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ANTENATAL SCREENING IN OXFORD FOR FETAL NEURAL TUBE DEFECTS
Author(s) -
Wald N. J.,
Cuckle H. S.,
Boreham Jillian,
Brett Rosemary,
Stirrat G. M.,
Bennett M. J.,
Turnbull A. C.,
Solymar Marianne,
Jones Nora,
Bobrow M.,
Evans C. J.
Publication year - 1979
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.1979.tb10574.x
Subject(s) - amniocentesis , medicine , spina bifida , anencephaly , obstetrics , pregnancy , neural tube , prenatal diagnosis , neural tube defect , fetus , gestational age , gestation , amniotic fluid , gynecology , pediatrics , embryo , genetics , biology , microbiology and biotechnology
Summary Between May 1975 and the end of 1977, 6443 antenatal patients were screened mainly between 16 and 22 weeks of pregnancy for neural tube defects (NTDs) at the John Radcliffe Hospital, Oxford, by maternal serum alpha‐fetoprotein (AFP) measurement; a take‐up of 72 per cent. Seventeen out of 18 (94 per cent) patients with open NTD pregnancies (9 out of 9 with anencephaly and 8 out of 9 with open spina bifida) had positive screening tests, and all except one were offered and accepted a termination of pregnancy. Two hundred and forty‐five (3.8 per cent) patients with unaffected pregnancies also had positive screening tests, although only 1 4 per cent had an amniocentesis. Following ultrasonography, about 50 per cent of patients with unaffected pregnancies with positive screening tests were not offered an amniocentesis because they had a multiple pregnancy or their gestational age had been underestimated. The odds of having a fetus with an NTD among the women who had an amniocentesis was about 1 to 6 (1 to 11 for open spina bifida alone). Two apparently normal pregnancies were terminated. A survey of the acceptability of the screening programme among a consecutive sample of 73 patients who knew that they had a positive screening test revealed that all except one had no objection to screening in general, and 68 (93 per cent) wanted to be tested again in a future pregnancy. The approximate direct cost of the programme was £2 to £3 per patient screened, or about £l000 per NTD detected (about £2200 per open spina bifida detected).