more information.

I don’t speak English well, what should I do?

• We have interpreters available for many different languages. If you think it would be helpful to have an interpreter, please ask your doctor or midwife to call us to let us know. You can also call us at 905-521-2100 ext. 73135 to let us know which language you need to have an interpreter for.

How do I get referred to the PND Clinic?

• We do require a formal referral from a doctor, midwife or nurse. We do not accept self-referrals to the PND Clinic.

I don’t have a family doctor/obstetrician, how can I get referred?

• Patients can be referred to us through their midwife or nurse, if you do not have a family doctor or obstetrician. If you do not have a health care team in place, you may wish to visit a walk-in clinic to request that they send a referral for you. If you feel you need to be seen in our clinic, and are unable to be referred, please contact our front desk for assistance (905-521-2100 ext. 73135).

Can I be seen sooner? Is there a cancellation list?

• We try to schedule each patient as soon as we possibly can. Unfortunately we have a high number of patient referrals, and so we do not have a cancellation list. We schedule our patient appointments based on the level of concern for their pregnancies, and how far along they are in the pregnancy. If there is new information regarding your case, such as new test results, please have your doctor or midwife contact the clinic to let us know. In some cases, this may change your appointment date.

Can the PND Clinic order bloodwork or testing for me before my appointment?

• No, we are not able to schedule any testing before your first appointment, as you are not legally our patient until you have met with us. During your first appointment, we will take as much time as you need to answer your questions and discuss possible testing options. Following our meeting, we will be able to organize any testing that you decide to have for you.

Prenatal Screening Ontario (PSO)

• https://www.prenatalscreeningontario.ca
• There is also a hotline to a Genetic Counsellor (1-833-351-6490) , who is available to answer any general questions you may have. This hotline is available to both patients, and medical professionals. Please be aware, the Genetic Counsellor is not able to counsel you regarding your specific situation, but can provide lots of helpful information.

What is an amniocentesis?

• https://www.prenatalscreeningontario.ca/en/pso/results-and-next-steps/amniocentesis.aspx

What is a CVS?

• https://www.prenatalscreeningontario.ca/en/pso/results-and-next-steps/chorionic-villus-sampling.aspx

What is NIPS/NIPT?

• https://www.prenatalscreeningontario.ca/en/pso/prenatal-screening-options/non-invasive-prenatal-testing.aspx

What is an eFTS/FTS?

• https://www.prenatalscreeningontario.ca/en/pso/prenatal-screening-options/enhanced-first-trimester-screening-efts.aspx

What is a Second Trimester Screen (STS)?

• https://www.prenatalscreeningontario.ca/en/pso/prenatal-screening-options/maternal-serum-screen-mss.aspx

What is a nuchal translucency (NT) ultrasound?

• https://www.prenatalscreeningontario.ca/en/pso/prenatal-screening-options/11-14-week-nuchal-translucency-ultrasound.aspx

What is an anatomy ultrasound?

• https://www.prenatalscreeningontario.ca/en/pso/prenatal-screening-options/18-22-week-ultrasound.aspx