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Bernardeco J, Cruz J, Rijo C, Cohen Á. Nasal bone in fetal aneuploidy risk assessment: are they independent markers in the first and second trimesters? J Perinat Med 2022; 50:462-466. [PMID: 35085431 DOI: 10.1515/jpm-2021-0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/12/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In the mid-trimester ultrasound, nasal bone (NB) length can be used to correct the a priori risk for trisomy 21. Our study aims to evaluate if there is a correlation between an absent NB in the first trimester and a hypoplastic NB in the second trimester. METHODS Our two year retrospective analysis of data derived from routine clinical practice. Single euploid fetuses were included. The NB was assessed in both trimesters according to international guidelines and transformed into categorical variables. Logistic regression was performed in order to accomplish our main objective. RESULTS From the 759 normal pregnancies included, 45 (5.93%) had abnormal NB in the first trimester and 23 (3%) in the second trimester. Eleven cases (47.8%) of the abnormal NB in the second trimester were abnormal in the 11-14 weeks scan. After the diagnosis of an absent NB in the first trimester the odds ratio (OR) for a hypoplastic NB in the second trimester is 18.926 (7.791-45.977; p-value <0.01). CONCLUSIONS Our data suggest a strong association between the NB in the first and in the second trimester in normal euploid fetuses. This is important information to consider when counseling patients on the basis of this ultrasound marker.
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Affiliation(s)
- Joana Bernardeco
- Obstetrics and Gynecology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Jader Cruz
- Fetal Medicine Unit, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Claudia Rijo
- Fetal Medicine Unit, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Álvaro Cohen
- Fetal Medicine Unit, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
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Fiorentino DG, Hughes F. Fetal Screening for Chromosomal Abnormalities. Neoreviews 2021; 22:e805-e818. [PMID: 34850145 DOI: 10.1542/neo.22-12-e805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
With more and more reproductive-aged women opting to pursue genetic screening during pregnancy, health care professionals must understand the variety of testing options available as well as the advantages and limitations of each testing option. Presently, no single screening test is universally believed to be superior because the combination of the specific test and the population being tested determines the range of potential identifiable conditions as well as the positive predictive values. As a result, pre- and posttest counseling are not always straightforward and may require discussions with multiple specialists including genetic counselors, obstetricians, and pediatricians/neonatologists. The purpose of this review is to summarize the screening options currently available to pregnant women to determine their risk of having a child affected by a chromosomal disorder. Screening for chromosomal abnormalities using ultrasonography, maternal serum analytes, cell-free DNA, and preimplantation genetic testing will be discussed here. Advances in the field, including the possible future use of cell-based noninvasive prenatal screening (NIPS) as a more accurate method for genetic screening and the incorporation of screening for copy number variants (microdeletions and duplications) into traditional cell-free NIPS will also be reviewed.
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Affiliation(s)
- Desiree G Fiorentino
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Obstetrics & Gynecology and Women's Health, Division of Maternal-Fetal Medicine, Bronx, NY
| | - Francine Hughes
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Obstetrics & Gynecology and Women's Health, Division of Maternal-Fetal Medicine, Bronx, NY
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He Y, Lu H, Zhang L. Serum AFP levels in patients suffering from 47 different types of cancers and noncancer diseases. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 162:199-212. [PMID: 30905450 DOI: 10.1016/bs.pmbts.2019.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Alpha-fetoprotein (AFP) is a glycoprotein and belongs to the gene family of serum albumins. The serum AFP levels were found to be elevated in the sera of liver cancer patients in 1964 and were subsequently developed and used as a liver cancer biomarker. However, elevated serum AFP levels have been observed in patients suffering from other cancer and noncancer diseases. Up to date, a systematic comparison of the serum AFP levels in different diseases has not been reported. In current study, 66,682 clinical lab test results of serum AFP levels from healthy individuals and patients with 47 different types of diseases during the past 5 years were retrieved and analyzed. Based on the mean (SD), median, and p (-Log10p) values, we found that patients suffering from liver, breast, esophagus, cervical, pancreatic, endometrial, gastric, lung, rectum cancers in addition to noncancer diseases cirrhosis, nephrotic syndrome, and gastritis had significantly (p<0.05) increased, whereas patients suffering from multiple myeloma, Wilms' tumor, and other 22 types of noncancer diseases had significantly decreased median serum AFP levels than that of healthy controls. Moreover, patients with liver cancer, cirrhosis, lymphoma, bone fracture, and Wilms' tumor had highest mean serum AFP levels and the biggest SD values. In summary, the increased serum AFP levels were most evident but not specific for liver cancer patients. The potential clinical use of the increased or decreased serum AFP levels for other types of cancer and noncancer diseases and the molecular mechanisms behind our current findings need to be investigated.
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Affiliation(s)
- Yanli He
- Systems Biology and Medicine Center for Complex Diseases, Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Haijun Lu
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lijuan Zhang
- Systems Biology and Medicine Center for Complex Diseases, Affiliated Hospital of Qingdao University, Qingdao, China.
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Alberti A, Salomon LJ, Le Lorc'h M, Couloux A, Bussières L, Goupil S, Malan V, Pelletier E, Hyon C, Vialard F, Rozenberg P, Bouhanna P, Oury JF, Schmitz T, Romana S, Weissenbach J, Vekemans M, Ville Y. Non-invasive prenatal testing for trisomy 21 based on analysis of cell-free fetal DNA circulating in the maternal plasma. Prenat Diagn 2016; 35:471-6. [PMID: 25643828 DOI: 10.1002/pd.4561] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 01/04/2015] [Accepted: 01/14/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE By-the-book implementation of non-invasive prenatal test and clinical validation for trisomy 21. STUDY DESIGN Publicly funded prospective study of 225 cases. Women at risk for trisomy 21 > 1/250 based on combined ultrasound and serum markers during first or second trimester were eligible following an informed consent. The technique was established from the available literature and performed on 10 mL of venous blood collected prior to chorionic villus sampling or amniocentesis. Investigators were blinded to the fetal karyotype. Results were expressed in Z-scores of the percentage of each chromosome. RESULTS Among 976 eligible cases, 225 were processed: 8 were used for pretesting phase and 23 to build a reference set. One hundred thirty six euploid cases and 47 with trisomy 21 were then run randomly. Eleven cases yielded no result (4.8%). Z-scores were above 3 (7.58+/-2.41) for chromosome 21 in all 47 trisomies and in none of the euploid cases (0.11+/-1.0). Z-scores were within normal range for the other chromosomes in both groups. Using a cut-off of 3, sensitivity and specificity were of 100% 95% CI [94.1, 100] and 100% 95% CI [98, 100], respectively. CONCLUSION Non-invasive prenatal test for trisomy 21 is a robust strategy that can be translated from seminal publications. Publicly funded studies should refine its indications and cost-effectiveness in prenatal screening and diagnosis. © 2015 John Wiley & Sons, Ltd.
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Nassiri N, Rootman J, Rootman DB, Goldberg RA. Orbital lymphaticovenous malformations: Current and future treatments. Surv Ophthalmol 2015; 60:383-405. [DOI: 10.1016/j.survophthal.2015.03.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/02/2015] [Accepted: 03/06/2015] [Indexed: 12/23/2022]
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Tournemire A, Groussolles M, Ehlinger V, Lusque A, Morin M, Benevent JB, Arnaud C, Vayssière C. Prenasal thickness to nasal bone length ratio: effectiveness as a second or third trimester marker for Down syndrome. Eur J Obstet Gynecol Reprod Biol 2015; 191:28-32. [PMID: 26070124 DOI: 10.1016/j.ejogrb.2015.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 04/22/2015] [Accepted: 05/19/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the value of the prenasal thickness to nasal bone length ratio (PT/NBL) for detecting trisomy 21 (T21) after the first trimester. METHOD Two examiners blinded to fetal T21 status retrospectively measured prenasal thickness (PT) and nasal bone length (NBL) of T21 and control fetuses at 15-36 weeks' gestational age on two-dimensional images from all T21-screening ultrasounds from November 2010 to April 2013. ROC curve analysis and its diagnostic values determined the best cut-off value for the ratio. Interobserver reproducibility was assessed. RESULTS Good quality ultrasound profile images were available for 26 fetuses with T21 compared to 91 normal fetuses. The median PT/NBL ratio was 1.28 for T21 and 0.73 for control fetuses (p<0.0001). The PT/NBL ratio performed significantly better (AUC 0.99; 95%CI 0.97-1) than either PT (0.82; 0.73-0.91) or NBL (0.91; 0.85-0.98). The optimal PT/NBL ratio cut-off was 0.98, with a sensitivity of 88.5% [76.2-100%] and a specificity of 100%. Interobserver variability was low. CONCLUSION The PT/NBL ratio is a strong marker for detecting T21 in the second and third trimesters, significantly more effective than either indicator alone.
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Affiliation(s)
- A Tournemire
- Maternal Fetal Medicine Department, Hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France
| | - M Groussolles
- Maternal Fetal Medicine Department, Hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France
| | - V Ehlinger
- UMR 1027 INSERM, Université Paul Sabatier Toulouse III, Toulouse, France
| | - A Lusque
- UMR 1027 INSERM, Université Paul Sabatier Toulouse III, Toulouse, France
| | - M Morin
- Maternal Fetal Medicine Department, Hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France
| | - J B Benevent
- Cabinet d'échographie des Pharaons, Toulouse, France
| | - C Arnaud
- UMR 1027 INSERM, Université Paul Sabatier Toulouse III, Toulouse, France; Clinical Epidemiology Unit, University Hospital, Toulouse, France
| | - C Vayssière
- Maternal Fetal Medicine Department, Hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; UMR 1027 INSERM, Université Paul Sabatier Toulouse III, Toulouse, France.
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Current principles and practice of ethics and law in perinatal medicine. CURRENT HEALTH SCIENCES JOURNAL 2014; 40:162-9. [PMID: 25729600 PMCID: PMC4340435 DOI: 10.12865/chsj.40.03.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 06/10/2014] [Indexed: 12/03/2022]
Abstract
One of the most controversial discussion topics in modern bioethics, science or philosophy is represented by the beginning of the individual human life. It is ethically, medically and scientifically correct that the human conception product to be born, so to gain personality and individuality, to be treated as a patient since the intrauterine life. Intrauterine foetal interventions, performed in various therapeutic purposes are still in the experimental stage even in centres with rich experience in perinatal medicine. Progresses truly outstanding are present especially in the prenatal diagnostic methods. Non invasive prenatal testing represents without a doubt a great progress in prenatal diagnosis, but from this point of view, the role of practitioners in the field of perinatal medicine, on counselling and addressing the indication of this test becomes essential. Beyond cultural, national, social or related differences, in perinatal medicine practice is particularly important to respect and permanently reassess the ethical codes. Our paper is targeting to spotlight the essential principles and practice of ethics and law in perinatal medicine nowadays on one hand, and to bring an update review on a controversial topic on the other hand.
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An integrated giant magnetoimpedance biosensor for detection of biomarker. Biosens Bioelectron 2014; 58:338-44. [DOI: 10.1016/j.bios.2014.03.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 03/03/2014] [Accepted: 03/03/2014] [Indexed: 11/19/2022]
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Noninvasive in vivo monitoring of tissue-specific global gene expression in humans. Proc Natl Acad Sci U S A 2014; 111:7361-6. [PMID: 24799715 DOI: 10.1073/pnas.1405528111] [Citation(s) in RCA: 227] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Circulating cell-free RNA in the blood provides a potential window into the health, phenotype, and developmental programs of a variety of human organs. We used high-throughput methods of RNA analysis such as microarrays and next-generation sequencing to characterize the global landscape circulating RNA in a cohort of human subjects. By focusing on genes whose expression is highly specific to certain tissues, we were able to identify the relative contributions of these tissues to circulating RNA and to monitor changes in tissue development and health. As one application of this approach, we performed a longitudinal study on pregnant women and analyzed their combined cell-free RNA transcriptomes across all three trimesters of pregnancy and after delivery. In addition to the analysis of mRNA, we observed and characterized noncoding species such as long noncoding RNA and circular RNA transcripts whose presence had not been previously observed in human plasma. We demonstrate that it is possible to track specific longitudinal phenotypic changes in both the mother and the fetus and that it is possible to directly measure transcripts from a variety of fetal tissues in the maternal blood sample. We also studied the role of neuron-specific transcripts in the blood of healthy adults and those suffering from the neurodegenerative disorder Alzheimer's disease and showed that disease specific neural transcripts are present at increased levels in the blood of affected individuals. Characterization of the cell-free transcriptome in its entirety may thus provide broad insights into human health and development without the need for invasive tissue sampling.
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10
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Genetic services and testing in China. J Community Genet 2013; 4:379-90. [PMID: 23595912 DOI: 10.1007/s12687-013-0144-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 02/22/2013] [Indexed: 10/27/2022] Open
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Wee LK, Chai HY, Samsury SRB, Mujamil NFB, Supriyanto E. Comparative studies of two dimensional and three dimensional ultrasonic nuchal translucency in trisomy assessments. AN ACAD BRAS CIENC 2012. [DOI: 10.1590/s0001-37652012000400030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Current two-dimensional (2D) ultrasonic marker measurements are inherent with intra- and inter-observer variability limitations. The objective of this paper is to investigate the performance of conventional 2D ultrasonic marker measurements and proposed programmable interactive three-dimensional (3D) marker evaluation. This is essentially important to analyze that the measurement on 3D volumetric measurement possesses higher impact and reproducibility vis-à-vis 2D measurement. Twenty three cases of prenatal ultrasound examination were obtained from collaborating hospital after Ethical Committee's approval. The measured 2D ultrasonic marker is Nuchal Translucency or commonly abbreviated as NT. Descriptive analysis of both 2D and 3D ultrasound measurement were calculated. Three trial measurements were taken for each method. Both data were tested with One-Sample Kolmogorov-Smirnov Test and results indicate that markers measurements were distributed normally with significant parametric values at 0.621 and 0.596 respectively. Computed mean and standard deviation for both measurement methods are 1.4495 ± 0.46490 (2D) and 1.3561 ± 0.50994 (3D). ANOVA test shows that computerized 3D measurements were found to be insignificantly different from the mean of conventional 2D at the significance level of 0.05. With Pearson's correlation coefficient value or R = 0.861, the result proves strong positive linear correlation between 2D and 3D ultrasonic measurements. Reproducibility and accuracy of 3D ultrasound in NT measurement was significantly increased compared with 2D B-mode ultrasound prenatal assessment. 3D reconstructed imaging has higher clinical values compare to 2D ultrasound images with less diagnostics information.
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Affiliation(s)
- Lai K. Wee
- Universiti Teknologi Malaysia, Malaysia; Universiti Teknologi Malaysia, Malaysia
| | | | | | | | - Eko Supriyanto
- Universiti Teknologi Malaysia, Malaysia; Universiti Teknologi Malaysia, Malaysia
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12
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Weingertner AS, Trieu NT, Kohler M, Viville B, Levy G, Montaya Y, Kutnahorsky R, Tissier I, Kohler A, Tanghe M, Mager C, Benassi E, Cancelier M, Neuman M, Bouffet N, Hunsinger MC, Hornecker F, Langer B, Nisand I, Favre R. [First trimester screening for Down syndrome: five years prospective experience]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2010; 39:353-61. [PMID: 20541874 DOI: 10.1016/j.jgyn.2010.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 04/06/2010] [Accepted: 04/28/2010] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- A-S Weingertner
- Pôle de gynécologie obstétrique, département d'échographie et de diagnostic anténatal, centre médicochirurgical et obstétrical SIHCUS, 19, rue Louis-Pasteur, 67303 Schiltigheim cedex, France.
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Zimmer EZ, Blazer S, Linn S, Bronshtein M. Fetal thickened nuchal soft tissues may first appear in the second trimester in Down syndrome. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:71-74. [PMID: 19830827 DOI: 10.1002/jcu.20638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To describe a series of cases of late-onset fetal nuchal translucency in Down syndrome. METHOD In our practice area, most pregnant women usually undergo 3 different sonographic examinations: a fetal nuchal translucency examination in the 1st trimester and 2 detailed surveys of all fetal organs in the early 2nd trimester and in midpregnancy. RESULT During the study period (2003-2008), we detected 11 fetuses with new appearance of severe thickened nuchal soft tissues (>or=6 mm) at 14-16 weeks' gestation after a normal nuchal screening in the 1st trimester. All of these fetuses had trisomy 21. Associated structural anomalies were observed in 10/11 of the cases. In addition, there were 12 fetuses with new appearance of thickened nuchal soft tissues (<4 mm); all these fetuses had a normal karyotype and were normal at delivery. CONCLUSION Obstetricians should be aware that a nuchal abnormality may first appear only at 14-16 weeks' gestation. Fetal karyotyping is advocated in these cases because of the high probability of Down syndrome.
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Affiliation(s)
- Etan Z Zimmer
- Department of Obstetrics and Gynecology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, 1 Efron St., Haifa 31096, Israel
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Cleary-Goldman J, Rebarber A, Krantz D, Hallahan T, Saltzman D. First-trimester screening with nasal bone in twins. Am J Obstet Gynecol 2008; 199:283.e1-3. [PMID: 18771984 DOI: 10.1016/j.ajog.2008.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Revised: 06/19/2008] [Accepted: 07/07/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the Down syndrome detection rate at a 5% screen positive rate in first-trimester screening for twins. STUDY DESIGN This was a retrospective study from August 2005 to July 2007 of twins who underwent first-trimester screening with nuchal translucency, nasal bone, pregnancy-associated plasma protein-A, and free beta-hCG. Risks were calculated on the basis of the Fetal Medicine Foundation twin algorithm. The model simulated distributions of unaffected and affected cases at 12 weeks of gestation. RESULTS Two thousand ninety-four twin pregnancies (4188 fetuses) met the inclusion criteria. The addition of nasal bone to nuchal translucency, pregnancy-associated plasma protein-A, and free beta-hCG increased the Down syndrome detection rate from 79-89% at a 5% screen-positive rate. CONCLUSION In twins, first-trimester screening with nasal bone is valuable. The improved Down syndrome detection rate can help these high-risk patients with the decision-making process of whether to pursue invasive testing with its associated pregnancy loss risk.
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Dulay AT, Copel JA. First-trimester ultrasound: current uses and applications. Semin Ultrasound CT MR 2008; 29:121-31. [PMID: 18450137 DOI: 10.1053/j.sult.2007.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article is aimed to aid the sonographer and medical care provider in better interpretation and clinical application of first-trimester ultrasound findings in early pregnancy. We review current uses, applications, and interpretations of first-trimester ultrasound. A discussion of basic embryology and normal as well as abnormal first-trimester sonographic findings are discussed. We also cover the utility of the first-trimester ultrasound in screening for fetal aneuploidy. Attention is also given to the role of the first-trimester ultrasound in the prediction of adverse perinatal and maternal outcomes.
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Affiliation(s)
- Antonette T Dulay
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
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Rosen T, D'Alton ME, Platt LD, Wapner R. First-trimester ultrasound assessment of the nasal bone to screen for aneuploidy. Obstet Gynecol 2007; 110:399-404. [PMID: 17666617 DOI: 10.1097/01.aog.0000275281.19344.66] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Increasingly, women are choosing first-trimester risk assessment for Down syndrome and other aneuploid conditions. Recent studies have suggested that adding ultrasound assessment of the nasal bone to nuchal translucency thickness and maternal serum analytes in the first trimester will improve performance. This report assesses the current literature and discusses practical issues that must be addressed before widespread implementation of nasal bone screening in the United States.
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Affiliation(s)
- Todd Rosen
- Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th Street, PH 16-66, New York, NY 10032, USA.
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Abstract
First-trimester risk assessment for fetal aneuploidy using nuchal translucency (NT) measurement is rapidly gaining popularity in the United States. In combination with maternal serum markers in the first trimester, the screening performance is exceptionally good, with detection rates of more than 80% at a screen positive rate of 5%. Recently, the method has been validated for screening for Down syndrome and other aneuploidies in multicenter trials in the United States and elsewhere. Compliance with established criteria for measurement of the NT is essential to achieve uniform reliability and high screening test sensitivity. There is an international consensus about the importance of specific training in the NT examination, conformity to standards of NT measurement, and regular audit for quality assurance. In the United States, the Nuchal Translucency Quality Review program has been developed to administer credentialing and quality review for registered practitioners. The Nuchal Translucency Quality Review credentials signify the proficiency of the sonographer or sonologist in NT measurement and participation in a regular quality assurance audit. We encourage accreditation of clinical sites offering first-trimester risk assessment to ensure the highest quality care.
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Affiliation(s)
- Celeste Sheppard
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX, USA.
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Breathnach FM, Malone FD. Screening for aneuploidy in first and second trimesters: is there an optimal paradigm? Curr Opin Obstet Gynecol 2007; 19:176-82. [PMID: 17353686 DOI: 10.1097/gco.0b013e3280895e00] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review serves to explore the recent literature regarding aneuploidy screening in both first and second trimesters. We aim to construct a comparative analysis of a range of proposed strategies for screening for trisomy 21. RECENT FINDINGS First trimester combined screening (sonographic nuchal translucency combined with serum markers pregnancy-associated plasma protein A and the free beta subunit of human chorionic gonadotrophin) has superseded second trimester serum screening (alpha-fetoprotein, total human chorionic gonadotrophin, unconjugated estriol with or without inhibin-A) as a screening paradigm for the detection of trisomy 21. This move is attributed to the recognition of superior detection rates, lower false-positive rates and earlier results associated with the former strategy. Septated cystic hygroma has been recognized as a distinct entity which confers a high risk of aneuploidy and structural malformations. Further advances in screening performance are achievable by combining the results of first and second-trimester screens in a sequential manner, with much interest generated by programs that only include second-trimester testing contingent upon first-trimester results. SUMMARY Screening strategies for aneuploidy continue to evolve, with the most recent evidence favouring a contingent sequential approach.
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Affiliation(s)
- Fionnuala M Breathnach
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
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