Document Detail

SURUSS in perspective.
MedLine Citation:
PMID:  15198778     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Until the publication of the Serum Urine and Ultrasound Screening Study (SURUSS) report, it was difficult to compare the different antenatal screening tests for Down's Syndrome because of variations in study designs. We here present the main results from SURUSS, updated to take account of recent information on nuchal translucency in Down's Syndrome pregnancies, and discuss their implications. METHODS: SURUSS was a prospective study of 47,053 singleton pregnancies (including 101 pregnancies with Down's Syndrome) conducted in 25 maternity units. Nuchal translucency measurements were taken. Serum and urine samples collected between 9 and 13 weeks, and again between 14 and 20 weeks of pregnancy were stored. Samples from each affected pregnancy and five matched controls were tested for currently used or suggested biochemical Down's Syndrome screening markers. Pregnancies were followed up to determine the presence or absence of Down's Syndrome. For an 85% Down's Syndrome detection rate, the false-positive rate for the Integrated test (nuchal translucency and pregnancy associated plasma protein-A [PAPP-A] at 11 completed weeks of pregnancy, and alpha-fetoprotein, unconjugated oestriol [uE(3)], free beta or total human chorionic gondaotrophin (hCG) and inhibin-A in the early second trimester) was 0.9%, the Serum integrated test (without nuchal translucency) 2.7%, the Combined test (nuchal translucency with free beta-hCG and PAPP-A at 11 weeks) 4.3%, the Quadruple test (alpha-fetoprotein, uE(3), free beta or total hCG and inhibin-A) 6.2%, and nuchal translucency at 11 weeks, 15.2%. All tests included maternal age. Using the Integrated test at an 85% detection rate, there would be six diagnostic procedure-related unaffected fetal losses following amniocentesis per 100,000 women screened compared with 35 using the Combined test or 45 with the Quadruple test. CONCLUSIONS: The Integrated test offers the most effective and safe method of screening for women who attend in the first trimester. The next best test is the Serum integrated test. The Quadruple test is the best test for women who first attend in the second trimester. There is no justification for retaining the Double (alpha-fetoprotein and hCG) or Triple (alpha-fetoprotein, uE(3), and hCG) tests, or nuchal translucency alone (with or without maternal age) in antenatal screening for Down's Syndrome.
N J Wald; C Rodeck; A K Hackshaw; A Rudnicka
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  BJOG : an international journal of obstetrics and gynaecology     Volume:  111     ISSN:  1470-0328     ISO Abbreviation:  BJOG     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-06-16     Completed Date:  2004-06-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  100935741     Medline TA:  BJOG     Country:  England    
Other Details:
Languages:  eng     Pagination:  521-31     Citation Subset:  AIM; IM    
Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, UK.
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MeSH Terms
Antigens / urine
Biological Markers / urine
Costs and Cost Analysis
Down Syndrome / diagnosis*,  economics
False Positive Reactions
Mass Screening / economics,  methods,  standards
Maternal Age
Neck / embryology,  ultrasonography
Pregnancy Trimester, First
Pregnancy Trimester, Second
Prenatal Diagnosis / economics,  methods*,  standards
Prospective Studies
Sensitivity and Specificity
Trophoblasts / immunology
Ultrasonography, Prenatal
Reg. No./Substance:
0/Antigens; 0/Biological Markers
Comment In:
BJOG. 2005 Jan;112(1):128; author reply 128   [PMID:  15663419 ]
BJOG. 2004 Jun;111(6):519-20   [PMID:  15198777 ]
BJOG. 2004 Jun;111(6):517-8   [PMID:  15198776 ]

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