What is Panorama Non Invasive Prenatal Test?
The Panorama test (NIPT) is currently the most advanced non-invasive pregnancy screening available for parents who would like to determine if they have a low probability or high probability for their baby having the conditions Down’s syndrome, Edwards’ syndrome or Patau’s syndrome. The Panorama test is available from as early as 10 weeks of pregnancy, for early screening before the NHS Nuchal Translucency scan. Panorama NIPT can be performed after the NHS 12-14 week Nuchal Translucency Scan, or even in the mid term of pregnancy after the 20 week anomaly scan.
It has been discovered that a blood sample taken from the mother from 10 weeks of pregnancy onwards can be analysed for cell free fetal DNA (cffDNA), which represents a sample of the baby’s DNA in the mother’s blood.
The Panorama prenatal screening method involves taking a safe blood sample from the mother’s arm. There is no increased miscarriage risk to your baby from having this simple, safe maternal blood test. The cell free fetal DNA (cffDNA) which is present in the mother’s blood is then analysed, the results determine if there is a high probability or low probability of the baby having one of the three screened conditions; Down’s syndrome, Edwards’ syndrome and Patau’s syndrome. These conditions are also known as Trisomy 21, Trisomy 18 and Trisomy 13.
The Panorama Non Invasive Prenatal Test can be used in twin, singleton donor and surrogate pregnancies. You can also choose to find out the sex of your baby by looking at baby’s X or Y chromosomes, this is optionally included with your Panorama Test. In some circumstances it may not be possible for Panorama to report on the sex of your baby.
Panorama can confirm the zygosity of your twin pregnancy. It can be important to determine if your twin pregnancy is Dizygotic (non-identical, two eggs were fertilised) or Monozygotic (identical, one egg was fertilised and the pregnancy divided into two). In monochorionic, identical, twin pregnancies Panorama NIPT can confirm the sex of each twin as it will be same. For dichorionic, non-identical, twin pregnancies Panorama can also confirm if there are two girls, two boys or one of each.
Why the Panorama Test?
The Panorama Test is one of the most accurate non invasive prenatal tests to detect the chance of the three most common chromosomal conditions screened for in pregnancy (T21, T18 and T13). The Panorama Test also provides screening for Triploidy, but the effectiveness of this screening is far less than with the three most commonly screened conditions: Downs syndrome, Edwards syndrome and Pataus syndrome.
The Panorama NIPT is processed and analysed for The Birth Company by Natera Laboratories in the U.S.A. We have an effective and supportive working relationship with the Natera team, ensuring we can give you the best support for your prenatal screening.
Parents to be who wish to find out the likelihood that their baby has one of three chromosomal conditions; Down’s syndrome (T21), Edward’ syndrome (T18) or Patau's syndrome (T13) choose the Panorama Test. The Panorama cffDNA test can be performed from 10 weeks of pregnancy, two weeks earlier than the NHS 12-14 week screening. The Panorama NIPT has a greater sensitivity, specificity and higher positive predictive value (PPV) than the Nuchal Translucency screening, also known as the Combined Test. The Panorama cffDNA Test offers early reassurance and can reduce unnecessary anxiety and invasive testing caused by less effective prenatal screening methods.
Tiny structures inside your baby’s cells called chromosomes carry the genes that determine how your baby develops. There are 23 pairs of chromosomes per cell, however changes may occur during the production of sperm or egg cells which can lead to your baby having an extra chromosome. Although babies with Downs syndrome (T21), Edwards syndrome (T18) and Pataus syndrome (T13) are born to mothers of all ages, maternal age does increase the likelihood of the presence of these conditions. The Panorama test analyses the cffDNA in the maternal blood, to determine if there is an increased likelihood that your baby has an extra chromosome present. In cases of Triploidy, a set of extra chromosomes are present.
The Nuchal Translucency screening, or combined test, offered by the NHS determines a background chance based on maternal age. From the maternal age of 35 years of age onwards this background chance increases substantially. This increases the likelihood of receiving a high probability result from the Nuchal Translucency screening. Due to the limitation of the Nuchal translucency screening, this lowers the positive predictive value (PPV) of the test, meaning that those over 35 are more likely to receive a high probability result, even if the baby does not have the condition.
The Panorama test has a higher positive predictive value than Nuchal translucency screening. This means less high probability results where the condition is not actually present. We do not use the term false positives, as these are screening tests therefore they do not determine positives or negatives. They offer likelihoods.
What you will receive:
- Detailed ultrasound and Panorama NIPT report, with charts and images, to file with your maternity notes.
- Expert prenatal screening care
- YourBabyScan Images and Videos direct to mobile and email
- Baby Ultrasound Images to take home
- Longer appointment times as routine
- A calm and relaxing environment
- High quality professional care from our Specialist Advanced Sonographers who are committed to advances in pregnancy care
How is the Panorama Test Performed?
- An ultrasound scan is always performed prior to the Panorama blood test. This ensures that your baby is healthy, with a strong heartbeat and growing well. This scan will also confirm if it is a singleton or multiple pregnancy. Our Specialist sonographer will check that baby is developing well and confirm your estimated due date, or EDD. Your baby must measure over 10 weeks gestation for the Panorama NIPT to be performed, therefore it may be best to wait until a few days past 10 weeks of pregnancy to visit us for your appointment to ensure your baby is developed enough.
- Panorama is offered from 9 weeks in the U.S.A, however we have experienced a very high test failure rate at this early gestation, therefore advise the Panorama NIPT is performed from 10 weeks. The purpose of NIPT is to reduce anxiety and the need for unnecessary testing.
- Our Specialist Sonographer will discuss the pros and cons of the three Non invasive prenatal tests available; Harmony NIPT, Panorama NIPT or SAFE NIPT. This prenatal screening counselling will help you choose the best test for baby and for you.
- A simple blood test is then taken from the vein of the mother’s arm like any other blood test. There is no risk to your baby from having this blood test performed.
- The specialised Panorama cffDNA blood sample tubes are immediately packaged and dispatched to the Natera laboratory for processing and analysis, with most samples arriving at the Laboratory in the United states within a few days.
- NIPT screening results determine if you have a low or high probability for Downs syndrome, Edwards syndrome, Pataus syndrome or Triploidy. As this is a screening test, the Panorama results are not positive or negative. The Panorama test report can also tell you the sex of your baby.
- If you receive a high probability result our expert team will discuss pathways, including further investigations such as detailed ultrasound scans, invasive testing, counselling or referral to your Fetal Medicine Unit (FMU). This can also be discussed with our Consultant.
- There can be circumstances where our Specialist Sonographers does not recommend the Panorama NIPT for your pregnancy. Each pregnancy is different. Other prenatal screening, diagnostic testing or further pregnancy care may then be recommended. Our Consultant provides support and advise where needed.
Please note in the circumstance that during your appointment an ultrasound scan is performed but we do not proceed to the NIPT, a fee of £120 (£180 for evening/weekend appointments) will be charged for the appointment only. If booked online or a pre payment is taken, £380 will be refunded to you.
Please note in the instance of a repeat full test failure, the Panorama test laboratory fees may be refunded. A fee for the appointment services provided will be retained.
Please note Anticoagulation therapy (commonly called blood thinners) can increase the possibility of receiving No Result for your NIPT. Please leave as long between administering your dose and your NIPT appointment as possible. For example, if you administer in the evening and have an early morning appointment, either change to an appointment late in the day, or refrain from your evening dose. If you administer in the morning, refrain from that dose until after your appointment. If you have any queries regarding this, please contact our team firstname.lastname@example.org.
For further information please see below:
Anticoagulation Therapy Publication
What Results Can I Expect from my Panorama Test
- The Panorama NIPT report will determine whether you have a low probability or high probability for Down’s Syndrome, Edwards’ Syndrome, Patau’s Syndrome or Triploidy (Trisomy 21, Trisomy 18, Trisomy 13 or 69,XXX). This can be particularly reassuring if you have received a high probability Nuchal translucency scan, or a sonographer has found a structural condition such as Renal Pelvis Dilatation or short femurs at your 20 week anomaly scan.
- If you receive Low probability results, the likelihood of your baby having each of the conditions is less than 1 in 10’000. This means that we would expect less than one baby to be born out of ten thousand births with the condition Down’s syndrome, Edwards’ syndrome or Patau’s syndrome. The result is not positive, nor negative as this is screening test only.
- If you receive a High probability result, this will specify which trisomy condition there is a high probability of your baby having; Downs syndrome, Edwards syndrome or Pataus syndrome. This is not a positive result, this does not confirm that your baby has this condition, as this is a screening test only.
- Please note that the positive predictive value (PPV) for NIPT varies between Downs syndrome, Edwards syndrome and Pataus Syndrome, between pregnancies and with maternal age. The PPV for Downs syndrome varies from 1 in 2 babies confirmed to have the condition to 9 in 10 babies confirmed to have the condition, therefore genetic counselling, further investigation and a supportive pregnancy pathway is recommended. During pregnancy, the only method available to diagnose if the condition is actually present is invasive testing such as chorionic villus sampling (CVS) or amniocentesis.
- Due to the nature of the Panorama test, there is a 4% chance of receiving No Result from your NIPT blood sample. This is not a low probability, nor high probability. This happens in around 4 in 100 samples, this does not mean that your baby has a condition present. It is most commonly because the Panorama blood sample did not contain the lowest quantity threshold of Fetal Fraction, which is the minimum quantity of cffDNA needed to perform an accurate Panorama NIPT analysis, In most cases it is suitable to offer a redraw of the sample free of charge, including an ultrasound scan. The chance of receiving a screening result on the second draw is 50%. No Result is increased by maternal weight greater than 85kg, as evidence supports that there is a negative relationship between maternal weight and the quantity of cffDNA fetal fraction.
- If you have selected the option of finding out the sex of your baby, this will also be documented on the Panorama NIPT report. In some circumstances, Panorama are unable to perform sex determination analysis.
Some early pregnancy ultrasound scans are performed using a transvaginal probe technique. This technique is used to view the pelvic anatomy optimally, as the ultrasound probe can transmit safe ultrasound waves more directly to the pelvic area. In later stages of pregnancy, it may be advised to perform a transvaginal ultrasound scan to have a closer look at a baby’s anatomy, or to assess the maternal cervix.
There is no clinical risk associated with performing a transvaginal ultrasound scan. Transvaginal ultrasound scans can safely be performed during episodes of vaginal bleeding.
It is important that you understand the procedure that is associated with this examination.
The ultrasound transducer will be placed in the vagina (the probe is prepared using high grade medical disinfectant)
The transducer will be introduced with a latex / non latex type covering and sterile ultrasound gel.
It will be necessary to move the transducer from side to side, up and down and may be swivelled to obtain ultrasound images of your pelvic anatomy.
If you prefer, you may insert the transducer yourself, otherwise the person conducting the examination will do this.
A third person may be present during the examination acting as a chaperone, if required by the sonographer or yourself.
You may request the examination to be stopped at any time during the procedure.
If you are a virgin (Virgo intacta; hymen intact), guidance determines that transvaginal ultrasound scans are clinically contraindicated. If you have discussed this concern with your referrer and wish to proceed with a transvaginal ultrasound scan, this type of examination can be performed.
Should I get the COVID-19 Vaccine in pregnancy?
COVID-19 vaccines are strongly recommended in pregnancy. Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for both women and babies. Women may wish to discuss the benefits and risks of having the vaccine with their healthcare professional and reach a joint decision based on individual circumstances.
Frequent questions regarding the COVID-19 Vaccine
Find below a link to a Q&A from the Royal College of Obstetricians and Gynaecologists regarding Covid-19 Vaccines, pregnancy, and breastfeeding.