One Stop Clinic for Assessment of Risk for Fetal Anomalies: A Report of the First Year of Prospective Screening for Chromosomal Anomalies in the First Trimester

Abstract

Objective To evaluate the introduction of a one stop multidisciplinary clinic for screening for fetal chromosomal abnormalities in the first trimester by a combination of maternal serum biochemistry and ultrasonography providing a risk of chromosomal abnormalities within a one hour clinic visit. Design One year retrospective review of screening performance. Population All women attending for routine antenatal care. The population included 4190 singleton pregnancies in women of all ages screened between 10 weeks and 3 days and 13 weeks and 6 days of gestation between the periods 1 June 1998 and 31 May 1999 in a district general hospital antenatal clinic. Methods All women booked into the clinic were offered screening by a combination of maternal serum free β human chorionic gonadotrophin (hCG) and pregnancy associated plasma protein A (PAPP-A) and fetal nuchal translucency thickness. Women at increased risk of carrying a fetus with trisomy 21 or trisomy 18/13 (≥ 1 in 300 at sampling) were offered counselling and an invasive diagnostic procedure. Follow up of the outcome of all pregnancies was carried out. Main outcome measures The detection rate for trisomy 21, trisomy 18/13 and all aneuploides, false positive rate, uptake of screening, uptake of chorionic villus sampling in women identified at increased risk and fetal loss after chorionic villus sampling. Results Overall 97.6% of the women (4088/4190) accepted first trimester screening. The rate of detection of trisomy 21 was 86% (6/7), for trisomy 18/13 100% (9/9) and for all aneuploides 95% (18/19). Fetal death at presentation was found in 1.6% of pregnancies (69/4088). Of women who accepted screening, 6.1% (257/4088) presented too late for fetal nuchal translucency measurement and 6.5% of the women (271/4088) presented too early. The false positive rate was 6.7% (253/3762). Uptake of invasive testing was 83% (207/253). Conclusion First trimester prenatal screening for chromosomal abnormalities using a combination of maternal serum biochemistry and fetal nuchal translucency thickness can achieve detection rates in excess of 90%. These services can be provided in a one stop multidisciplinary clinic.