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Screening for Down syndrome using first‐trimester ultrasound and second‐trimester maternal serum markers in a low‐risk population: a prospective longitudinal study
Author(s) -
Audibert F.,
Dommergues M.,
Benattar C.,
Taieb J.,
Thalabard J.C.,
Frydman R.
Publication year - 2001
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.1469-0705.2001.00457.x
Subject(s) - medicine , obstetrics , amniocentesis , nuchal translucency measurement , gynecology , pregnancy , population , down syndrome , nuchal translucency , prospective cohort study , gestation , first trimester , prenatal diagnosis , fetus , surgery , environmental health , psychiatry , biology , genetics
Objectives To compare nuchal translucency and second‐trimester maternal serum measurements as alternative methods of antenatal screening for Down syndrome in a low‐risk population and to evaluate the consequence of combining the results in the estimation of risk. Design In a consecutive series of 4130 women aged less than 38 years with a singleton pregnancy, we examined both the detection rate of Down syndrome by nuchal translucency measurement at 10–14 weeks and maternal serum screening by human chorionic gonadotrophin and alpha‐fetoprotein at 14–18 weeks. Women with a nuchal translucency measurement of ≥ 3 mm and women with a maternal serum screening‐derived risk ≥ 1/250 were recommended to have amniocentesis. A second‐trimester detailed ultrasound scan was also performed in all women. The outcome of all pregnancies was recorded prospectively and the detection rate and false‐positive rate of different screening strategies were retrospectively analyzed. Results Out of the 4130 pregnancies that were followed (mean maternal age, 30.1 years), 12 cases of Down syndrome were observed (0.28%), all detected prenatally. Seven of 12 cases had a nuchal translucency measurement of ≥ 3 mm (58%), and six out of 10 cases with available maternal serum screening had a calculated risk of ≥ 1/250 (60%). Four of the five Down syndrome cases with a nuchal translucency measurement of < 3 mm were detected by subsequent maternal serum screening. At a threshold giving 5% of positive tests, the sensitivity of nuchal translucency, maternal serum screening and combined risk screening were 75%, 60% and 90%, respectively. Conclusions In screening for Down syndrome, an approach which combines the results from first‐trimester nuchal translucency and second‐trimester biochemistry is effective and increases the detection rate compared to the use of any single test. However, this strategy is likely to raise the false‐positive rate and the interpretation of maternal serum screening‐derived risk should be combined with the first‐trimester nuchal translucency measurement. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology