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Previous Volume 353:2001-2011 November 10, 2005 Number 19 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Simpson, J. L. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background It is uncertain how best to screen pregnant women for the presence of fetal Down's syndrome: to perform first-trimester screening, to perform second-trimester screening, or to use strategies incorporating measurements in both trimesters.

Methods Women with singleton pregnancies underwent first-trimester combined screening (measurement of nuchal translucency, pregnancy-associated plasma protein A [PAPP-A], and the free beta subunit of human chorionic gonadotropin at 10 weeks 3 days through 13 weeks 6 days of gestation) and second-trimester quadruple screening (measurement of alpha-fetoprotein, total human chorionic gonadotropin, unconjugated estriol, and inhibin A at 15 through 18 weeks of gestation). We compared the results of stepwise sequential screening (risk results provided after each test), fully integrated screening (single risk result provided), and serum integrated screening (identical to fully integrated screening, but without nuchal translucency).

Results First-trimester screening was performed in 38,167 patients; 117 had a fetus with Down's syndrome. At a 5 percent false positive rate, the rates of detection of Down's syndrome were as follows: with first-trimester combined screening, 87 percent, 85 percent, and 82 percent for measurements performed at 11, 12, and 13 weeks, respectively; with second-trimester quadruple screening, 81 percent; with stepwise sequential screening, 95 percent; with serum integrated screening, 88 percent; and with fully integrated screening with first-trimester measurements performed at 11 weeks, 96 percent. Paired comparisons found significant differences between the tests, except for the comparison between serum integrated screening and combined screening.

Conclusions First-trimester combined screening at 11 weeks of gestation is better than second-trimester quadruple screening but at 13 weeks has results similar to second-trimester quadruple screening. Both stepwise sequential screening and fully integrated screening have high rates of detection of Down's syndrome, with low false positive rates.

Source Information

From the Columbia University College of Physicians and Surgeons, New York (F.D.M., M.E.D.); the Royal College of Surgeons in Ireland, Dublin (F.D.M.); Brown University School of Medicine, Providence, R.I. (J.A.C., S.R.C., G.L.-M.); the University of Utah and Intermountain HealthCare, Salt Lake City (R.H.B.); the Swedish Medical Center, Seattle (D.A.N.); William Beaumont Hospital, Royal Oak, Mich. (C.H.C.); the University of Texas Medical Branch, Galveston (R.B.); Mount Sinai School of Medicine, New York (R.L.B.); Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, N.Y. (S.J.G.); the University of Colorado Health Sciences Center, Denver (L.D.); Tufts University School of Medicine, Boston (S.D.C., D.W.B.); New York University School of Medicine, New York (I.E.T.-T.); the University of North Carolina Medical Center, Chapel Hill (H.M.W.); DM-STAT, Boston (K.D.); the Wolfson Institute of Preventive Medicine, London (A.R.R., A.K.H., N.J.W.); and University College London, London (A.K.H.).

Address reprint requests to Dr. Malone at the Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Parnell Square, Dublin 1, Ireland, or at fmalone{at}rcsi.ie.

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