Document Detail


First-trimester combined ultrasound and biochemical screening for Down syndrome in routine clinical practice.
MedLine Citation:
PMID:  15503268     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To assess the effectiveness of combined ultrasound and biochemical (CUB) screening for chromosome abnormalities in singleton pregnancies in a routine antenatal clinic and laboratory setting. METHODS: Women whose pregnancies fell within the gestational age range of 11 to 14 weeks by ultrasound assessment were offered CUB screening on the basis of measurement of nuchal translucency (NT), maternal serum free beta-human chorionic gonadotrophin (FbetahCG) and pregnancy-associated plasma protein A (PAPP-A). NT measurements were obtained using a standardised method defined by the Fetal Medicine Foundation and FbetahCG, and PAPP-A were measured using the DELFIA immunoassay system. Each screening marker measurement was converted to a multiple of the appropriate gestational median and a risk was derived using previously published parameters for each marker in chromosomally abnormal and unaffected pregnancies. A combined risk of Down syndrome and of trisomy 18/13, incorporating the maternal age risk, was calculated for all women. Invasive diagnostic testing was offered to women whose combined risk exceeded the cut-off risk of 1 in 250 (term). RESULTS: Five thousand and eighty-four women accepted a first-trimester screening test for Down syndrome, representing 75% of the eligible booking population. Out of the population eligible for CUB screening at the time of booking, NT measurements were obtained from 93% at the first clinic visit and 7% had to return for a second attempt. After excluding women who defaulted on a return visit, satisfactory NT measurements were obtained in 99.5% of pregnancies. Fifteen cases of Down syndrome and eleven pregnancies with other chromosome abnormalities were ascertained. The detection rate for Down syndrome was 93% (14/15) at a false-positive rate of 5.9% and for all chromosome abnormalities it was 96% (25/26) at an overall false-positive rate of 6.3%. CONCLUSIONS: CUB screening offers a significant improvement in sensitivity over second-trimester biochemical screening and is deliverable within a routine prenatal clinical setting.
Authors:
E J Stenhouse; J A Crossley; D A Aitken; K Brogan; A D Cameron; J M Connor
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Prenatal diagnosis     Volume:  24     ISSN:  0197-3851     ISO Abbreviation:  Prenat. Diagn.     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-11-01     Completed Date:  2005-04-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8106540     Medline TA:  Prenat Diagn     Country:  England    
Other Details:
Languages:  eng     Pagination:  774-80     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2004 John Wiley & Sons, Ltd.
Affiliation:
Fetal Medicine Department, Queen Mother's Maternity Hospital, Yorkhill Hospitals, Glasgow, UK.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Biological Markers / blood
Chorionic Gonadotropin, beta Subunit, Human / blood*
Down Syndrome / diagnosis*,  embryology,  ultrasonography
False Positive Reactions
Female
Gestational Age
Humans
Middle Aged
Nuchal Translucency Measurement / methods*
Pregnancy
Pregnancy Trimester, First / blood
Pregnancy-Associated Plasma Protein-A / analysis*
Prenatal Diagnosis / methods
Risk Assessment
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Chorionic Gonadotropin, beta Subunit, Human; EC 3.4.24.-/Pregnancy-Associated Plasma Protein-A

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