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Evans MI, Chen M, Britt DW. Understanding False Negative in Prenatal Testing. Diagnostics (Basel) 2021; 11:888. [PMID: 34067767 PMCID: PMC8156690 DOI: 10.3390/diagnostics11050888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 12/16/2022] Open
Abstract
A false negative can happen in many kinds of medical tests, regardless of whether they are screening or diagnostic in nature. However, it inevitably poses serious concerns especially in a prenatal setting because its sequelae can mark the birth of an affected child beyond expectation. False negatives are not a new thing because of emerging new tests in the field of reproductive, especially prenatal, genetics but has occurred throughout the evolution of prenatal screening and diagnosis programs. In this paper we aim to discuss the basic differences between screening and diagnosis, the trade-offs and the choices, and also shed light on the crucial points clinicians need to know and be aware of so that a quality service can be provided in a coherent and sensible way to patients so that vital issues related to a false negative result can be appropriately comprehended by all parties.
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Affiliation(s)
- Mark I. Evans
- Fetal Medicine Foundation of America, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA; (M.I.E.); (D.W.B.)
- Department of Obstetrics & Gynecology, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA
| | - Ming Chen
- Department of Genomic Medicine, Changhua Christian Hospital, Changhua 50046, Taiwan
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, Taipei 10041, Taiwan
- Department of Biomedical Science, Dayeh University, Changhua 51591, Taiwan
- Department of Medical Sciences, National Tsing Hua University, Hsinchu 30013, Taiwan
| | - David W. Britt
- Fetal Medicine Foundation of America, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA; (M.I.E.); (D.W.B.)
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Reljič M, Porović A. Maternal serum levels of angiogenic markers and markers of placentation in pregnancies conceived with fresh and vitrified-warmed blastocyst transfer. J Assist Reprod Genet 2019; 36:1489-1495. [PMID: 31104293 DOI: 10.1007/s10815-019-01484-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The aim of the study was to compare the levels of angiogenic markers and markers of placentation between pregnancies conceived with fresh (ET) and vitrified-warmed blastocyst transfer (FET). METHODS Women with singleton pregnancies resulting from fresh ET or FET during the period between 2013 and 2017 were included in this prospective observational study. Fresh ET was performed in a stimulated and FET in natural cycle. At 6-7 weeks of gestation, after ultrasound confirmation of a single gestational sac with a viable embryo, serum levels of free β-hCG, pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PIGF) and fms-like tyrosine kinase (sFlt-1) were measured. Data on the patients' characteristics, pregnancy complications and outcomes were collected from a questionnaire and National Perinatal Information System of Slovenia. RESULTS Among 211 pregnancies, 126 were achieved with fresh ET and 85 with FET. There were no significant differences in perinatal outcome, pregnancy complication and PIGF level between the fresh ET and FET group. Women achieving pregnancy with FET had significant higher levels of free β-hCG (40.20 ± 30.62 IU/L vs. 28.74 ± 23.52, p = 0.002), PAPP-A (0.09 ± 0.06 vs. 0.06 ± 0.05 IU/L, p = 0.004) and sFlt-1 (596.19 ± 283.06 vs. 436.53 ± 248.23 pg/L, p < 0.0001) compared to women having conceived with fresh ET. There were no significant differences in the levels of evaluated biomarkers between patients with different pregnancy outcomes and complications. CONCLUSION Levels of angiogenic markers and markers of placentation differ between pregnancies achieved with fresh ET and FET which may reflect altered implantation and early placentation with some forms of assisted reproductive technologies.
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Affiliation(s)
- Milan Reljič
- Department of Reproductive Medicine and Gynaecologic Endocrinology, Division of Gynaecology and Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
| | - Admir Porović
- Department of Gynaecology and Perinatology, Academic HELIOS Hospital Köthen, University Martin-Luther Halle-Wittenberg, Hallesche Str. 29, 06366, Köthen (Anhalt), Germany
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Evans MI, Evans SM, Bennett TA, Wapner RJ. The price of abandoning diagnostic testing for cell-free fetal DNA screening. Prenat Diagn 2018; 38:243-245. [DOI: 10.1002/pd.5226] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 12/27/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Mark I. Evans
- Department of Obstetrics and Gynecology; Mt Sinai School of Medicine; New York NY USA
- Fetal Medicine Foundation of America; New York NY USA
- Comprehensive Genetics; New York NY USA
| | - Shara M. Evans
- Fetal Medicine Foundation of America; New York NY USA
- Comprehensive Genetics; New York NY USA
| | - Terry Ann Bennett
- Department of Obstetrics and Gynecology, Tisch Medical School; New York University; New York NY USA
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology; Columbia University College of Physicians and Surgeons; New York NY USA
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Tørring N. First trimester combined screening – focus on early biochemistry. Scandinavian Journal of Clinical and Laboratory Investigation 2016; 76:435-47. [DOI: 10.1080/00365513.2016.1200131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Niels Tørring
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
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Abstract
There have been tremendous advances in the ability to screen for the "odds" of having a genetic disorder (both mendelian and chromosomal). With microarray analyses on fetal tissue now showing a minimum risk for any pregnancy being at least 1 in 150 and ultimately greater than 1%, it is thought that all patients, regardless of age, should be offered chorionic villus sampling/amniocentesis and microarray analysis. As sequencing techniques replace other laboratory methods, the only question will be whether these tests are performed on villi, amniotic fluid cells, or maternal blood.
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Bernard JP, Salomon L, Ville Y, Cuckle H, Bernard M, Brochet C. Reply: To PMID 23673229. Am J Obstet Gynecol 2014; 210:172-3. [PMID: 23994745 DOI: 10.1016/j.ajog.2013.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
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Krantz DA, Carmichael JB. Impact of blood collection method on first-trimester dried blood free Beta hCG and PAPP-A. Ann Clin Biochem 2013; 50:611-612. [DOI: 10.1177/0004563213484906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Analysis of dried blood specimens has been an integral part of laboratory medicine dating back to the early 1960s when they were introduced as part of neonatal screening programs. More recently, they have been used in Down syndrome screening programmes. Dried blood spot specimens can be collected either by finger-stick or by traditional venipuncture and spotted onto filter paper. We sought to evaluate whether first-trimester free Beta hCG and PAPP-A multiples of the median (MoMs) were different in dried blood specimens collected via finger-stick compared to specimens collected via venipuncture. Methods A total of 2786 consecutive dried blood specimens were evaluated including 2144 collected using finger-stick and 644 specimens collected using venipuncture and spotted onto filter paper. Linear regression was used to assess the overall impact of collection method on dried blood free Beta hCG and PAPP-A and the impact of collection method on the trend of dried blood free Beta hCG and PAPP-A with transport time. Results For finger-stick and venipuncture, the median for free Beta hCG MoM was 0.99 and 1.04, respectively while the median PAPP-A MoM was 1.00 and 1.01, respectively. The regression formula for free Beta hCG was ln(MoM) = −0.00918 + 0.05112×Venipuncture + 0.00299×Days −0.00983×Days×Venipuncture and for PAPP-A the formula was ln(MoM) = −0.01000 + 0.04779×Venipuncture −0.00051×Days −0.02117×Days×Venipuncture. None of the coefficients were significant. Conclusions Collection method does not impact MoM values. Thus, centres have flexibility in the collection method utilized while being able to use a single reference database for all dried blood specimens.
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Spencer K, Cowans NJ. Analytical goal setting in aneuploidy screening: within person biological variability of first trimester biochemical markers. Prenat Diagn 2012; 33:124-9. [DOI: 10.1002/pd.4019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kevin Spencer
- Prenatal Research Unit, Department of Clinical Biochemistry; King George Hospital; Barley Lane; Goodmayes; IG3 8YB; UK
| | - Nicholas J. Cowans
- Prenatal Research Unit, Department of Clinical Biochemistry; King George Hospital; Barley Lane; Goodmayes; IG3 8YB; UK
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Evans MI, Cuckle HS. Performance adjusted risks: a method to improve the quality of algorithm performance while allowing all to play. Prenat Diagn 2011; 31:797-801. [DOI: 10.1002/pd.2769] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 03/21/2011] [Accepted: 03/25/2011] [Indexed: 11/06/2022]
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Krantz D, Hallahan T, Ravens R, He K, Cuckle H, Sherwin J, Carmichael J. First trimester Down syndrome screening with dried blood spots using a dual analyte free beta hCG and PAPP-A immunofluorometric assay. Prenat Diagn 2011; 31:869-74. [PMID: 21692092 DOI: 10.1002/pd.2792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 04/07/2011] [Accepted: 04/29/2011] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the effectiveness of first trimester Down syndrome screening with dried blood spots using a dual analyte free beta human chorionic gonadotrophin (hCG)/pregnancy-associated plasma protein A (PAPP-A) immunofluorometric assay. METHOD An initial retrospective study of 54 Down syndrome cases and 1064 control specimens was performed followed by a series of 146,513 specimens from routine screening. Detection rates at a fixed 5% false-positive rate were determined separately based on reference data from the retrospective study set and then adjusted based on the routine screening study set. RESULTS On the basis of the retrospective analysis, the estimated detection rate using free beta hCG, PAPP-A and maternal age varied from 78% at 9 weeks of pregnancy to 70% at 13 weeks of pregnancy. Using a combined protocol, including NT, the detection rate varied from 92 to 90% between 9 and 13 weeks of gestation. Adjusting distribution parameters based on the routine screening dataset reduced the detection rate by at most 1%. CONCLUSION Analysis of free beta hCG and PAPP-A using a dual analyte dried blood spot assay is an effective tool in Down syndrome screening, adding an important option for those considering implementation or modification of existing prenatal screening programs.
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Affiliation(s)
- David Krantz
- NTD Laboratories/PerkinElmer, Melville, NY 11747, USA.
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Maski M, Rana S, Karumanchi SA. Biomarkers in Obstetric Medicine. Biomarkers 2010. [DOI: 10.1002/9780470918562.ch13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kuc S, Koster MPH, Visser GHA, Schielen PCJI. Performance of first-trimester serum screening for trisomy 21 before and from 11 + 0 weeks of gestational age in The Netherlands. Prenat Diagn 2010; 30:906-8. [DOI: 10.1002/pd.2581] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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The impact of temporal variability of biochemical markers PAPP-A and free beta-hCG on the specificity of the first-trimester Down syndrome screening: a Croatian retrospective study. BMC Res Notes 2010; 3:194. [PMID: 20630069 PMCID: PMC2919561 DOI: 10.1186/1756-0500-3-194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 07/14/2010] [Indexed: 11/10/2022] Open
Abstract
Background The variability of maternal serum biochemical markers for Down syndrome, free β-hCG and PAPP-A can have a different impact on false-positive rates between the 10+0 and 13+6 week of gestation. The study population comprised 2883 unaffected, singleton, spontaneously conceived pregnancies in Croatian women, who delivered apparently healthy child at term. Women were separated in 4 groups, dependently on the gestational week when the analyses of biochemical markers were performed. The concentrations of free β-hCG and PAPP-A in maternal serum were determined by solid-phase, enzyme-labeled chemiluminiscent immunometric assay (Siemens Immulite). Concentrations were converted to MoMs, according to centre-specific weighted regression median curves for both markers in unaffected pregnancies. The individual risks for trisomies 21, 18 and 13 were computed by Prisca 4.0 software. Findings There were no significant differences between the sub-groups, regarding maternal age, maternal weight and the proportion of smokers. The difference in log10 MoM free β-hCG values, between the 11th and 12th gestational week, was significant (p = 0.002). The difference in log10 MoM PAPP-A values between the 11th and 12th, and between 12th and 13th week of gestation was significant (p = 0.006 and p = 0.003, respectively). False-positive rates of biochemical risk for trisomies were 16.1% before the 11th week, 12.8% in week 12th, 11.9% in week 13th and 9.9% after week 13th. The differences were not statistically significant. Conclusions Biochemical markers (log10 MoMs) showed gestation related variations in the first-trimester unaffected pregnancies, although the variations could not be attributed either to the inaccuracy of analytical procedures or to the inappropriately settled curves of median values for the first-trimester biochemical markers.
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Osmanağaoğlu MA, Erdoğan I, Eminağaoğlu S, Karahan SC, Ozgün S, Can G, Bozkaya H. The diagnostic value of beta-human chorionic gonadotropin, progesterone, CA125 in the prediction of abortions. J OBSTET GYNAECOL 2010; 30:288-93. [PMID: 20373934 DOI: 10.3109/01443611003605286] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study was conducted to investigate the effectiveness of serum levels of free beta-hCG, progesterone, CA125 and their combined use in the prediction of first trimester abortions. A total of 140 singleton pregnant women between 5 and 13 weeks' gestational age were included as Group I (n = 21) who resulted in abortion including missed abortion, incomplete abortion, complete abortion and inevitable abortion; Group II (n = 129) included normal pregnancies. When using the free beta-hCG level of <20 ng/ml as a cut off point, the sensitivity, specificity, PPV and NPV were 91%, 82%, 46% and 98%, when using a progesterone of <15 ng/ml as a cut off point, they were 91%, 89%, 59%, 98%. The single measurement of free beta-hCG or progesterone levels can be useful in the prediction of first trimester spontaneous abortions, but using progesterone may be recommended since it has high availability and low cost.
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Affiliation(s)
- M A Osmanağaoğlu
- Department of Obstetrics and Gynecology, Karadeniz Technical University, Trabzon, Turkey.
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Abstract
Maternal serum screening for neural tube defects and fetal aneuploidy in the second trimester has been incorporated into obstetrical practice over the past two decades. Now, as a result of several multicenter trials, first trimester screening between 11 and 14 weeks has been shown to be an effective and reliable screening test for Down syndrome and trisomy 18. This policy updates the American College of Medical Genetics policy statement entitled Second Trimester Maternal Serum Screening for Fetal Open Neural Tube Defects and Aneuploidy (2004), incorporates First trimester diagnosis and screening for fetal aneuploidy (2008) and complements the sections of American College of Medical Genetic’s Standards and Guidelines for Clinical Genetics Laboratories entitled Prenatal Screening for Down syndrome (2005) and Prenatal Screening for Open Neural Tube Defects (2005).
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Technical standards and guidelines: Prenatal screening for Down syndrome that includes first-trimester biochemistry and/or ultrasound measurements. Genet Med 2009; 11:669-81. [DOI: 10.1097/gim.0b013e3181ad5246] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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de Medeiros S, Norman R. Human choriogonadotrophin protein core and sugar branches heterogeneity: basic and clinical insights. Hum Reprod Update 2008; 15:69-95. [DOI: 10.1093/humupd/dmn036] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Seppo A, Frisova V, Ichetovkin I, Kim Y, Evans MI, Antsaklis A, Nicolaides KH, Tafas T, Tsipouras P, Kilpatrick MW. Detection of circulating fetal cells utilizing automated microscopy: potential for noninvasive prenatal diagnosis of chromosomal aneuploidies. Prenat Diagn 2008; 28:815-21. [DOI: 10.1002/pd.1987] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cuckle HS, Malone FD, Wright D, Porter TF, Nyberg DA, Comstock CH, Saade GR, Berkowitz RL, Ferreira JC, Dugoff L, Craigo SD, Timor IE, Carr SR, Wolfe HM, D'Alton ME. Contingent screening for Down syndrome--results from the FaSTER trial. Prenat Diagn 2008; 28:89-94. [PMID: 18236423 DOI: 10.1002/pd.1913] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Comparison of contingent, step-wise and integrated screening policies. METHODS Mid-trimester Down syndrome risks were retrospectively calculated from FaSTER trial data. For contingent screening, initial risk was calculated from ultrasound measurement of nuchal translucency (NT), maternal serum pregnancy-associated plasma protein (PAPP)-A and free beta-human chorionic gonadotrophin (hCG) at 11-13 weeks, and classified positive (>1 in 30), borderline (1 in 30-1500) or negative. Borderline risks were recalculated using alpha-fetoprotein, hCG, unconjugated estriol (uE3) and inhibin at 15-18 weeks, and reclassified as positive (>1 in 270) or negative. For step-wise screening, initial negative risks were also recalculated. For integrated screening, a single risk was calculated from NT, PAPP-A and the second trimester markers. RESULTS There were 86 Down syndrome and 32,269 unaffected pregancies. The detection rate for contingent screening was 91% and false-positive rate was 4.5%; initial detection rate was 60%, initial false-positive rate was 1.2% and borderline risk was 23%. Step-wise screening had 92% detection rate and 5.1% false-positive rate; integrated screening had 88% and 4.9% respectively. CONCLUSION As predicted by modelling, the contingent screening detection rate for a fixed false-positive rate is comparable with step-wise and integrated screening, but substantially reduces the number needing to return for second trimester testing.
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Henry GP, Britt DW, Evans MI. Screening Advances and Diagnostic Choice: The Problem of Residual Risk. Fetal Diagn Ther 2008; 23:308-15. [DOI: 10.1159/000123619] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 08/07/2007] [Indexed: 11/19/2022]
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Wright D, Spencer K, Nix B. First trimester screening for Down syndrome using free β hCG, total hCG and PAPP-A: an exploratory study. Prenat Diagn 2007; 27:1118-22. [DOI: 10.1002/pd.1844] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Evans MI, Galen RS. Comparison of Serum Markers in First-Trimester Down Syndrome Screening. Obstet Gynecol 2007; 109:782; author reply783. [PMID: 17329537 DOI: 10.1097/01.aog.0000257614.71418.4c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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