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First-trimester Screening (first-trimester + screening)
Selected AbstractsFirst-trimester fetal heart rate in mothers with opioid addictionADDICTION, Issue 7 2010Maximilian Schmid ABSTRACT Aim To investigate the difference in fetal heart rate of opioid-dependent mothers compared to non-dependent mothers in the first trimester of pregnancy. Design The data of 74 consecutive singleton pregnancies of mothers enrolled in a maintenance programme for opioid-dependent women was matched to 74 non-exposed singleton pregnancies by maternal age, crown,rump length, smoking status, ethnic background and mode of conception. Measurement Fetal heart rate measured as part of first-trimester screening by Doppler ultrasound between 11+0 and 13+6 gestational weeks was compared retrospectively. Findings The mean fetal heart rate in opioid-dependent mothers was 156.0 beats per minute (standard deviation 7.3) compared to 159.6 (6.5) in controls. The difference in fetal heart rate was significant (P = 0.02). There was a significant difference in mean maternal body mass index (P = 0.01) but not in mean nuchal translucency (P = 0.3), gestational age (0.5), fetal gender (P = 0.3) and parity (P = 0.3) between both groups. Fifty-five per cent (41 of 74) of cases were taking methadone, 30% (22 of 74) buprenorphine and 15% (11 of 74) were taking slow-release morphines throughout the pregnancy. Conclusions In fetuses of opioid-dependent mothers a decreased fetal heart rate can already be observed between 11+0 and 13+6 gestational weeks. The effect of opioid intake needs to be taken into consideration when interpreting fetal heart rate in opioid-dependent mothers at first-trimester screening. [source] Improved prenatal aneuploidy screening using the novel advanced first-trimester screening algorithm: A multicenter study of 10,017 pregnanciesJOURNAL OF CLINICAL ULTRASOUND, Issue 7 2008Peter Schmidt MD Abstract Purpose. It has been postulated that the maternal age component should be completely excluded from first-trimester screening (FTS) for fetal aneuploidies. In this study, we tested a new algorithm known as advanced first-trimester screening (AFS), which disregards maternal age. Method. In a multicenter study, FTS findings were retrieved from 10,017 pregnancies. FTS risk assessment was performed using the Nicolaides method, and the AFS score was calculated. The results of both methods were compared. Results. Within this population, 81 fetuses had an abnormal karyotype. The sensitivity of the 2 algorithms was 86.4%. When the AFS method was used, the positive predictive value rose from 9.6% (FTS) to 12.4% (AFS). Using AFS, the test positive rate could be decreased by 161 cases (,22.2%) (p < 0.0001), due to a reduction of false positive cases. As a result, the false positive rate of AFS was 24.5% lower than that of FTS, while the same number of aneuploidies was detected. Conclusion. AFS can markedly reduce the rate of false positive test results. If these results are confirmed by larger multicenter studies, the new AFS will represent a great improvement in fetal aneuploidy screening. © 2008 Wiley Periodicals, Inc. J Clin Ultrasound, 2008 [source] Maternal weight and ethnic adjustment within a first-trimester Down syndrome and trisomy 18 screening programPRENATAL DIAGNOSIS, Issue 8 2005David A. Krantz Abstract Objective(s) To estimate weight and ethnic group correction factors for first-trimester screening markers. Methods Ethnic-specific median MoM free beta hCG and pregnancy associated plasma protein A (PAPP-A) and delta nuchal translucency values were calculated for cohorts of maternal weight (20 lb each) using data from 51 206 patients undergoing first-trimester screening. False-positive rates for Down syndrome and trisomy 18 were evaluated both prior to and after weight and ethnicity adjustment. Results Free beta hCG and PAPP-A significantly decreased with increasing maternal weight while nuchal translucency increased by a clinically insignificant amount. For free beta hCG the regression formula indicated that after accounting for maternal weight MoM values were 16% higher for African Americans, 6% higher for Asians and 9% lower for Hispanics compared to Caucasians (p < 0.001, p = 0.001, p < 0.001, respectively) but there was no significant difference for Asian Indians. For PAPP-A, MoM values were 35% higher for African Americans (p < 0.001) but were not significantly different for the other ethnic groups compared to Caucasians. Down syndrome false-positive rates did not vary with maternal weight prior to (p = 0.291) or after weight adjustment of biochemistry (p = 0.054). Trisomy 18 false-positive rates varied significantly with weight both before (OR = 1.455 per 20-pound increase, p < 0.001) and after (OR = 1.066 per 20-pound increase, p = 0.01) weight adjustment of biochemistry; however, the odds ratio was greatly reduced after weight adjustment. Conclusion(s) The first-trimester screening markers, free beta hCG, PAPP-A and nuchal translucency vary with maternal weight and ethnicity. Adjustment of free beta hCG and PAPP-A is indicated but adjustment of nuchal translucency results may not be necessary. Copyright © 2005 John Wiley & Sons, Ltd. [source] Ethnic variation of fetal nasal bone length between 11,14 weeks' gestationPRENATAL DIAGNOSIS, Issue 8 2005Fadi Collado Abstract Objective We sought to compare the fetal nasal bone length (FNBL) between different ethnic groups at 11,14 weeks' gestation. Methods FNBL and the FNBL/CRL ratio were measured in patients undergoing first trimester ultrasound for nuchal translucency (NT) and the ethnicity of the patient was recorded under four categories: non-Hispanic White, non-Hispanic black, Hispanic, and Chinese. Results Two hundred and one patients were included in the study. Measurement of the FNBL could not be obtained in nine patients (4.5%) and foetal nasal bone was absent in one fetus. Comparing the four groups, non-Hispanic White, non-Hispanic Black, Hispanic, and Asian, there were no statistical differences in crown-rump length (61 ± 14 mm; 68.6 ± 15 mm; 60.2 ± 14 mm; 62.4 ± 8.8 mm, respectively) or the NT (1.3 ± 0.5 mm; 1.25 ± 0.4 mm; 1.35 ± 1 mm; 1.4 ± 0.4 mm, respectively). However, the FNBL (2.9 ± 0.7 mm; 2.5 ± 0.6 mm; 2.5 ± 0.6 mm; 2.2 ± 0.4 mm, respectively, p < 0.01) and the FNBL/CRL ratio (0.049 ± 0.01, 0.045 ± 0.01, 0.043 ± 0.01, 0.037 ± 0.01, respectively, p < 0.01) were both statistically different, when comparing between these groups. Conclusion If the FNBL is to be introduced into first-trimester screening, it should be adjusted for ethnicity. Copyright © 2005 John Wiley & Sons, Ltd. [source] The impact of first-trimester screening on AMA patients' uptake of invasive testingPRENATAL DIAGNOSIS, Issue 5 2005Andrea M. Wray Abstract Objective Prenatal testing for AMA includes invasive procedures such as CVS and amniocentesis, which have risks. We sought to determine the effects of first-trimester screening (FTS) on referrals for genetic counseling and patients' decisions to pursue invasive testing after FTS was offered in 2002. Methods We compared AMA patients presenting for prenatal care who underwent early genetic counseling (<13 weeks' gestation) from 2001 to those from 2003. Charts were reviewed for maternal age, gestational age, past obstetric history, prior CVS or amniocentesis, abnormal ultrasound findings and decision to proceed with invasive testing. The two groups were compared using Student t -test and chi-square tests. Results In 2001, 552 AMA women enrolled in prenatal care; 68 presented for early genetic counseling. In 2003, 728 AMA women enrolled in prenatal care; 172 presented for early genetic counseling. More counseled women chose genetic testing in 2003 than in 2001 (95% vs 79%, p < 0.01). More patients elected an invasive procedure in 2001 compared to 2003 (71% vs 26%, p < 0.01). Conclusion Availability of FTS results in more AMA women having early prenatal genetic counseling and choosing some form of genetic testing. Such women are less likely to choose invasive tests than those without access to FTS. Copyright © 2005 John Wiley & Sons, Ltd. [source] | ||||||||||