Serum Free Beta-human Chorionic Gonadotropin Research Articles

Correlation between elevated maternal serum alpha-fetoprotein and ischemic placental disease: a retrospective cohort study

ABSTRACT Background To evaluate the correlation between elevated maternal serum alpha-fetoprotein (AFP) in the second trimester and ischemic placental disease (IPD). Methods A retrospective cohort study was conducted to analyze the data of 22,574 pregnant women who delivered in the Department of Obstetrics at Hangzhou Women’s Hospital from 2018 to 2020, and were screened for maternal serum AFP and free beta-human chorionic gonadotropin (free β-hCG) in the second trimester. The pregnant women were divided into two groups: elevated maternal serum AFP group (n = 334, 1.48%); and normal group (n = 22,240, 98.52%). Mann-Whitney U-test or Chi-square test was used for continuous or categorical data. Modified Poisson regression analysis was used to calculate the relative risk (RR) and 95% confidence interval (CI) of the two groups. Results The AFP MoM and free β-hCG MoM in the elevated maternal serum AFP group were higher than the normal group (2.25 vs. 0.98, 1.38 vs. 1.04) and the differences were all statistically significant (all P < .001). Placenta previa, hepatitis B virus carrying status of pregnant women, premature rupture of membranes (PROM), advanced maternal age (≥35 years), increased free β-hCG MoM, female infants, and low birth weight (RR: 2.722, 2.247, 1.769, 1.766, 1.272, 0.624, 2.554 respectively) were the risk factors for adverse maternal pregnancy outcomes in the elevated maternal serum AFP group. Conclusions Maternal serum AFP levels during the second trimester can monitor IPD, such as IUGR, PROM, and placenta previa. Maternal women with high serum AFP levels are more likely to deliver male fetuses and low birth weight infants. Finally, the maternal age (≥35 years) and hepatitis B carriers also increased maternal serum AFP significantly.

Analysis of the Effectiveness of First Trimester Nucal Translucence, Free Beta-Human Chorionic Gonadotropin, and Pregnancy-Related Plasma Protein-A in Prediction of Pregnancy Complications

In this study, we aimed to investigate whether there was an association between fetal nuchal translucency (NT) and the serum markers plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (β-hCG) measured by the first-trimester screening test, as well as birth weight and hypertension. 454 pregnant women who had undergone the first-trimester screening test for Down syndrome were included in the study. All measurements and values of NT, PAPP-A and β-hCG levels were performed between gestational weeks 11-14. Values of PAPP-A and β-hCG converted to multiples of the corrected median (MoM) were obtained using the PRISCA software package. Regarding the prediction of SGA infants, when the PAPP-A value &lt; was 0.99MoM as a threshold, and when the free β-hCG value &lt; was 0.69 MoM, SGA cases could be detected with a sensitivity of 83% and a specificity of 71.9%. Regarding the prediction of hypertension, at a threshold PAPP-A value of

The Relationship Between First-Trimester Aneuploidy Markers and Birth Weight

OBJECTIVE: We aimed to determine the relationship between the first-trimester aneuploidy screeningma and the predicted weight at birth: Small for gestational age and large for gestational age. STUDY DESIGN: 594 low-risk pregnant women with a singleton pregnancy, who underwent first-trimester aneuploidy screening by measuring nuchal translucency, maternal serum free beta-human chorionic gonadotropin, and pregnancy-associated plasma protein-A were included in the study. Those weighing above the 3rd percentile and below the 10th percentile were defined as small for gestational age, and those over the 90th percentile were defined as large for gestational age. RESULTS: A total of 594 pregnant women were enrolled. The mean maternal age of the studied group was 28.8±5.5 years. Low maternal serum pregnancy-associated plasma protein-A levels and decreased nuchal translucency measurements were associated with the small for gestational age newborn (p&lt;0.001 and p=0.001, respectively). There is a significant correlation with large for gestational age for newborns only with an increase in maternal serum pregnancy-associated plasma protein-A levels (p=0.001). beta-human chorionic gonadotropin levels were not associated with the birth weight (p=0.735). CONCLUSION: Maternal serum pregnancy-associated plasma protein-A levels, one of the markers in first-trimester aneuploidy screening, can be used in the prediction of small for gestational age and large for gestational age However, due to its low correlation, it is not a suitable screening test for clinical practice.

Combination of three-dimensional placental vascular indices and volume and uterine artery pulsatility index at 10-13 weeks of gestation could improve the prediction of adverse pregnancy outcomes.

To evaluate whether three-dimensional (3D) placental vascular indices and volumes during the first trimester of pregnancy can be used as predictors of subsequent adverse outcomes. This was a prospective cohort study including women with singleton pregnancies between 10 and 13 weeks. 3D placental volume and vascular indices and uterine artery pulsatility index (UtA-PI) were measured. Adverse outcomes were defined whether there was any of the following complications: small for gestational age pregnancy, preterm delivery, and preeclampsia. The serum pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (β-hCG) levels were also compared. We analyzed the screening performances of these parameters for prediction of any of adverse outcomes. Of 348 women screened, 300 women were completed follow-up. Overall, 57 (19.0%) of 300 women developed any of adverse pregnancy outcomes. Multiple logistic regression analysis demonstrated that gestational age-adjusted z-scores of log10 placental volume (odds ratio [OR], 0.572; 95% confidence interval [CI], 0.416-0.788), log10 placental vascularization flow index (VFI; OR, 0.676; 95% CI, 0.496-0.921), and log10 UtA-PI (OR, 1.910; 95% CI, 1.335-2.731) were significantly associated adverse pregnancy outcomes. The multivariate model combining placental VFI, placental volume, UtA-PI, and underweight or obese body mass index exhibited the highest screening performances (AUC=0.77) and PAPP-A and β-hCG did not add any significance to multivariate model. Placental volume and vascular indices at 10-13 weeks of gestation are significantly associated with adverse pregnancy outcomes. Combination of these placental indices and UtA-PI could improve the screening performance for adverse outcomes.

This Month in Pediatric Urology

You have accessJournal of UrologyThis Month in Pediatric Urology1 May 2020This Month in Pediatric Urology Julian Wan Julian WanJulian Wan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000784AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail The pediatric articles published in this issue of The Journal represent 2 ends of the pathological spectrum. Peycelon et al focus on the beginning in their report on in utero maternal hormone levels that may predict the risk for hypospadias.1 Aksenov and Granberg evaluate the potential complications of minimally invasive surgery to treat common conditions such as ureteropelvic junction narrowing and vesicoureteral reflux.2 Linking the articles is the acquisition, collection and analysis of large pools of data. The collection, storage, examination and commerce of personal data including medical information has expanded in the last few decades and is likely to continue to grow as greater segments of the population become associated with electronic medical record systems. Despite the many real concerns about privacy and exploitation, there are legitimate scientific applications of these larger data collections. By sampling blood collected as part of general screening, specific disease relationships can be identified and complications may emerge when gathering reports of procedures. Association of Maternal Human Chorionic Gonadotropin and Hypospadias Using a large national registry, Peycelon et al (page 1017) from France examined the association between first trimester maternal serum free beta-human chorionic gonadotropin (HCG) levels and subsequent finding of hypospadias in the newborn. It has been established that tubularization of the urethra occurs early and is usually complete by 16 to 18 weeks of gestation. This process is affected by testosterone activity which, in turn, is affected by the release of HCG from maternal placental syncytiotrophoblasts. The authors suspect that the relationship may depend more on total HCG rather than just the beta subunit. Using a large metropolitan Paris database of maternal blood samples taken as part of routine prenatal screening, they found that proximal hypospadias, but not distal hypospadias or hypospadias overall, was associated with significantly higher levels of beta-HCG. The study was controlled for age and excluded pregnancies that were initiated by artificial reproductive technologies (a known risk for hypospadias), chromosomal anomalies, twins, fetal death and terminations. However, the authors acknowledged the limitations inherent with this type of analysis, most of which relate to potential bias from underreporting of less severe forms and the small number of proximal hypospadias cases (13 of 194 hypospadias cases). Complications of Minimally Invasive Surgery in Children To assess complications in patients treated with minimally invasive surgery, Aksenov et al (page 1010) from North Carolina and Minnesota conducted a review of the existing literature.2 While the Clavien-Dindo (CD) system of classification has been widely used, it was used in only a third of the articles in their review, whereas for the remaining articles complications were adjudicated by the authors and assigned a CD grade. In particular, the authors focused on complications resulting in subsequent surgical, radiological and endoscopic interventions (CD grade IIIa without general anesthesia, CD grade IIIb with general anesthesia). They also noted conversion rates related to open surgery. A significantly lower rate of grade III complications was reported for nephrectomy than for pyeloplasty and ureteral reimplantation. Complex reconstructions, as one would expect intuitively, resulted in the highest grade III complication rate at 12%. Likewise, the complication rate was highest for conversion to open surgery, followed by partial nephrectomy, nephrectomy and ureteral reimplantation. The lowest complication rate occurred after pyeloplasty (1%) which may reflect longer experience with this procedure. The clear separation of open conversion and the need for a complication related subsequent procedure is of practical use when discussing possible risks with families, patients and referring physicians.

First-trimester screening for trisomies in pregnancies with vanishing twin.

To examine multiples of the median (MoM) values of serum free beta-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) in a large series of pregnancies with a vanishing twin, determine the association of these values with the interval between embryonic death and blood sampling, and develop a model that would allow incorporation of these metabolites in first-trimester combined screening for trisomy. This was a retrospective study comparing maternal serum free β-hCG and PAPP-A levels at 11-13 weeks' gestation in 528 dichorionic pregnancies with a vanishing twin, including 194 (36.7%) with an empty gestational sac and 334 (63.3%) with a dead embryo, with those in 5280 normal singleton pregnancies matched for method of conception and date of examination. In vanishing-twin pregnancies with a dead embryo, marker levels were examined in relation to the estimated time between embryonic death and maternal blood sampling. First, in pregnancies with a vanishing twin, median free β-hCG MoM was not significantly different from that in normal singleton pregnancies (1.000; 95% CI, 0.985-1.016 vs 0.995; 95% CI, 0.948-1.044; P = 0.849). Second, PAPP-A MoM was higher in vanishing-twin pregnancies than in normal singleton pregnancies (1.000; 95% CI, 0.985-1.015), both in the group with an empty gestational sac (1.165; 95% CI, 1.080-1.256; P = 0.0001) and in that with a dead embryo (1.175; 95% CI, 1.105-1.249; P < 0.0001). Third, in vanishing-twin pregnancies with a dead embryo, PAPP-A MoM was related inversely to the interval between estimated gestational age at embryonic demise and blood sampling (P < 0.0001). Fourth, in first-trimester screening for trisomy 21 in singleton pregnancies, the estimated detection rate, at a 5% false-positive rate, was 82% in screening by a combination of maternal age and fetal nuchal translucency thickness, and this increased to 86% with the addition of serum free β-hCG and to 91% with the addition of serum PAPP-A. Fifth, similar performance of screening can be achieved in pregnancies with a vanishing twin, provided the appropriate adjustments are made to the level of PAPP-A for the interval between estimated gestational age at embryonic demise and blood sampling. First-trimester screening for trisomy in pregnancies with a vanishing twin should rely on a combination of maternal age, fetal nuchal translucency thickness and serum free β-hCG, as in singleton pregnancy, without the use of serum PAPP-A. Alternatively, PAPP-A can be included but only after appropriate adjustment for the interval between estimated gestational age at fetal demise and blood sampling. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

The effect of oral micronized progesterone on first trimester screening test markers and neonatal outcome

Objective: It was aimed to investigate whether or not nuchal translucency(NT) thickness, maternal serum free beta-human chorionic gonadotropin(β-hCG) and pregnancy-associated plasma protein-A(PAPP-A) levels may affected by the use of oral micronized progesterone(OMP) in first trimester pregnancies. Also we aimed to evaluate pregnancy outcome in pregnant women using OMP. Method: This study was performed retrospectively including 1192 pregnant women, between January 2015 and August 2017. Body mass index(BMI), maternal and gestational age, levels of maternal serum PAPP-A and free β-hCG, NT measurement and the crown–rump length(CRL), fetal sex, fetal birth weight, Apgar score 5thminute<7 and admission to neonatal intensive care unit(NICU) were evaluated. Results: Maternal characteristics, ultrasound and biochemical parameters, fetal characteristics and neonatal outcome were evaluated. There was no statistically significant difference for maternal age, BMI, gestational age, PAPP-A, β-hCG, CRL, NT thickness, fetal sex, fetal birth weight, Apgar score 5th minute <7 and the number of admission to NICU during the first 28 days. Conclusions: Our results suggest that in clinical practice, 1) it seems that using OMP cannot affect on NT, CRL and birth weight. 2) OMP cannot adversely affect on production of PAPP-A and β-hCG in vivo. 3) NT, serum PAPP-A and β-hCG levels and MoM values, which are markers of the first trimester screening test, do not change by using OMP. Therefore using OMP cannot affect reliability of the first trimester screening test in pregnancy with threatened abortion. 4) OMP does not look like adversely affect on poor neonatal outcome.

Second-trimester maternal serum screening for fetal Down syndrome: As a screening test for hemoglobin Bart's disease: A prospective population-based study.

The purpose of this study is to determine the effectiveness of second-trimester maternal serum screening for Down syndrome as a screening test for fetal hemoglobin (Hb) Bart's disease among an unselected population. A secondary analysis of a large prospective database (20254 pregnancies) was conducted to compare the levels of maternal serum screening, alpha-fetoprotein (AFP), free beta-human chorionic gonadotropin, and unconjugated estriol between pregnancies with Hb Bart's disease and unaffected pregnancies. The median AFP levels were much higher among affected fetuses (1.96 vs 1.12 multiple of the median; P<.001), yielding a sensitivity of 81.6% and specificity of 86.4%. Thus, AFP measurement is effective in predicting fetal Hb Bart's disease among an unselected population when using a cutoff value of 1.5 multiple of the median. The serum free beta-human chorionic gonadotropin levels were slightly, but significantly, higher in the affected pregnancies, while the serum unconjugated estriol levels were minimally, but significantly, lower among the affected pregnancies. Second-trimester maternal serum AFP levels were significantly elevated in cases of fetal Hb Bart's disease. Pregnancies with unexplained elevated serum AFP levels in areas of high prevalence of Hb Bart's disease should always undergo a detailed ultrasound examination to detect any early signs of fetal anemia before development of hydrops fetalis.

331: Maternal serum free-beta human chorionic gonadotrophin (hCG) and the risk of spontaneous preterm delivery

331: Maternal serum free-beta human chorionic gonadotrophin (hCG) and the risk of spontaneous preterm delivery

Cell-free DNA Testing: Where are We now?

ABSTRACTPrenatal screening for fetal aneuploidies has been focused on mainly Down syndrome in the last 40 years. The method of screening has changed from maternal age in the 1970s, with a detection rate of 30 and 5% false positive rate (FPR), to a combination of maternal age and second-trimester serum biochemical markers (triple test and quadruple test) in the 1980s and 1990s, with 60 to 75% detection rate and 5% false positive rate (FPR). Following this, the era of first trimester screening for Down syndrome has started with the clinical implementation of fetal nuchal translucency screening. The combination of maternal age, NT thickness and serum free beta-human chorionic gonadotropin (â-hCG) and pregnancy-associated plasma protein A (PAPP-A) in the first trimester has yielded a 90% detection rate with a 5% FPR. Starting from the year 2008, studies have shown that the performance of screening may be improved by analysis of cell-free deoxyribonucleic acid (DNA) (cfDNA) in maternal blood. Several studies in the last few years have reported the clinical validation of cell free fetal DNA test in the maternal serum in screening for trisomies 21, 18, and 13 and sex chromosome aneuploidies.Its widespread use is limited by the relatively high cost of the test and the lack of consensus about the optimal way for its clinical implementation. Until the optimal way of incorporating cfDNA into the clinical practice gets identified, it would be wise not to substitute cfDNA testing in place of first-trimester screening for fetal defects and other major complications of pregnancy. Furthermore, it would be preferable for clinicians managing individual patients not to counsel them for their result as positive or negative, rather the clinicians should use the risk estimate from the first-line method of screening as the prior risk and modify this by the appropriate positive or negative likelihood ratio from the cfDNA test.How to cite this articleSen C, Api O, Yayla M, Goynumer G. Cell-free DNA Testing: Where are We now? Donald School J Ultrasound Obstet Gynecol 2016;10(2):172-177.

The effect of maternal polycystic ovary morphology on first-trimester maternal serum biochemical markers of aneuploidy and fetal nuchal translucency thickness

Objective: To evaluate the effect of maternal polycystic ovary (PCO) morphology on maternal serum free beta-human chorionic gonadotropin (&#x03B2;-hCG), pregnancy associated plasma protein A (PAPP-A), and nuchal translucency (NT) thickness in the first-trimester. Material and Methods: A total of 92 pregnant women in the first-trimester were included in the study. Of them, 57 had PCO morphology, and 35 women constituted the control group, with apparently normal ovaries. Maternal serum free &#x03B2;-hCG, PAPP-A, and NT thickness were measured and compared in all patients. Results: The multiples of median (MoM) levels of serum free &#x03B2;-hCG were significantly higher in the PCO morphology group compared to the normal ovary group (p = 0.024). However, the MoM levels of PAPP-A were similar in both groups (p = 0.947). No difference was found between the groups in terms of fasting glucose levels and NT measurements (p = 0.976 and 0.565, respectively). Conclusion: In pregnancies with maternal PCO morphology, the presence of higher maternal serum free &#x03B2;-hCG levels may require correction in the calculation of risks related to first-trimester screening for chromosomal abnormalities. Larger studies are needed to confirm our preliminary data.

Maternal serum alpha-fetoprotein and free beta-human chorionic gonadotropin in the second trimester: implication for high risk of down’s syndrome in the ghanaian population

Maternal serum screening during pregnancy for adverse changes in levels of alpha-fetoprotein (AFP) and free beta- Human Chorionic Gonadotropin (free β-HCG) in the second trimester to assess risk of Down’s syndrome (DS) is a rare obstetric practice in Ghana. The aim of this study was to determine changes in the levels of these markers, and assess for risk of DS and adverse pregnancy outcomes in the Ghanaian population. Levels of AFP and free β-HCG were determined in maternal serum samples from eighty one women with singleton pregnancy collected at recruitment (12-13 gestational weeks), and in the second trimester (16 gestational weeks). AFP and free β-HCG markers were expressed in multiples of the normal median (MoM) for gestation. Delivery outcomes and features of the new born at delivery were also noted. The mean age of subjects at recruitment was 33.9±3.2 years. AFP levels at recruitment and in the second trimester were 18.8 ± 7.5 ng/ml (mean ± SD) and 30.9 ± 9.8 ng/ml (mean ± SD) respectively. Similarly, free β-HCG at recruitment and in the second trimester were 47.2 ± 12.2 ng/ml (mean ± SD) and 29.8 ± 11.3 ng/ml (mean ± SD) respectively. The differences in the serum levels of AFP and free β-HCG between the first and second trimesters were significant (p<0.0001: 95% CI -14.9-(-9.3) and p<0.0001: 95% CI 13.6-21.2). Whilst the AFP level did not correlate with weight, free β-HCG weakly correlated with maternal weight (p=0.29 and r 2 =0.017; p=0.08 and r 2 =0.055 respectively), but not age in the second trimester. There were no cases of DS observed in the study population. The mean concentrations of free β-HCG in adverse pregnancies were higher than in normal pregnancies (38.4 ± 6.6; 29.3 ± 10.6) but not for AFP (p=0.059, and p=0.477 respectively). Although no DS was seen for comparison, free b-HCG appears to be a useful marker for risk assessments of poor pregnancy outcomes in the population.

Obstetrical complications associated with first‐trimester screening markers in twin pregnancies

The aim of this retrospective study was to investigate the relation between perinatal complications in twin pregnancies and the combination of first-trimester maternal serum pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotrophin (β-hCG) levels. The study was conducted at the Perinatology Department of Baskent University between January 2005 and December 2011. In total, 104 patients with twin pregnancies were recruited. The association of first-trimester maternal serum-screening markers with perinatal complications was investigated for small-for-gestational-age (SGA) fetuses or intrauterine growth restriction (IUGR), preterm delivery (before 34 weeks of gestation), pregnancy-induced hypertension (PIH), and growth discordance between fetuses. Low serum PAPP-A (below 10th percentile) levels were not correlated with preterm labor, PIH, or IUGR in twin gestations. Elevated free β-hCG levels (>90th percentile) were linked to increased rates of PIH and small-for-gestational-age fetuses or IUGR. Elevated first-trimester free β-hCG was related to adverse pregnancy outcomes in twin pregnancies, whereas low PAPP-A levels were not linked to adverse pregnancy outcomes.

First trimester risk assessment for trisomy 21 in twin pregnancies combining nuchal translucency and first trimester biochemical markers

The aim is to describe the performance of first-trimester combined risk assessment in twin pregnancies. Maternal serum free beta-human chorionic gonadotrophin and pregnancy-associated plasma protein A (PAPP-A) were determined at 8 to 12 weeks and fetal nuchal translucency (NT) was measured at 11 to 13+6 weeks. The individual risk was estimated for each fetus using the combined test in dichorionic twins. In monochorionic twins, the mean risk assessment of the two fetuses was used. An invasive diagnostic procedure was offered when the risk was ≥ 1 : 270 in either one of the fetuses. From February 2007 to June 2011, 447 twin pregnancies were enrolled in this study. There were 402 (89.9%) dichorionic and 45 (10.1%) monochorionic twins. In dichorionic twins, mean crown-rump length (CRL) was 63.9 mm; median NT multiples of the median (MoM) was 0.97; median Β-hCG was MoM 1.74; median PAPP-A was 1.72. In monochorionic twins, mean CRL was 61.9 mm; median NT MoM was 0. 98; median Β-hCG MoM was 1.44; and median PAPP-A was 1.51. Two pregnancies with Down syndrome were detected by first trimester screening, both in dichorionic twins. The false positive rate was 5.7% (95% confidence interval 4.1-7.3) and 4.4% (95% confidence interval 0.1-8.8%) in dichorionic and monochorionic twins, respectively. The combined test in twins appears to be a good method for Down syndrome screening with a high detection rate and an acceptable false-positive rate.

First trimester, second trimester, and integrated screening for Down's syndrome in China

To compare the effectiveness of first trimester, second trimester, and integrated screening for Down's syndrome. Two prenatal diagnosis centres in China. A total of 11,966 pregnant women (≥18 years) were screened over 21 months. First trimester screening (11-13 weeks) comprised measurement of serum free beta-human chorionic gonadotrophin (β-hCG) and pregnancy-associated protein-A concentrations, and fetal nuchal translucency thickness. Second trimester screening (15-20 weeks) comprised measurement of β-hCG and alpha fetoprotein concentrations. Computer software was used to calculate the risk of carrying a Down's syndrome fetus. The overall incidence of Down's syndrome was 0.2% (23/11,966). When the false-positive rate was fixed at 5%, detection rates for first trimester, second trimester, and integrated screening were 73.9%, 69.6%, and 82.6%, respectively. When the false-positive rate was fixed at 3%, detection/sensitivity rates for first trimester, second trimester, and integrated screening were 65.2%, 56.5%, and 73.9%, respectively. These findings suggest that integrated screening was the most effective means of screening for Down's syndrome in a Chinese population.

Improved diagnostic accuracy by using secondary ultrasound markers in the first‐trimester screening for trisomies 21, 18 and 13 and Turner syndrome

The aim of this study was to examine the effectiveness of a combination of parameters at first-trimester screening for fetal aneuploidies, including ultrasound assessment of the nasal bone (NB), blood flow in the ductus venosus (DV) and flow across the tricuspid valve. Screening for aneuploidy was carried out in 4172 singleton pregnancies between January 2006 and December 2010. Diagnostic accuracy of combined screening [inclusive of maternal age, fetal nuchal translucency (NT) thickness and maternal serum free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A] and of secondary ultrasound markers [NB, tricuspid regurgitation (TR) and Doppler studies of the DV] obtained at the same visit was assessed using the receiver operating characteristic (ROC) curve analysis. The individual areas under the ROC curves of NT, NB, DV or TR ranged between 0.7 and 0.8, representing acceptable discrimination. The area under the ROC curve of combined first-trimester screening was 0.87, whereas the addition of secondary ultrasound markers increased the area under the curve to 0.92, which represents excellent discrimination. At a risk cutoff of 1 : 275, the detection rate for aneuploidy increased from 87% to 92% (z statistic = 1.78, P = 0.076), and the false positive rate decreased from 5.3% to 4.8%. The addition of secondary ultrasound markers (NB, DV and TR) to combined first-trimester screening showed a tendency toward improved accuracy of the screening.

Bölgemizde İlk Trimester Tarama Testi Parametrelerinin Medyan Düzeylerinin Belirlenmesi

Objective: In this study our purpose was to determine the median values of the first trimester screening parameters in pregnancy in our region to decide whether Prisca medians are appropriate or not and reevaluate risky pregnancies according to prisca medians by the way of the new regional median values and compare results. Methods: In this study we evaluated serum free beta-human chorionic gonadotropin (free β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) values of 1,613 pregnant women who admitted to our biochemistry laboratory for the first trimester screening test between 2005-2010. Results: β-hCG and PAPP-A median values were calculated for each week between 11-13th gestational weeks. When regional medians calculated by Prisca median values on 11-13th weeks are compared, statistically no significant difference was found on free β-hCG levels (p>0.05) as there was statistically a significant difference on PAPP-A levels (p<0.05). Conclusion: We believe that calculating regional median values or determining appropriateness of used medians can decrease the need for invasive diagnostic procedures which carries risk for both mother and fetus.

Screening for aneuploidies by maternal age, fetal nuchal translucency and maternal serum biochemistry at 11-13+6 gestational weeks

Aneuploidies are the major cause of perinatal death and early psychophysical disorders. In this study, we analyzed detection and false-positive rates of screening for aneuploidies in the first trimester by the combination of maternal age, fetal nuchal translucency (NT) thickness and maternal serum free beta-human chorionic gonadotrophin (beta-hCG), and pregnancy-associated plasma protein-A (PAPP-A) at 11-13+6 weeks of gestation, using the appropriate software developed by the Fetal Medicine Foundation. Our screening study for aneuploidies analyzed 4172 singleton pregnancies from January 2006 to December 2010. The sensitivities and false-positive rates using the combined aneuploidies determination for the risk cut-off of 1:275 were evaluated. In the trisomy 21 pregnancies, the fetal NT was higher than 95th centile, in 72.8%, serum free b-hCG concentration it was above the 95th centile in 55% and serum PAPP-A was below the 5th centile in 47% of the cases. In the trisomy 18 and 13, the fetal NT was above 95th centile in 66.6% and 44.4% of the cases, respectively.The serum free b-hCG concentration was above the 95th centile in 0 and 10%, but serum PAPP-A was below 5th centile in 80.9% and 88.8% of pregnancies. In the trisomy 21 pregnancies the median free beta-hCG was 2.3 MoM and the median PAPP-A was 0.45 MoM. Chromosomal abnormalities were detected in 169 fetuses: trisomy 21 (97), Turner syndrome (19), trisomy 18 (28), trisomy 13 (11) and others (14). Detection rate of combined screening for aneuploides were 86.0% with false positive rate of 5.3% (mean age 33 +/- 4.9 years, > 35 years in 35% of pregnancies). Our study suggests that the strategy of first-trimester combined screening of biochemical values and ultrasonographic parameters at 12 gestational weeks identifies higher percentage of aneuploidies with a lower false-positive rate than a single parameter strategy.

Effects of knowledge, education, and experience on acceptance of first trimester screening for chromosomal anomalies

To assess pregnant women's knowledge and understanding of first trimester prenatal screening (nuchal translucency, maternal serum free beta-human chorionic gonadotrophin and pregnancy-associated plasma-protein-A), to evaluate the impact of a new information booklet and investigate the effects of education and experiential knowledge of congenital disabilities on the perceived likelihood of accepting prenatal screening. A quasi-experimental quantitative study with a self-completion questionnaire. Five different maternity care clinics in Iceland. Expectant mothers in first trimester of pregnancy (n = 379). Expectant mothers were divided into two groups, an intervention and a control group, both receiving traditional care and information. The intervention group additionally received an information booklet about prenatal screening and diagnosis. Women's knowledge score of prenatal screening. The correlation between education, knowledge score, experiential knowledge of congenital disabilities, and the likelihood of accepting prenatal screening. More than half of the women (57%) believed they received sufficient information to make an informed decision about screening. Knowledge scores were significantly higher for the intervention group (with mean 4.8 compared with 3.7 on a 0-8 scale, p < 0.0001). Those with higher scores were more likely to accept screening (p < 0.0001). Women with experiential knowledge of congenital anomalies in their own families were more likely to accept prenatal screening (p = 0.017). Various factors, e.g. experiential knowledge, education and information about prenatal screening affect the likelihood of participation in prenatal screening programs. More information results in better knowledge and higher uptake rate.

Dépistage combiné de la trisomie 21 au premier trimestre : à propos de cinq ans d’expérience prospective multicentrique

First trimester screening for Down syndrome is yet to become the first intention strategy in France. This screening program at 11-14 weeks of gestation using maternal age, fetal nuchal translucency, maternal serum free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A has already been validated for a long time by many international studies. It seems to improve detection rate and decrease false positive rates. We report here five years prospective experience.