Impact of Ductus Venosus Assessment in Screening Down Syndrome Protocols: An Improved Strategy in a Fetal Medicine Unit (original) (raw)
Related papers
Journal of the Turkish German Gynecological Association, 2010
The aim of the study was to improve nuchal translucency (NT) and serum marker Down syndrome (Tri21) screening methods by including fetal ductus venosus (DV) Doppler measurements. A total of 213 pregnant women were screened consecutively by combining maternal age, fetal NT and maternal serum pregnancy associated plasma protein A (PAPP-A) and free β-human chorionic gonadotropin (f β-HCG) values at 11-14 weeks of gestation. Also, a DV Doppler analysis was performed for the contribution to the screening for Tri21 and other fetal anomalies or adverse pregnancy outcomes. Twelve fetuses had DV PI measurements above the 95th percentile and two (17%) developed intrauterine growth retardation. DV PI values negatively correlated with birth weight (p=0.013, r=0.171). Two patients had T 21 among the study group (0.9%) with abnormal biochemical screening results. In these with Tri21, the combined test risk was above the suggested limit (>1/250). PAPP-A was <0.4 MoM in 23, and f β-HCG was &g...
Ultrasound in Obstetrics & Gynecology, 2010
Objective To investigate if ductus venosus (DV) pulsatility index for veins (PIV) and a-wave measurements can increase the accuracy of first-trimester Down syndrome screening in a high-risk population. Methods The database of our fetal medicine unit was searched for all cases at increased first-trimester Down syndrome risk. Multivariable logistic regression was used to construct a prediction rule for chromosomal anomalies at any given maternal age, nuchal translucency multiples of the median (NT MoM) and DV-PIV MoM. The discriminative ability of the model was assessed by using receiver-operating characteristics (ROC) analysis. Results The study population included 445 fetuses. DV-PIV was increased (≥95th percentile) in 239 (54%) and DV a-wave was abnormal in 187 fetuses (42%). In this cohort, 80% of all chromosomal anomalies were identified by an increased DV-PIV and 68% by an abnormal a-wave. The odds of chromosomal anomalies increased by a factor of 4.2 per MoM increase in DV-PIV, adjusted for NT and maternal age. The area under the ROC curve for the prediction of chromosomal anomalies was 0.79. After correction for DV-PIV, DV a-wave did not significantly add to the prediction of chromosomal anomalies. Conclusion In a population of fetuses at increased first trimester risk for Down syndrome, the combination in a logistic regression model of NT, DV-PIV and maternal age can improve the accuracy of screening for trisomy 21 and other chromosomal anomalies. This is the first study that models the additional value of DV-PIV as a continuous variable to NT measurement alone in a high-risk first-trimester population.
Evaluation of First Trimester Contingent Test for Down ’ S Syndrome Screening
Journal of Evolution of medical and Dental Sciences, 2015
Down's syndrome is the most common chromosomal disorder among children. There are various screening strategies to detect Down ' s syndrome antenatally, each having its own advantages and disadvantages. Much research is being carried out to improve the detection rate, lower the false positive rate and to make it more cost effective. The emphasis is on first trimester screening as it allows us to reassure the majority of patient's early on in pregnancy and allows the patient to take an early decision regarding continuation of pregnancy. The gold standard of first trimester screening is the 'combined test'. Combined test involves measurement of Nuchal Translucency (NT) in all cases, and is difficult to implement in a developing country like India. Our study on first trimester 'contingent screening' showed that NT was required in 22% cases only, and the overall detection rate and the false positive rate were comparable to combined screening. Furthermore, this screening strategy is cost effective and will be easier to implement in our country. The study is being continued to include larger number of patients to evaluate the outcome analysis data more accurately.
The utility of fetal biometry as an adjunct to the multiple-marker screening test for Down syndrome
American Journal of Obstetrics and Gynecology, 1994
Am J Obstet Gynecol 11. Wald Nj, Cuckle HS, Densem jw, et al. Maternal serum unconjugated oestriol as an antenatal screeing test for Down syndrome. Br j Obstet Gynaecol 1988;95:334-41. 12. Cheng EY, Luthy DA, Zebelman AM, Williams MA, Lieppman RE, Hickok DE. A prospective evaluation of a secondtrimester screening test for fetal Down syndrome using maternal serum alpha-fetoprotein, hCG, and unconjugated estriol. Obstet Gynecol 1993;81:72-7. 13. Gravett CP, Buckmaster jG, Watson PT, Gravett MG. Elevated second trimester maternal serum B-hCG concentrations and subsequent adverse pregnancy outcome. Am j Med Genet 1992;44:485-6. 14. Gonen R, Perez R, David M, Dar H, Merksamer R, Shart M. The association between unexplained second-trimester maternal serum hCG elevation and pregnancy complications. Obstet Gynecol 1992;80:83-6. 15. BrumfieldCG, Cloud GA, Davis RO, Finley SC, HauthjL, Boots L. The relationship between maternal serum and amniotic fluid a-fetoprotein in women undergoing early amniocenteses. AM j OBSTET GYNECOL 1990;163:903-5. 16. Barford DH, Dickerman LH,johnson WE. a-Fetoprotein: relationship between maternal serum and amniotic fluid levels. AMj OBSTET GYNECOL 1985;151:1038-41. 17. Berkeley AS, Killackey MA, Cederqvist LL.Elevated ma-Owen et al. ternal serum a-fetoprotein levels associated with breakdown in fetal-maternal placental barrier. AM j OBSTET GYNECOL 1983;146:859-61. 18. Fox H. Effect of hypoxia on trophoblast in organ culture: a morphologi<; and autoradiographic study. AM j OBSTET GYNECOL 1970;107;1058-64. 19. Loraine jA, Matthew GD. Chorionic gonadotropin on toxaemias of pregnancy.j Obstet Gynaecol Br Emp 1950; 57:542-51. 20. Teoh ES, Sivasamboo R. Immunological chorionic gonadotropin titres in severe toxaemia of pregnancy.j Obstet Gynaecol Br Commortw 1968;75:724-7. 21. Sorensen TK, Williams MA, Zingheim RW, Clement Sj, Hickok DE. Elevated second-trimester human chorionic gonadotropin and subsequent pregnancy-induced hypertension. AMj OBSTET GYNECOL 1991;169:834-8. 22. Lieppman RE, Williams MA, Cheng EY, et al. An association between elevated levels of human chorionic gonadotropin in the midtrimester and adverse pregnancy outcome. AM j OBSTET GYNECOL 1993;168:1852-7. 23. Crosignani PC. Correlation of human chorionic somatomammotropin (hCS) with fetal nutrition. In: josimovich jB, ed. Lactogenic hormones, fetal nutrition, and lactation. New York: john Wiley, 1973:203-20.
Strategies for antenatal detection of Down's syndrome
Archives of Disease in Childhood - Fetal and Neonatal Edition, 1997
Aim-To predict the eVect of maternal serum screening and fetal echocardiography on the birth prevalence of Down's syndrome. Methods-The outcome of all Down's syndrome pregnancies in the Northern Health Region between 1985 and 1991 was retrospectively ascertained. The number and outcome of all Down's syndrome pregnancies were used to define a theoretical population which would exist in the absence of screening. Published reports were used to predict the eVects of screening strategies. Results-Down's syndrome was identified in 412 pregnancies of which 315 (76%) resulted in live birth. A theoretical population with no antenatal screening would be expected to produce 31 stillbirths and 381 (92%) live births aVected by Down's syndrome. In the same population a programme of maternal serum screening and fetal echocardiography would lead to 155 and 14 terminations, respectively, and when combined, would reduce aVected live births to 229 (56%). Conclusions-Even if maternal serum screening and fetal echocardiography achieve their predicted potential, around half of all pregnancies aVected by Down's syndrome will result in live born babies.
Ultrasound in Obstetrics and Gynecology, 2005
Methods A total of 39 572 pregnant women were randomized to a scan at 12-14 gestational weeks including NT screening for DS (12-week group) or to a scan at 15-20 weeks with screening for DS based on maternal age (18-week group). Fetal karyotyping was offered if risk according to NT was ≥ 1 : 250 in the 12-week group and if maternal age was ≥ 35 years in the 18-week group. Both policies included the offer of karyotyping in cases of fetal anomaly detected at any scan during pregnancy or when there was a history of fetal chromosomal anomaly. The number of babies born with DS and the number of invasive tests for fetal karyotyping were compared. Results Ten babies with DS were born alive with the 12week policy vs. 16 with the 18-week policy (P = 0.25). More fetuses with DS were spontaneously lost or terminated in the 12-week group (45/19 796) than in the 18-week group (27/19 776; P = 0.04). All women except one with an antenatal diagnosis of DS at < 22 weeks terminated the pregnancy. For each case of DS detected at < 22 weeks in a living fetus there were 16 invasive tests in the 12-week group vs. 89 in the 18-week group. NT screening detected 71% of cases of DS for a 3.5% test-positive rate whereas maternal age had the potential of detecting 58% for a test-positive rate of 18%.