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Prenatal testing options are expanding rapidly, along with various algorithms for managing positive screens. Previously, women with abnormal traditional screens (nuchal translucency integrated with first- and second-trimester serum analytes) could only proceed with or decline invasive diagnostic procedures. Now, they have the alternative of secondary screening by cell-free DNA analysis, also known as noninvasive prenatal testing (NIPT). However, NIPT does not detect uncommon chromosomal abnormalities as effectively as diagnostic testing. Investigators used data from the California Prenatal Screening Program to determine the proportion of abnormal karyotypes that would have been missed had the women who screened positive with traditional met…