Document Detail

A prospective evaluation of a second-trimester screening test for fetal Down syndrome using maternal serum alpha-fetoprotein, hCG, and unconjugated estriol.
MedLine Citation:
PMID:  7677967     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To test the efficacy of a screening protocol using a combination of maternal age plus three biochemical markers--maternal serum alpha-fetoprotein (MSAFP), hCG, and unconjugated estriol (E3)--for the antenatal detection of fetal Down syndrome. METHODS: We conducted a prospective cohort study of 7718 women who underwent the triple-marker analysis between weeks 15-18 of pregnancy. A second-trimester risk for Down syndrome of 1:195 or greater was considered positive. Sensitivity, specificity, positive predictive value, and their 95% confidence intervals (CIs) were calculated. We evaluated test performance for various maternal age groups and screen-positive cutoffs, as well as the relative screening efficacies of maternal age and MSAFP, MSAFP plus hCG, and MSAFP, hCG, and unconjugated E3. RESULTS: Four hundred sixty-one of the 7718 women screened (6%) were identified as positive; 319 women chose amniocentesis, for an overall amniocentesis rate of 4.1%. Twenty of 22 pregnancies affected with Down syndrome were correctly identified, as were 7255 of 7696 unaffected pregnancies, yielding a sensitivity and specificity of 91% (95% CI 79-100%) and 94% (95% CI 93.8-94.8%), respectively. The use of maternal age plus all three analytes improved test performance compared with maternal age plus MSAFP and hCG, but either had a significantly improved detection rate compared with that for maternal age and MSAFP alone. CONCLUSION: The triple-marker screen appears to be an effective method of detecting Down syndrome pregnancies while maintaining an acceptable amniocentesis rate.
E Y Cheng; D A Luthy; A M Zebelman; M A Williams; R E Lieppman; D E Hickok
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  81     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  1993 Jan 
Date Detail:
Created Date:  1993-01-21     Completed Date:  1993-01-21     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  72-7     Citation Subset:  AIM; IM    
Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington.
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MeSH Terms
Chorionic Gonadotropin / blood*
Chromosome Aberrations / diagnosis
Chromosome Disorders
Down Syndrome / diagnosis*
Estriol / blood*
Fetal Diseases / diagnosis
Maternal Age
Predictive Value of Tests
Prenatal Diagnosis*
Prospective Studies
Sensitivity and Specificity
alpha-Fetoproteins / analysis*
Grant Support
MCJ41102-07//PHS HHS
Reg. No./Substance:
0/Chorionic Gonadotropin; 0/alpha-Fetoproteins; 50-27-1/Estriol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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