Pregnancy Screening Test Research Articles

Urinary sex steroid hormone and placental leucine aminopeptidase concentration differences between live births and stillbirth of Bornean orangutans (Pongo pygmaeus).

Under the environment of pregnancy, the placenta assumes an important steroidogenic role in the maintenance of pregnancy. Urinary placental leucine aminopeptidase (PLAP), estrone-3-glucuronide (E1 G), and pregnanediol-3-glucuronide (PdG) concentrations were compared among five pregnancies (four live births and one stillbirth) in four orangutans. The gestation period of the stillbirth (223days) was shorter than that of the live births (239-254days). In females who gave a live birth, average PLAP and E1 G concentrations increased until the delivery. Conversely, in the female who gave a stillbirth, PLAP concentration failed to increase, and E1 G concentration was significantly low in late pregnancy period. Regarding PdG concentrations, there was no significant difference among all pregnancies. This is the first study reporting a change in urinary PLAP, E1 G, and PdG concentrations during orangutan stillbirth and live birth pregnancies. The findings will assist in developing pregnancy screening tests.

Analysis of the results of implementation of a pregnancy screening policy at a comprehensive cancer center.

256 Background: Institutional implementation of a standard pregnancy screening policy for women will enhance the safe and timely delivery of treatment throughout the care continuum. In 2012, we developed and implemented an initial policy on pregnancy screening test (PST). The policy indicated that all providers should fully discuss with their female patients of child bearing potential regarding the potential risks of cancer treatment on fertility and the adverse effects on the fetus. The providers should also discuss the contraceptive options with female patients and their partners prior to diagnostic studies and/or treatment. In 2015, we revised the initial policy to further clarify timeframe for PST and clinical indicators and also developed an algorithm to support this best practice. We assessed practice changes as a result of the policy changes regarding PST at our institution. Methods: A retrospective data review was conducted to assess the number of PST over a 5 year period at The University of Texas MD Anderson Cancer Center. The timeframe includes both baseline and post-implementation policy and reflects annual changes from fiscal year (FY) 2010 to 2015. The pregnancy test was defined as measuring human chorionic gonadotropin (hCG) level in a urine sample. Results: We observed a significant increase in PSTs over time among female patients between ages 10 to 55 years. Over 5 years, there were 23,793 urine pregnancy tests performed. The number of urine pregnancy tests performed per FY were as shown on table below (trend test, p< 0.01). The percentage of PST performed among age groups (years): 1.8% of 10 to 15, 11.6% of 16 to 25, 22.3% of 26 to 35, 34.7% of 36 to 45, and 29.5% of 46-55 years old. Conclusions: Wedemonstrated that developing a standard institutional policy on pregnancy screening tests with further enhancements contributed to a significant increase in the number of PSTs performed over 5 years at our comprehensive cancer center. The majority of PSTs were conducted among female patient between the ages of 26 and 55. [Table: see text]

First trimester combined screening test in pregnancies derived from blastocyst transfer

ObjectiveTo investigate whether first trimester combined screening for major fetal trisomies is influenced by assisted reproduction techniques from blastocyst transfer, with or without cryopreservation. Study designretrospective case-control analysis involving 298 singleton pregnancies with euploid fetuses recruited between 2012 and 2014. Forty-seven women conceived with fresh blastocysts from in vitro fertilization cycles (fresh-blasto), 51 with frozen–thawed blastocysts (frozen-blasto) and 200 were natural conceptions (controls). All cases underwent ultrasound assessment at 11+0–13+6 weeks with measurements of crown rump length, nuchal translucency, free β-hCG and PAPP-A concentrations. The outcome of pregnancy was recorded (gestational age at birth, birth weight, obstetric complications). ResultsBaseline characteristics and pregnancy outcomes did not differ substantially among the study groups. The median delta nuchal translucency was significantly higher both in frozen-blasto group (median: 0.27mm; Interquartile Range [IQR]: 0.02–0.44; p<0.001) and in fresh-blasto group (median: 0.17mm; IQR: 0.04–0.39; p=0.014) as compared to control group (median: 0.06mm; IQR: −0.08 to 0.20), whereas it was not different in the frozen-blasto compared to the fresh-blasto group. The median free β-hCG multiples of the median (MoMs) was significantly higher both in frozen-blasto group (median 1.15; IQR 0.83–2.11; p=0.001) and in fresh-blasto group (median 0.95; IQR 0.52–1.48; p=0.001) as compared to control group (median 0.99; IQR 0.57–1.26), and it was also higher in frozen-blasto group compared to fresh-blasto group (p<0.001). The three groups showed no significant differences in the median PAPP-A MoMs. The median delta crown rump length was also not significantly different among the three groups. Conclusionsin assisted reproduction technique pregnancies from blastocyst transfer, with or without cryopreservation, both the nuchal translucency measurement and free β-hCG concentration are higher as compared to spontaneous conceptions, whereas PAPP-A does not show any significant difference. These features are apparently unrelated to the outcome of pregnancy and may be due to alterations or delays in embryogenesis or placentation with potential relevance for the screening test performance.

Next generation sequencing and its applications in non-invasive prenatal testing of aneuploidies

The development of the new generation sequencing techniques brought a new era in the field of DNA sequencing, that also revolutionized the prenatal screening for aneuploidy. In order to provide a more complete view, the authors describe some first generation methods as well as the theoretical and technical background of the next generation methods. In the second part of this review, the authors focuse on non-invasive prenatal testing, which is a fetal cell-free DNA based method requiring advanced sequencing procedures. After discussing the theoretical and technical background, the authors review current application and utility of non-invasive prenatal testing. They conclude that non-invasive prenatal testing is the most effective screening test in high risk pregnancies and its efficiency can be justified in studies involving low risk pregnancies as well.

The evaluation of rubella and sitomegalovirus IgG avidity tests in pregnants: four-year experience

Objective: In this study, we aim to evaluate the retrospective IgG avidity index (AI) test results of the pregnant, who have applied to our hospital and had pregnancy screening test and have been asked for rubella and cytomegalovirus antibody tests and IgG AI test in 4 year period. Methods: Anti-rubella IgM, anti-rubella IgG, anti-CMV IgM and anti-CMV antibodies were performed by IMMULITE 2000XPit Immunoassay System (Siemens, Germany) whereas IgG AI tests were performed by commercial kits of rubella and cytomegalovirus antibody tests (Dia.Pror Diagnostic, Milano-Italy). Results: Between January 2010 and December 2013, 23 (7.32 %) of 314 pregnant women tested rubella IgG AI had low AI, and 266 cases had high AI rate; 14 (17.28%) of 81 pregnant women tested CMV IgG AI, had lower AI rate, 52 of them had high AI. 9 out of 23 pregnant women, who were detected low rubella were requested only AI without any IgM and IgG value; the IgG antibody of 13 pregnant was reactive, and IgM antibody was not requested; IgG and IgM antibody of 1 pregnant was detected positive. When 5 pregnant, who were detected low CMV AI were requested AI without IgG and IgM value; the IgG and IgM of 4 was reactive; 4 of them had IgG reactive but IgM negative; 1 had IgG and IgM negative. Conclusion: As a result, our low rubella AI rate has been detected lower than the rates in our country since our study population contains only the pregnant. Our low CMV AI rate varies due to the same reasons as literature data. During pregnancy scanning, performing of AI testing together with specific IgG and IgM will save both time and will be more meaningful in clinical evaluation for pregnant women. J Clin Exp Invest 2014; 5 (3): 420-423

A multi-centre phase IIa clinical study of predictive testing for pre-eclampsia. IMproved PRegnancy Outcomes Via Early Detection (IMPROVED)

1 in 20 first time pregnancies is complicated by pre-eclampsia, the leading cause of maternal death in Europe. No clinically useful early pregnancy screening test exists, consequentially clinicians are unable to offer targeted surveillance or preventative strategies. IMPROVED Consortium members have pioneered a personalised medicine approach in identifying blood-borne biomarkers through recent technological advancements, involving mapping of the blood metabolome and proteome. The Consortium recently received funding under the auspices of the 7th Framework Programme of the European Union under the call: HEALTH- 2012-INNOVATION-1.2-1 (Grant Agreement no. Health-F5-2012-305169). The objective is to develop a sensitive, specific, high-throughput and economically viable early pregnancy screening test for pre-eclampsia. We report the design of a multicentre, phase IIa clinical study to assess and refine innovative prototype tests based on emerging metabolomic and proteomic technologies. Participation involves serial maternal phlebotomy, collection of clinical data, and pregnancy outcome data. Participants will attend essential visits at 15 and 20 weeks' gestation, with optional 11 and 34 weeks' gestation. Blood samples will undergo a combination of proteomic and metabolomic tests, and diagnostic performance will be assessed in accord with a pre-approved statistical analysis plan which will report Receiver Operating Curves, and Positive Predictive Values. The study is expected to refine proteomic and metabolomic panels, combined with clinical parameters, and evaluate clinical applicability as an early pregnancy predictive test for pre-eclampsia. If 'at risk' patients can be identified, this will allow stratified care with personalised fetal and maternal surveillance, early diagnosis, timely intervention, and significant health economic savings. The IMPROVED biobank will be accessible to the European scientific community for high quality research into the cause and prevention of adverse pregnancy outcome.

Risk of Ionizing Radiation in Women of Childbearing Age undergoing Radiofrequency Ablation

BackgroundThe International Commission of Radiology recommends a pregnancy screening test to all female patients of childbearing age who will undergo a radiological study. Radiation is known to be teratogenic and its effect is cumulative. The teratogenic potential starts at doses close to those used during these procedures. The prevalence of positive pregnancy tests in patients undergoing electrophysiological studies and/or catheter ablation in our midst is unknown. ObjectiveTo evaluate the prevalence of positive pregnancy tests in female patients referred for electrophysiological study and/or radiofrequency ablation. MethodsCross-sectional study analyzing 2,966 patients undergoing electrophysiological study and/or catheter ablation, from June 1997 to February 2013, in the Institute of Cardiology of Rio Grande do Sul. A total of 1490 procedures were performed in women, of whom 769 were of childbearing age. All patients were screened with a pregnancy test on the day before the procedure. ResultsThree patients tested positive, and were therefore unable to undergo the procedure. The prevalence observed was 3.9 cases per 1,000 women of childbearing age. ConclusionBecause of their safety and low cost, pregnancy screening tests are indicated for all women of childbearing age undergoing radiological studies, since the degree of ionizing radiation needed for these procedures is very close to the threshold for teratogenicity, especially in the first trimester, when the signs of pregnancy are not evident.

Risk and uncertainty: Shifting decision making for aneuploidy screening to the first trimester of pregnancy

PurposeThe clinical introduction of first trimester aneuploidy screening uniquely challenges the informed consent process for both patients and providers. This study investigated key aspects of the decision-making process for this new form of prenatal genetic screening. MethodsQualitative data were collected by nine focus groups that comprised women of different reproductive histories (N = 46 participants). Discussions explored themes regarding patient decision making for first trimester aneuploidy screening. Sessions were audio recorded, transcribed, coded, and analyzed to identify themes. ResultsMultiple levels of uncertainty characterize the decision-making process for first trimester aneuploidy screening. Baseline levels of uncertainty existed for participants in the context of an early pregnancy and the debate about the benefit of fetal genetic testing in general. Additional sources of uncertainty during the decision-making process were generated from weighing the advantages and disadvantages of initiating screening in the first trimester as opposed to waiting until the second. Questions of the quality and quantity of information and the perceived benefit of earlier access to fetal information were leading themes. Barriers to access prenatal care in early pregnancy presented participants with additional concerns about the ability to make informed decisions about prenatal genetic testing. ConclusionsThe option of the first trimester aneuploidy screening test in early pregnancy generates decision-making uncertainty that can interfere with the informed consent process. Mechanisms must be developed to facilitate informed decision making for this new form of prenatal genetic screening.

Prevalence and distribution of structural heart diseases in high and low risk pregnancies

To establish and compare the frequency of intrauterine congenital heart defects in high-risk and low-risk pregnancies for congenital heart diseases. Records of 3782 patients who underwent fetal echocardiography at the Pediatric Cardiology Unit were reviewed for reasons of referral and results of echocardiography retrospectively. The categorical variables between the groups were analyzed using a Chi-square test. Structural heart defects were found in 213 (5.6%) fetuses in both high and low risk groups. Most common defects were ventricular septal defect (36.2%) and atrioventricular septal defect (14.1%). Frequency of congenital heart diseases was 7.8% (169 fetuses) in high-risk group: 4.1% were complex, 2.3% significant and 1.4% were minor. In low-risk group, the frequency was 2.7% (44 fetuses): 0.6% were complex, 0.8% significant and 1.3% were minor. In this group, rates of congenital defects were high regarding particular reasons: intrauterine fetal death in previous pregnancy (6.3%), abnormal first or second trimester screening tests (4.3%), and multiple gestations (3.4%). The sensitivity and specificity of fetal echocardiography according to transthoracic echocardiography were found to be 86% and 99%, respectively. Congenital heart diseases rate, as expected, was found to be higher in high-risk group. However, regarding intrauterine fetal death in previous pregnancy, abnormal first or second trimester screening tests and multiple gestation, no statistically significant difference was observed between low-risk and high-risk groups. Therefore, we suggest the routine use of fetal echocardiography in cases we have mentioned above if the staff and equipment of the pediatric cardiology clinic are eligible.

Acute HIV Infection in Pregnancy: The Case for Third Trimester Rescreening

Combination testing with anti-HIV Elisa and Western blot is both sensitive and specific for diagnosis of established HIV-1 infection but could not detect acute HIV infection (AHI). AHI is a time of extremely high viral load, which may correlate to increased risk of horizontal or vertical transmission. Thus, early identification of AHI could allow for interventions to decrease transmission. However, recognition of AHI can be challenging as symptoms could be absent or nonspecific, therefore, AHI is often not detected, particularly in pregnancy. We present a case report of AHI in a pregnant woman who presented with headache and fever. She tested negative for HIV in the first trimester and at time of AHI at 26 3/7 weeks by anti-HIV Elisa, but was diagnosed with AHI based on an HIV RNA viral load of 434,000 copies/mL. This report presents a case for improved awareness of AHI in pregnancy, and the need for repeat HIV testing in late pregnancy, and highlighted that early detection of AHI might be possible with adding HIV RNA testing at time of standard anti-HIV Elisa screening test in pregnancy. Novel laboratory approaches including pooling of sera for HIV RNA could reduce the cost of HIV RNA testing.

Cochrane Reviews' summaries and their relevance for imaging: Doppler in obstetrics

Cochrane Reviews' summaries and their relevance for imaging: Doppler in obstetrics

Immunologic Characteristics of Preeclampsia, a Comprehensive Review

Preeclampsia (PE) remains a leading cause of maternal and fetal morbidity and mortality. Despite decades of intense research on the problem, there is no early pregnancy screening test to recognize those at risk. Recently, altered immune responses have been suspected to be involved in preeclampsia pathogenesis, which may involve the inflammatory context in which an immune response is mounted. In this review, the immunologic pathogenesis of the PE is reviewed in context of innate and adaptive immunity (both cellular, i.e., T and NK cells, and humoral immunity) in relation to thrombophilic conditions.

Abnormal Ductus Venosus Flow and Tricuspid Regurgitation at 11–14 Weeks' Gestation have High Positive Predictive Values for Increased Risk in First-Trimester Combined Screening Test: Results of a Pilot Study

To investigate the relationship between two novel first-trimester ultrasound markers (abnormal fetal ductus venosus [DV] flow and presence of tricuspid regurgitation [TR]) and the results of the first-trimester combined screening test in pregnancies with a normal karyotype. The screening test involves nuchal translucency measurement by ultrasound, and measurement of serum free beta-chorionic gonadotropin and pregnancyassociated plasma protein A. The study included 58 pregnancies with amniocentesis-proven normal karyotypes and ultrasound-proven normal fetal anatomy. DV flow and TR were initially evaluated by ultrasound at 11-14 weeks' gestation. Sensitivity, specificity, and positive and negative predictive values of abnormal DV flow and TR for determining increased test risk (> 1 in 300) were calculated. Abnormal DV flow and TR were detected in seven (12%) and six (10%) women, respectively. The sensitivities of abnormal DV flow, TR, and dual abnormalities (abnormal DV flow plus TR) for predicting increased risk in the combined screening test were low (33.3%, 27.7%, and 26.3%, respectively). However, their corresponding specificities (97.5%, 97.5%, and 100%) and positive predictive values (85.7%, 83.3%, and 100%) were reasonably high, with particularly low false-positive rates (2.5%, 2.5%, and 0%). When abnormal DV flow and TR were both positive, the combined test risk was consistently above 1 in 300. Determination of DV flow and TR as initial markers in unselected pregnancies merits further investigation, as the combination of these parameters might reliably predict an increased risk in combined screening test result, with low false positivity.

Obstetrics in October and endometriosis

Obstetrics in October and endometriosis

False‐positive pregnancy test after passive transfusion of β‐human chorionic gonadotropin from donor red blood cells during erythrocytapheresis

Patients transfused with blood products may passively receive soluble antibodies, proteins, and other analytes that persist during the collection, processing, and transfusion of the blood product. In this report, a female patient who received transfusion of five red blood cell (RBC) units during erythrocytapheresis later demonstrated an unexpected positive result in assays for the beta-subunit of human chorionic gonadotropin (bHCG), a screening test for pregnancy. The result caused postponement of an elective surgical procedure. A follow-up test 1 week later was negative. To investigate the possibility of passive transfusion of the hormone from a donor RBC unit, a sample from each of the units transfused was assayed for the level of bHCG. One of the 5 units transfused to the patient had a high level of bHCG. The observed bHCG level in the recipient was found to be comparable to the predicted level, given the donor's plasma bHCG level and accounting for the dilution factors in the preparation of the RBC unit and the erythrocytapheresis procedure and the in vivo t((1/2)) of the hormone. The donor, who was unaware of her pregnancy status at the time of donation, harbored a high bHCG level that caused the positive test result in the recipient patient's serum and urine. If an unexpected analyte or serology is detected in a recipient of a blood transfusion, it is important to consider the possibility of passive transfusion of the analyte.

Transmission of HIV-1 from an obstetrician to a patient during a caesarean section

We have recently reported [1] a probable case of the transmission of HIV-1 from an obstetrician to a patient during a caesarean section. In response to a request from the editors for clarification of the HIV testing that took place and in response to a reader's query, so that others are aware of the details available on this report of HIV transmission between a healthcare professional and a patient, we would like to underline and or reinforce the following points: (i) The HIV-negative test during pregnancy was reported by the patient only, and any results for screening for HIV-1 antibodies and viral load could not be directly verified. There was, however, a fully verified HIV-negative test report from the laboratory of the blood bank of our institution for a blood donation sample taken approximately 3 months before pregnancy; (ii) The newborn was HIV antibody negative immediately after the caesarean section and the viral load was undetectable; (iii) According to our medical records on the obstetrician, he had not been tested previously for HIV before the caesarean section. The first time he reported to us to be tested (the test was positive) for HIV was in September 2001 (7 months after the caesarean section); (iv) The needlestick injury was reported by the patient, and this was seen by the patient and her relatives, and the obstetrician was said to have admitted the accident to the patient and her relatives but not directly to us; and (v) The summary of the dates the blood samples were taken and the results are as follows: On 20 March 2000 on the occasion of a blood donation at our institution, the HIV serology of the patient (enzyme-linked immunosorbent assay test) was negative. Around June–July 2000 the pregnancy was diagnosed. Routine pregnancy screening tests including HIV serology were performed at another hospital and were reported to be negative to the patient by her obstetrician. On 1 February 2001 delivery by caesarean section took place. A needlestick accident happened during the caesarean section. HIV antibodies of the newborn were negative and the HIV viral load of the newborn was undetectable. On 13 March 2001 the patient developed clinical manifestations consistent with an acute HIV infection. On 29 March 2001 the patient had for the first time an HIV-positive serology. In September 2001 an HIV test on the obstetrician was positive. No previous tests were available or at least none were reported to us. On 21 January 2002 a blood sample was drawn from the obstetrician and the patient in the setting of a legal litigation. HIV sequence analysis performed in our laboratory demonstrated that the viruses were almost identical. A duplicate test was performed in the Hospital Germans Trías i Pujol (Badalona, Barcelona) also showing the virtual identity of both viruses. After carefully re-reviewing of all these data we strongly believe that the main conclusion of the paper (‘highly likely HIV-1 transmission from an obstetrician to a patient during a caesarean section’) remain unchanged or even further reinforced.

Is 1-hour glucose screening test reliable after a short-term administration of antenatal betamethasone?

This study was designed to determine whether betamethasone has any effect on 1-hour (50-g) glucose screening test in nongestational diabetic pregnancy, and if any exists, to determine if this effect is transient or permanent. If the effect is temporary, the study was designed to determine the duration of this glucose intolerance effect and to determine the timing of 1-hour glucose screening test after betamethasone usage. One hundred fourteen pregnant women with a diagnosis of preterm labor at 24 to 34 weeks gestation were enrolled into the prospective study. One-hour glucose screening test was performed before initiation of hydration treatment. Forty pregnant women with normal 1-hour glucose results, who also had responded to hydration therapy, made up our study group. Twenty-four hours, 72 hours, and 1 week after administration of betamethasone, 50-g glucose challenge tests were again performed. A 3-hour glucose tolerance test was performed in pregnant women, whose 1-hour screening test had been positive 1 week after corticosteroid administration. In the evaluation of data, one-way, variance analysis and Tukey's multiple comparison test were used. The mean value of 1-hour glucose results of 50-g challenge test at the 24 hours was significantly higher than the mean value of 1-hour glucose results of the test done initially before betamethasone administration and than those of the tests done at 72 hours and 1 week (p < 0.001 for these three groups). There was no statistically significant difference between the mean values of 1-hour glucose results of the test done before betamethasone administration and both the results of the tests done at 72 hours (p = 0.96) and 1 week (p = 0.99), separately. There was no significant difference between the mean 1-hour glucose results of the tests at 72 hours and 1 week (p = 0.99). The test results were positive in 42.5%, 10%, and 5% of the patients, respectively at 24 hours, 72 hours, and 1 week. The betamethasone administration significantly deteriorates 1-hour glucose screening test results in the nongestational diabetic patients but this effect of betamethasone is transient. Because of its high false-positivity at 24 hours (42.5%) and at 72 hours (10%) in women with initial negative 1-hour glucose screening test, we suggest that 1-hour glucose screening test in pregnant women be postponed at least 1 week after betamethasone administration or perform the test before administration of betamethasone.

Nasal bone evaluation with ultrasonography: a marker for fetal aneuploidy.

Nasal bone evaluation with ultrasonography: a marker for fetal aneuploidy.

Editor's choice

Editor's choice

A measure of informed choice.

To develop a measure of informed choice. CONCEPTUALIZATION AND MEASUREMENT: The measure is based on the following definition of an informed choice: one that is based on relevant knowledge, consistent with the decision-maker's values and behaviourally implemented. The measure comprises an eight-item scale of knowledge, a four-item scale assessing attitudes towards undergoing the screening test and a record of test uptake. Sixty-six women awaiting their first antenatal clinic appointments. MEASURE DEVELOPMENT: In women offered a screening test in pregnancy, the internal reliability of both the knowledge and the attitude scales was acceptable (alpha coefficients 0.82 and 0.83, respectively). Of the 42 women completing both scales, 18 were classified as having made an informed choice, and 24 were classified as having made an uninformed choice. The results of this preliminary study provide some evidence to support the feasibility of conceptualizing and measuring informed choices regarding screening using a brief measure assessing knowledge and attitudes. The validity and utility of this approach awaits further studies, involving larger numbers of participants, offered different screening tests.