Abstract
To evaluate the impact of a universal screening strategy in the first trimester (including nuchal translucency, PAPP-A and β-HCG), introduced in a local public hospital during second half of 2010. Before July 2010, a prenatal screening or invasive test for Down syndrome was offered to women of 35 or above only. This was a cohort study in an obstetric department with total annual deliveries of around 6,000. All the sonographers were trained, and the markers were assayed in a certified laboratory. An invasive test was offered to women with a screen positive result (1 in 250 or above). From 1 July to 31 December, 2010, of 2034 eligible women, 82.5%, 14.1%, 1.0%, and 2.4% opted for first trimester combined screening, second trimester biochemical screening, screening by nuchal translucency measurement alone, and nothing respectively. The overall false positive rate was 6.0%. Of 126 women being screened positive, 68 (54.0%), 29 (23.0%), 29 (23.0%) underwent chorionic villus sampling, amniocentesis, and no invasive test respectively. Compared to 2009, there was a slight decrease in the total number of invasive procedures by 3.5% in 2010, but an increase in the proportion of chorionic villus sampling to total invasive procedures from 5.9% to 25.9%. In 2008, 2009, and 2010, the total number of women attending our antenatal clinic was 5089, 5098 and 6,762 respectively. The corresponding number (%) of prenatal invasive procedure was 321 (6.3%), 340 (6.7%) and 328 (4.5%). The total number of Down syndrome detected prenatally was 4, and 2, and 11, while the corresponding number detected after birth was 5, 3 and 1 respectively. Like the experience in other countries, the introduction of universal prenatal screening program for Down syndrome in our hospital increased the prenatal detection of Down syndrome, decreased the number of invasive prenatal procedures, but increased the proportion of chorionic villus sampling.
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