R445 is the clinical indicator code in the National Genomic Test Directory offering non-invasive pre-natal testing (NIPT) where there is any previous pregnancy with reported full trisomy of chromosomes 13,18 or 21. We advise that you refer to the latest version of the test directory for detailed information on specific eligibility criteria.
This page contains links to all the resources which have been developed to support professionals offering the R445 pathway in clinical practice.
Background to R445
Since 2021, the NHS has offered NIPT as a screening test for trisomies 13,18 and 21, following a higher chance result from the NHS combined or quadruple test via the NHS Fetal Anomaly Screening Programme.
In 2024, following an NHS England funded proof-of-concept project, the offer of NIPT was extended to women with a previous pregnancy with reported full trisomy of 13, 18 or 21.
To facilitate implementation of R445, NHS England Genomics Unit and the NHS England screening sub directorate established an R445 working group with representation from other key stakeholder organisations, groups, and experts. This group developed the R445 pathway, operational guidance and information for parents. These documents were further updated in March 2026 in response to changes to the offer of NIPT on both the Fetal Anomaly Screening Programme (R470) and via R445.
The following leaflets were developed by the R445 working group.
R445 Information for Healthcare Professionals
Further resources for professionals
- NHS England Genomics Education Programme – GeNotes
GeNotes are ‘Genomic Notes’ for clinicians. They provide quick, concise information to help healthcare professionals make the right genomic decisions at each stage of a clinical pathway. The following GeNotes are relevant for R445:
Non-invasive prenatal testing (NIPT) — Knowledge Hub
- R445 non-invasive prenatal testing (NIPT) referral pathway audit
This poster details findings of an audit of the R445 NIPT service at the Birmingham Women’s laboratory, TDL Genetics & Health Service Laboratories and St George’s Hospital to determine number of referrals and outcomes during the first 6 months of the service going live (April 2024-October 2024).
Link to NIPT online learning:
Information about NIPT will be incorporated into the Antenatal and Newborn screening e-learning module under unit 4: Screening for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome. You can access the learning at: Learning Hub – Home
Link to webinar:
The following webinar, hosted by Central and South GMSA, includes an update on the R445 pathway. The information contained within the webinar was correct at time of recording on 10 Sept 2025.
Spotlight on common aneuploidy testing: Update on R445 and QF PCR explained