In a low-risk patient with negative cell-free DNA screening for Down syndrome, the finding of an isolated soft marker on second-trimester ultrasound such as a single echogenic intracardiac focus is not clinically significant. In the absence of other abnormal ultrasound findings, no follow-up testing is recommended for this isolated result. Reassurance can be provided to the patient. In the era of immediate release of ultrasound reports with the electronic medical record, anticipatory guidance regarding possible findings can be reviewed with patients at the time of ordering tests and studies to reduce anxiety.

Intercourse is an integral part of human well-being and over the course of a pregnancy its frequency usually declines, at times due to discomfort and prejudice but in some cases due to medical advice. This chapter reviews the evidence for the safety of sexual activity in low- and high-risk pregnancies and establishes the validity of recommendations of abstinence in different clinical scenarios. The main concern regarding sexual intercourse is its ability to cause uterine contractions that could possibly result in premature labor or endanger a pregnancy complicated by placental pathologies. In light of the existing evidence, which is limited in amount and quality, it seems that coitus does not produce contractions powerful enough to precipitate labor, either in women who are at increased risk for preterm labor or in those who are not. Another significant concern is the possibility that sexual intercourse may trigger migration of pathogens to the cervix and cause an ascending infection and chorioamnionitis, especially in the setting of premature rupture of the membranes, and some studies indeed support this hypothesis; however, they were conducted decades ago, and their quality is low. It is clear that there is insufficient high-quality research to establish proper evidence-based guidelines for women who wish to receive medical advisement regarding sexual activity. However, when examining the existing literature and taking into consideration that coitus is part of every couple’s healthy and normal lifestyle, it seems that overall engaging in sexual activity during pregnancy is safe. In selected cases of high-risk pregnancies, recommendations should be tailored individually according to the parturient’s obstetric history.