What is SmartNT? Inside the protocol improving first-trimester assessment for increased nuchal translucency
Article produced in association with London Pregnancy Clinic
First-trimester ultrasound is a routine part of antenatal care across the UK.
For most expectant parents, the nuchal translucency scan offers the first detailed visual assessment of the pregnancy and returns a reassuring result.
For a smaller subset, however, a measurement above the expected range introduces a level of clinical complexity that standard follow-up pathways are not always equipped to address comprehensively.
The SmartNT protocol, developed at London Pregnancy Clinic by fetal medicine specialist Dr Fred Ushakov, was designed specifically to address this gap.
What Is Nuchal Translucency?
The nuchal translucency (NT) is a small area of fluid at the back of the fetal neck, visible on ultrasound between 11 and 14 weeks of pregnancy.
The Fetal Medicine Foundation publishes reference centiles against which individual measurements are assessed. An NT at or above the 99th percentile, or above 3.5mm, is generally classified as increased and warrants further clinical evaluation.
In the majority of cases, a mildly elevated NT is not associated with any underlying condition and the pregnancy progresses without complication.
What Increased NT Can Indicate
Elevated NT is most frequently associated with chromosomal trisomies, including Down’s syndrome (trisomy 21), Edwards’ syndrome (trisomy 18) and Patau’s syndrome (trisomy 13).
It is also associated with sex chromosome anomalies, certain structural cardiac defects, skeletal dysplasias and single-gene disorders.
Research published in Ultrasound in Obstetrics and Gynaecology (2024) identifies adverse outcomes in a meaningful proportion of pregnancies with increased NT even where chromosomal testing returns a normal result. In a substantial number of cases, no underlying cause is identified and the baby is born healthy.
Where Standard Follow-Up Falls Short
Current clinical guidance recommends offering chromosomal testing following an increased NT finding, typically via non-invasive prenatal testing (NIPT), chorionic villus sampling (CVS) or amniocentesis.
This addresses the chromosomal dimension of increased NT effectively. It does not, however, provide a comprehensive evaluation of structural causes.
Detailed anatomical scanning and early fetal echocardiography are rarely included in standardised increased NT pathways, meaning that conditions affecting the heart or other organ systems may not be identified until a later scan, if at all.
The SmartNT Protocol
SmartNT is a structured clinical protocol developed by Dr Fred Ushakov of London Pregnancy Clinic to provide a more thorough first-trimester assessment for pregnancies where increased NT has been identified.
The protocol begins at 10 weeks of pregnancy, earlier than the standard NT scan window, and integrates three components that are typically not combined in routine practice: a detailed anatomical survey, early fetal echocardiography, and advanced genomic testing including expanded NIPT panels capable of screening for microdeletions and, in indicated cases, single-gene disorders.
The Case for Early Fetal Echocardiography
Congenital heart disease affects approximately eight in every 1,000 live births and remains the leading cause of birth defect-related mortality.
Despite this, prenatal detection rates remain variable across clinical settings, partly because early fetal echocardiography requires specialist training and equipment.
Dr Ushakov has described his clinical mission as equipping ultrasound practitioners with the skills needed to identify congenital heart disease earlier in pregnancy, with the explicit aim of improving outcomes.
SmartNT incorporates cardiac assessment from 10 weeks as a core, rather than optional, component.
Integrated Results and Genetic Counselling
A comprehensive NT assessment under the SmartNT approach integrates scan findings, NIPT results and specialist input into a coherent clinical picture.
Where advanced testing reveals complex findings, families are connected with appropriate specialists, including fetal cardiologists and genetics counsellors, without delay.
Where no underlying condition is identified, the detailed nature of the assessment allows a higher level of evidence-based reassurance than standard NIPT or chromosomal results alone would provide.
Who This Is Relevant For
The SmartNT protocol is relevant for any expectant parent who has received an increased NT result, whether that finding came from an NHS scan or a private appointment.
It is also suitable for families who want the most detailed first-trimester assessment available from the very start of their pregnancy, or for those seeking a second opinion on an elevated measurement.
It is important to be clear that SmartNT is not a replacement for your NHS care. Standard NHS antenatal scans and midwifery support should continue alongside any private assessment.
The two work together, not in competition.
As a private protocol, SmartNT comes at an additional cost and may not be the right option for everyone.
Whether it is appropriate will depend on your individual scan findings, clinical history, and personal circumstances.
Private fetal medicine services, including London Pregnancy Clinic in the City of London, can discuss whether the protocol is suitable for you and what it would involve before any commitment is made.
Disclaimer: This article is produced for informational purposes only and does not constitute medical advice, diagnosis or treatment.
Clinical guidance referenced reflects published NHS, NICE and RCOG standards as at March 2026. Individual circumstances vary; readers are advised to consult a qualified healthcare professional before acting on any information in this article.
This piece was produced in association with London Pregnancy Clinic, which provided background clinical information for editorial purposes.
Hyperlinks to external sources are included for reference only and do not represent an endorsement of any product, service or organisation.
