Multiple-marker Screening Test Research Articles

Panel of Markers Can Accurately Predict Endometriosis in a Subset of Patients

Because imaging methods are unreliable for diagnosing or staging endometriosis, a definitive diagnosis requires surgery. The fact that the disease produces a local, and probably also a systemic, inflammatory process raises the possibility that a combination of inflammatory markers and cancer antigen-125 (CA-125) could make up a multiple-marker screening test for endometriosis. This possibility was tested in a case-control study of women of reproductive age having laparoscopy for a variety of reasons. Marker levels were compared in 63 women with operatively confirmed stage II-IV endometriosis and 78 others who were found surgically not to have the disease. The putative markers, estimated by enzyme-linked immunosorbent assays, were interleukin-6, tumor necrosis factor-α, macrophage migration inhibitory factor, macrophage chemotactic protein-1, interferon-β, leptin, and CA-125. The diagnostic performance of each of the 6 cytokines individually and of CA-125, based on receiver operating characteristic curves, was poor. After eliminating interferon-γ because levels were below the assay’s limit for detection, there was marked overlap in concentrations of the other 6 markers between the 2 study groups. The only markers whose levels were significantly higher in women with endometriosis were CA-125 and leptin. Evaluation of combinations of markers by classification tree analysis showed that a 3-marker panel of CA-125, macrophage chemotactic protein-1, and leptin predicted the presence of endometriosis in 51% of participants with 89% accuracy. Adding a fourth marker, macrophage migration inhibitory factor, diagnosed 48% of subjects with 93% accuracy. Using markers will not diagnose all patients as having, or not having, endometriosis, but disease status can be predicted with high accuracy in a substantial number of them, making diagnostic surgery unnecessary. The investigators believe that marker estimates will be an efficient adjunct to the work-up of patients suspected of having endometriosis.

Panel of markers can accurately predict endometriosis in a subset of patients

To evaluate whether a combination of putative markers of inflammation and CA-125 could serve as a multiple-marker screening test for endometriosis in a heterogeneous population of patients. Case-control evaluation of a diagnostic test. University medical center. Consenting women of reproductive age undergoing laparoscopy for indications of pain, infertility, elective tubal ligation, tubal reanastomosis, or other benign indications. Diagnostic laparoscopy and peripheral venipuncture. Serum concentrations of interleukin-6, tumor necrosis factor-alpha, macrophage migration inhibitory factor, macrophage chemotactic protein-1, interferon-gamma, leptin, and CA-125 measured by using ELISA assays; surgical staging of endometriosis. Concentrations of the seven markers were compared between the 63 women with surgically confirmed stage II-IV endometriosis and 78 women who were surgically confirmed to be free of endometriosis. The individual diagnostic performance of each of the markers, based on receiver operating characteristic curves, was poor. When combinations of markers were evaluated by using classification tree analysis, a three-marker panel of CA-125, macrophage chemotactic protein-1, and leptin could diagnose 51% of subjects as to the presence of endometriosis with 89% accuracy. A four-marker panel of CA-125, macrophage chemotactic protein-1, leptin, and macrophage migration inhibitory factor could diagnose 48% of subjects with 93% accuracy. The remaining subjects would have no definitive diagnosis on the basis of the algorithm and would need to undergo standard evaluation. This large study evaluates the combined use of putative serum markers for the diagnosis of endometriosis, rather than the use of each singly. Using the serum concentration of four markers in a two-tiered decision rule, nearly half of the subjects in this population would have been diagnosed (and could have avoided surgery) with 93% accuracy.

P-371: Cytokines used as a panel, but not alone, can accurately predict endometriosis

There have been reports of cytokines and tumor markers in the serum that can predict the presence of endometriosis. We set out to evaluate if a combination of these putative markers could serve as a multiple marker screening test for endometriosis in a heterogeneous population of patients.

Evaluating the Thresholds of Abnormal Second Trimester Multiple Marker Screening Tests Associated with Intra-Uterine Growth Restriction

Our objective was to evaluate the optimal thresholds for unexplained abnormal multiple marker screening (MMS) results that are associated with intrauterine growth restriction (IUGR). This was a case-control study from our perinatal database. MMS analyte levels (multiples of median [MoM]) of cases with IUGR (birthweight < 5th percentile for gestational age) were compared with a control group without IUGR. Pregnancies with fetal anomalies were excluded. Biochemical markers evaluated include alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and unconjugated estriol (uE3). Using receiver operating characteristic curves, the optimal thresholds of MMS (OTMs) associated with IUGR were determined. We identified 255 (12.3%) cases with IUGR and complete MMS records from the database. These were compared with 1785 controls without IUGR randomly selected from our perinatal database in a 1:7 ratio. The OTMs associated with IUGR were AFP > 2.0 MoM (odds ratio [OR] = 2.3; 95% confidence interval [CI], 1.4 to 3.7), hCG > 2.5 MoM (OR = 1.8; 95% CI, 1.1 to 3.2) and uE3 < 0.9 MoM (OR = 2.7; 95% CI, 2.0 to 3.7). The sensitivity, specificity, and positive and negative predictive values for predicting IUGR in the presence of at least one abnormal MMS were 46, 66, 11, and 90%, respectively. Elevated AFP > 2.0 MoM and hCG > 2.5 MoM were the most specific markers for MMS, with specificity of 94 and 95%, respectively. When all three analytes were abnormal, the specificity for predicting IUGR increased to 99%. Abnormal MMS results are associated with IUGR. As a screening tool for IUGR, the biochemical markers were associated with poor sensitivity. Elevated AFP and hCG, however, were highly specific in predicting IUGR. The provided thresholds could be useful in designing policies regarding women who would benefit most from sonographic screening for IUGR.

Multiple-marker screening in human immunodeficiency virus–positive pregnant women: screen positivity rates with the triple and quad screens

Objective The study was undertaken to determine the screen-positive rates of multiple-marker screening tests in pregnant women who are positive for human immunodeficiency virus (HIV) at our institution for open neural tube defects and aneuploidy, for both triple (α-fetoprotein, human chorionic gonadotropin [hCG], unconjugated estriol) and quad (α-fetoprotein, hCG, unconjugated estriol, inhibin A) screens, and to compare these rates with a matched control group. Study design A 1:1 matched case-control study was performed comparing multiple marker screening test results in 34 HIV-positive women with age- and race-matched HIV-negative controls. Individual serum markers and screen positive rates for both the triple and quad screens were compared among the cases and controls. Results In each group, there were 19 women with triple screens and 15 with quad screens. Serum hCG multiples of the median were significantly higher in the HIV-positive compared with the HIV-negative women ( P = .033). There was no difference in screen positive rates between the cases and controls using the triple screen, but there was a significantly higher overall screen positive rate in the HIV-positive group when the quad screen was used (33% vs 7%, P = .046). Conclusion There is a significantly higher rate of overall quad screen positivity on multiple-marker screening among HIV-positive women compared with a matched control group.

Prenatal diagnosis of de novo terminal deletion of chromosome 7q

To present the prenatal diagnosis and perinatal findings of a de novo terminal deletion of chromosome 7q. Amniocentesis was performed at 21-weeks gestation owing to a positive result of maternal serum multiple-marker screening. The 30-year-old woman, gravida 2, para 1, had a maternal serum multiple-marker screening test at 18-weeks gestation. The risk of Down syndrome was 1/11 calculated from the gestational age, maternal age, a maternal serum alpha-fetoprotein level of 1.026 multiples of the median (MOM), and a maternal serum free beta-human chorionic gonadotrophin (hCG) level of 8.678 MoM. Cytogenetic analysis of the cultured amniotic fluid cells revealed a de novo terminal deletion of 7q, 46,XX,del(7)(q35). Ultrasonography showed intrauterine growth restriction, microcephaly, and tetralogy of Fallot. The pregnancy was terminated subsequently. Grossly, the placenta was normal. On autopsy, the proband additionally manifested a prominent forehead, hypertelorism, epicanthus, upslanting palpebral fissures, a flat and broad nasal bridge, micrognathia, large low-set ears, overriding toes, and a normal brain. Radiography demonstrated a normal spine. Fluorescence in situ hybridization analysis demonstrated a 7q terminal deletion. Genetic marker analysis showed a maternally derived terminal deletion of chromosome 7(q35-qter). Fetuses with a de novo 7q terminal deletion may be associated with a markedly elevated maternal serum hCG level and abnormal sonographic findings of intrauterine growth restriction, microcephaly, and congenital heart defects in the second trimester.

Pregnancies with false positive midtrimester multiple marker screening tests (MMST) for Down's syndrome are not associated with adverse pregancy outcomes

The objective of this study was to determine whether pregnancies with false positive MMST are associated with increased pregnancy complications. The pregnancy outcomes of 211 pregnancies with false positive MMST were compared to a control group of 300 patients with low-risk MMST results. Both groups were from a low-risk population, matched for age and parity and gestation confirmed with ultrasonography. Adverse outcomes (preterm delivery < 37 weeks gestation, low-birth weight (LBW) < 2500 gm, fetal loss > 20 weeks gestation, congenital infections and abnormalities, APGAR scores < 7 at 5 minutes and operative deliveries). Chi-square analysis and Fisher's tests were used for comparison as appropriate. Preterm delivery 12 of 211 (5.6%) versus 14 of 300 (4.6%), odds ratio 1.2 CI (0.56–2.7); LBW 5 of 211 (2.3%) versus 5 of 300 (1.6%) OR 1.5 CI (0.43–5.3); Instrumental delivery 20 of 211 (9.4%) versus 22 of 300 (7.3%) OR 0.85 CI (0.46–1.6); and caesarean section 45 of 211 (21.3%) versus 51 of 300 (17%) OR 1.3 CI (0.84–2.1); APGAR scores < 7 at 5 minutes 12 of 211 (5.6%) versus 17 of 300 (5.6%) OR 0.88 CI (0.39–2.0). No fetal loss or congenital infections occurred. There was 1 case of rudimentary extra-digit in the false positive group.

Can antenatal clinical and biochemical markers predict the development of severe preeclampsia?

Objective:This study was undertaken to develop a multivariacle clinical predictive rule for severe preeclampsia using second-trimester clinical factors and biochemical markers. Study Design:We performed a retrospective cohort study of all pregnant patients with single gestations from 1995 through 1997 for whom we had complete follow-up data. Through medical record review we determined whether patients had severe preeclampsia develop according to American College of Obstetricians and Gynecologists criteria. Case patients with severe preeclampsia were compared with control subjects with respect to clinical data and multiple-marker screening test results. With potential predictive factors identified in the bivariate and stratified analyses both an explanatory logistic regression model and a clinical prediction rule were created. Patients were assigned a predictive score according to the presence or absence of predictive factors, and receiver operating characteristic analysis was used to determine the optimal score cutoff point for prediction of severe preeclampsia with maximal sensitivity. Results:Among the 1998 patients we found 49 patients with severe preeclampsia (prevalence, 2.5%). After we controlled for confounding variables, case patients and control subjects had similar human chorionic gonadotropin and a-fetoprotein levels, and the only variables that remained significantly associated with severe preeclampsia were nulliparity (relative risk, 3.8; 95% confidence interval, 1.7–8.3), history of preeclampsia (relative risk, 5.0; 95% confidence interval, 1.7–17.2), elevated screening mean arterial pressure (relative risk, 3.5; 95% confidence interval, 1.7–7.2), and low unconjugated estriol concentration (relative risk, 1.7; 95% confidence interval, 0.9–3.4). Our predictive model for severe preeclampsia, which included only these 4 variables, had a sensitivity of 76% and a specificity of 46%. Conclusions:Even after incorporation of the strongest risk factors, our predictive model had only modest sensitivity and specificity for discrimination of patients at risk for development of severe preeclampsia. The addition of the human chorionic gonadotropin and a-fetoprotein biochemical markers did not enhance the model's predictive value for severe preeclampsia.

Ultrasound findings and multiple marker screening in trisomy 18

Objective: To compare detection of trisomy 18 in the second trimester by ultrasound and multiple-marker testing. Methods: A computerized genetics database was used to identify fetuses of 14–22 weeks’ gestation who had comprehensive ultrasound examinations, multiple-marker screening tests (alpha-fetoprotein [AFP]), hCG, unconjugated estriol [E3], and trisomy 18 karyotype. A positive trisomy 18 screen was defined as AFP up to 0.75 multiples of the median (MoM), hCG up to 0.55 MoM, and unconjugated E3 up to 0.60 MoM. A risk of at least 1:190 defined a positive Down syndrome screen. Ultrasound abnormalities were diagnosed prospectively and were confirmed later by retrospective review of sonographic images. Results: From 1988–1997, 30 trisomy 18 fetuses who had comprehensive ultrasounds and multiple-marker testing were identified. Twenty-one (70%) had abnormalities detected by ultrasound, of which the most common isolated finding was choroid plexus cyst. Eleven fetuses (37%) had positive trisomy 18 screens, and two had positive Down syndrome screens, for a total of 13 of 30 (43%) fetuses with positive multiple-marker screening tests. Conclusion: We found that ultrasound was more likely to be abnormal than multiple-marker screening tests in fetuses with trisomy 18 (70%) (95% confidence interval [CI] 54, 86 versus 43% CI 25, 61). However, combining the two testing methods yielded the highest detection rate (80% [CI 66%, 94%]).

Prospective evaluation of free β-subunit of human chorionic gonadotropin and dimeric inhibin A for aneuploidy detection

Objective: Our goal was to prospectively evaluate the use of the free β-subunit of human chorionic gonadotropin and dimeric inhibin A for the detection of fetal Down syndrome and other aneuploidies. Study Design: Women who had a second-trimester multiple-marker screening test (α-fetoprotein, unconjugated estriol, human chorionic gonadotropin) and genetic amniocentesis from August 1996 to August 1998 were included. Serum was also analyzed for inhibin and the free β-subunit of human chorionic gonadotropin. Detection and false-positive rates for 4 analyte combinations at 5 different screening risk cutoff points for Down syndrome were determined and compared. Results: We evaluated 1256 patients, including 23 with aneuploidy (13 with Down syndrome, 10 others). The maternal age was 35.9 ± 4.6 years (mean ± SD). At the optimal risk cutoff point for Down syndrome detection (1:190; false-positive rate, 19%), the multiple-marker screening test plus inhibin was superior, detecting 85% of Down syndrome cases, in comparison with 69% when the multiple-marker screening test alone was used and 62% when the other 2 combinations were used. The multiple-marker screening test plus inhibin also detected 60% of the other aneuploidies. Conclusions: When evaluated prospectively in a high-risk population, the multiple-marker screening test plus inhibin was superior to the traditional multiple-marker screening test and 2 other analyte combinations, with a lower false-positive rate and increased detection of all aneuploidies in a high-risk population. (Am J Obstet Gynecol 1999;181:887-92.)

Prenatal diagnosis of trisomy 20 mosaicism by maternal serum screening for Down syndrome

We report two cases of prenatally diagnosed trisomy 20 mosaicism associated with positive Down syndrome screening at 16 weeks’ gestation. Both infants exhibited normal growth and mental development.These cases suggest that the multiple-marker screening test may play an important role in prenatal detection and diagnosis of chromosomal anomalies in addition to Down syndrome.

Maternal serum α-fetoprotein and dimeric inhibin A detect aneuploidies other than Down syndrome

Objective: Our purpose was to determine whether the combination of maternal serum α-fetoprotein, free human chorionic gonadotropin-β, dimeric inhibin A, and maternal age detects aneuploidies other than Down syndrome. Study Design: We retrieved stored serum from pregnancies complicated by aneuploidies other than Down syndrome from 1988 to 1997 (n = 55, mean maternal age 35.2 ± 5.6 years). α-Fetoprotein levels were obtained from our database, and free human chorionic gonadotropin-β and dimeric inhibin A levels were measured in the thawed serum with use of commercial assays. Analyte values were used in both 3-analyte and 2-analyte multiple-marker screening tests; detection rates were determined at several different Down syndrome risk-positive cutoff values. Results: In the 3-analyte test 58% (32/55) of all aneuploidies were detected with use of both the Down syndrome protocol at a screen-positive risk cutoff value of 1:300 (false-positive rate 17%) and a novel trisomy 18 screening algorithm. However, 67% (37/55) detection was obtained with use of the 2-analyte combination of α-fetoprotein and dimeric inhibin A, with both the Down syndrome protocol (screen positive cutoff value 1:300) and the trisomy 18 algorithm: 12 of 13 trisomy 18 (92%), 9 of 17 Turner’s syndrome (53%), 10 of 17 other sex chromosome aneuploidies (59%), 1 of 1 trisomy 22 (100%), and 5 of 7 trisomy 13 (71%). Conclusions: The combination of maternal serum α-fetoprotein, dimeric inhibin A, and maternal age detects autosomal trisomies other than Down syndrome at a rate superior to that of the traditional analyte combination. (Am J Obstet Gynecol 1998;179:966-70.)

Alpha-fetoprotein, free beta-human chorionic gonadotropin, and dimeric inhibin A produce the best results in a three-analyte, multiple-marker screening test for fetal Down syndrome: Wenstrom K.D.; Owen J.; Chu D.C.; Boots L. USA Am J Obstet Gynecol 1997 177/5 (987–991)

Alpha-fetoprotein, free beta-human chorionic gonadotropin, and dimeric inhibin A produce the best results in a three-analyte, multiple-marker screening test for fetal Down syndrome: Wenstrom K.D.; Owen J.; Chu D.C.; Boots L. USA Am J Obstet Gynecol 1997 177/5 (987–991)

Second trimester maternal dimeric inhibin-A in the multiple-marker screening test for Down's syndrome.

The aim of this study was to evaluate the additional value of dimeric inhibin-A serum concentration in second trimester multiple-marker screening tests for pregnancies affected by Down's syndrome. We anticipated that second trimester maternal serum dimeric inhibin-A concentrations would be altered in pregnancies complicated by fetal Down's syndrome and that dimeric inhibin-A would perform better than one of the three substances analysed in the multiple-marker screening test currently in use. A total of 1156 serum samples were screened for dimeric inhibin-A in parallel with the routine classic triple test screening programme performed on a random obstetric population. Classic triple test performance was compared with detection rates obtained after substitution of unconjugated oestriol by inhibin-A and with the performance of inhibin-A and alpha-fetoprotein alone. Absolute dimeric inhibin-A maternal serum concentrations of Down's syndrome pregnancies were indeed significantly higher than those of normal pregnancies in our screened population. The performance of dimeric inhibin-A in combination with the multiple-marker screening test, however, is limited because of its strong correlation with intact human chorionic gonadotrophin.

Significance of a False-Positive Trisomy 18 Multiple-Marker Screening Test

Objective: To determine if a false-positive trisomy 18 multiple-marker screening test (all three analytes low: maternal serum alpha-fetoprotein [AFP] at most 0.75 multiples of the median [MoM], unconjugated estriol at most 0.60 MoM, and hCG at most 0.55 MoM) indicates increased risk for obstetric complications or is related to maternal weight.Methods: We accessed our genetic database to obtain multiple-marker screening test results, fetal karyotypes, and pregnancy outcomes from all patients with a normal multiple-marker screening test (n = 3900) and from all patients with a positive trisomy 18 screening test (n = 103) seen in the prenatal diagnosis clinic from 1992 to 1996. During this period, only maternal serum AFP was adjusted for maternal weight.Results: A positive trisomy 18 screen identified five of 12 trisomy 18 fetuses. Women with a false-positive trisomy 18 screen were heavier (175.6 ± 43.8 lb versus 159.9 ± 37.9 lb, P < .001) and younger (29.7 ± 6.5 years versus 32.3 ± 6.5 years, P < .001) than women with a normal multiple-marker screening test, but were not at increased risk for pregnancy complications. Weight-adjusting all three analytes reduced the false-positive trisomy 18 screen rate by 42% (from 1.9% to 1.1%) but did not change the trisomy 18 detection rate.Conclusion: A false-positive trisomy 18 screening test does not indicate increased risk to develop pregnancy complications and may be related to inadequate correction for increased maternal weight.

Elevated second-trimester dimeric inhibin A levels identify Down syndrome pregnancies

Objective: Our purpose was to determine whether second-trimester dimeric inhibin A levels distinguish Down syndrome pregnancies from euploid pregnancies. Study Design: With use of a commercially available enzyme-linked immunosorbent assay (Serotec, Oxford) inhibin A medians were established in stored sera from 40 to 50 euploid pregnancies at each week of gestation from 14 to 20 weeks and from 33 Down syndrome pregnancies. Maternal serum α-fetoprotein, unconjugated estriol, and human chorionic gonadotropin levels measured in each sample before storage were retrieved. The performance of inhibin A in the multiple-marker screening test was evaluated. Results: The mean inhibin A multiple of the median was significantly higher in the Down syndrome group than in the euploid group (2.84 ± 2.0 vs 1.22 ± 1.0, p = 0.0001). An inhibin A level ≥1.6 multiples of the median identified 70% of all Down syndrome pregnancies at a false-positive rate of 22%. Replacing estriol with inhibin A in the multiple-marker screening test resulted in a higher Down syndrome detection rate at a lower screen-positive rate. Conclusion: Elevated second-trimester maternal serum inhibin A levels identify Down syndrome pregnancies; replacing estriol with inhibin A in the multiple-marker screening test improves test performance.

α-Fetoprotein, free β-human chorionic gonadotropin, and dimeric inhibin A produce the best results in a three-analyte, multiple-marker screening test for fetal Down syndrome

Objective: The purpose of this study was to determine, among six second-trimester maternal serum analytes, the best three-analyte combination for fetal Down syndrome detection. Study Design: With use of commercially available assay kits, medians for free β-human chorionic gonadotropin, CA 125, and dimeric inhibin A were established in stored sera from 45 to 50 euploid pregnancies at each week of gestation from 14 to 22 weeks and from 33 Down syndrome pregnancies. Maternal serum α-fetoprotein, unconjugated estriol, and intact human chorionic gonadotropin levels measured in each sample before storage were retrieved. All 20 possible three-analyte combinations were evaluated in the multiple-marker screening test for Down syndrome. Results: The mean maternal age of the study population was 35.6 ± 5.3 years. The best three-analyte combination was maternal serum α-fetoprotein, free β-human chorionic gonadotropin, and dimeric inhibin A: 97% of Down syndrome cases were detected at a false-positive rate of 16%. At a slightly higher false-positive rate (18%) maternal serum α-fetoprotein, estriol, and intact human chorionic gonadotropin detected only 79% of cases. Conclusions: Of six second-trimester maternal serum analytes, the best three-analyte combination for fetal Down syndrome detection was maternal serum α-fetoprotein, free β-human chorionic gonadotropin, and dimeric inhibin A. This retrospective analysis should now be confirmed prospectively.

Free β-hCG Subunit Versus Intact hCG in Down Syndrome Screening

Objective: To assess the ability of second-trimester maternal serum free β-hCG to detect fetal Down syndrome and to compare free β-hCG to intact hCG in the multiple-marker screening test for Down syndrome.Methods: From our bank of stored maternal sera, we selected 40–50 samples from euploid pregnancies at each week of gestation from 14 to 20 weeks and 31 samples from Down syndrome pregnancies. Free β-hCG was measured by enzyme-linked immunosorbent assay, and week-specific multiples of the median (MoM) were derived. The free β-hCG Down syndrome detection and false-positive rates were determined. Free β-hCG was then substituted for intact hCG in the multiple-marker screening test, and the Down syndrome detection and false-positive rates at various risk cutoffs were compared.Results: The mean (± standard deviation) maternal age of all study samples was 35.6 ± 5.3 years. The mean Down syndrome free β-hCG MoM was significantly higher than the mean euploid MoM (2.4 ± 1.1 versus 1.2 ± 1.0; P < .001). A free β-hCG level of at least 1.7 MoM identified 68% of Down syndrome pregnancies at a false-positive rate of 20%. When intact hCG was replaced with free β-hCG in the multiple-marker screening test, a higher Down syndrome detection rate was achieved at a lower false-positive rate at each of several screen positive risk cutoffs.Conclusion: Elevated free β-hCG levels identify Down syndrome pregnancies. Replacing intact hCG with free β-hCG in the multiple-marker screening test results in a higher Down syndrome detection rate at a lower false-positive rate.

Pregnancy outcomes following false-positive multiple marker screening tests.

Pregnancy outcomes in women with a false-positive midtrimester multiple marker screening test (MMST) were reviewed. A genetic database was used to identify all women > or = age 30 who had a MMST at 15-20 weeks of gestation, a targeted ultrasound, and amniocentesis, and complete pregnancy outcome data. All patients with an abnormal fetal ultrasound (US) or karyotype were excluded. The incidence of adverse outcomes (defined as fetal death, preterm delivery, or a birth weight less than the 10th percentile for gestational age), in those women with a positive MMST (risk of Down's syndrome > or = 1:190) was compared to the incidence of adverse outcomes in control women with negative MMST. Chi-square analysis and Fisher's exact tests were used for comparisons as appropriate. Complete data was available from 1135 women. Seventy-seven percent were over age 35. Two hundred and forty-six women (22%) had a positive multiple marker test. No significant differences in outcomes were discovered after comparisons to controls: fetal death 1 of 246 (0.4%) versus 12 of 889 (1.3%), p = 0.32; preterm delivery 32 of 246 (13.0%) versus 147 of 889 (16.5%), p = 0.17; birth weight less than the 10th percentile, 9 of 246 (3.7%) versus 30 of 889 (3.4%), p = 0.83. Our data suggest that women > or = age 30 with a false-positive MMST and a normal midtrimester obstetrical sonogram are not at an increased risk for adverse pregnancy outcomes in later gestation.

Second-trimester maternal serum CA-125 versus estriol in the multiple-marker screening test for Down syndrome: Wenstrom K.D.; Owen J.; Boots L. USA Obstet Gynecol 1997 89/3 (359–363)

International Journal of Gynecology & ObstetricsVolume 57, Issue 3 p. 345-345 Citations from the literature (including the russian literature) trisomy Second-trimester maternal serum CA-125 versus estriol in the multiple-marker screening test for Down syndrome Wenstrom K.D.; Owen J.; Boots L. USA Obstet Gynecol 1997 89/3 (359–363) First published: 15 December 1997 https://doi.org/10.1016/S0020-7292(97)89953-5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume57, Issue3June 1997Pages 345-345 RelatedInformation