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COMBINED ULTRASOUND-BIOCHEMICAL SCREENING OF FETAL TRISOMIA IN THE FIRST TRIMESTER AND DOUBLE BIOCHEMICAL SCREENING IN THE SECOND TRIMESTER AT NONRISK PREGNANCIES
Dubravka Tišlarić-Medenjak
; Endokrinološki laboratorij, Klinička bolnica »Sestre milosrdnice«, Vinogradska 29, 10 000 Zagreb
Ivana Zec
; Endokrinološki laboratorij, Klinička bolnica »Sestre milosrdnice«, Vinogradska 29, 10 000 Zagreb
Vesna Košec
; Klinika za ginekologiju i porodništvo, Klinička bolnica »Sestre milosrdnice«
Tomislav Ivičević-Bakulić
; Klinika za ginekologiju i porodništvo, Klinička bolnica »Sestre milosrdnice«
Krunoslav Kuna
; Klinika za ginekologiju i porodništvo, Klinička bolnica »Sestre milosrdnice«
Radoslav Herman
; Klinika za ginekologiju i porodništvo, Klinička bolnica »Sestre milosrdnice«
Dražan Butorac
; Klinika za ginekologiju i porodništvo, Klinička bolnica »Sestre milosrdnice«
Ivan Bolanča
; Klinika za ginekologiju i porodništvo, Klinička bolnica »Sestre milosrdnice«
Martina Ujević
; Ginekološka ordinacija, Poliklinika »Vili«
Erden Radončić
; Ginekološka ordinacija, Poliklinika »Vili«
Sanja Boras-Slivar
; Ginekološka ordinacija, Poliklinika »Dr. Harni«
Nataša Šemnički
; Ginekološka ordinacija, Poliklinika »Dr. Harni«
Ivana Tonković-Đurišević
; Zavod za genetiku i bolesti metabolizma, Klinika za pedijatriju KBC »Rebro«
Saša Kralik-Oguić
; Endokrinološki laboratorij, Klinika za ženske bolesti i porode KBC »Petrova« u Zagrebu
Boris Lovrić
; Ginekološki odjel, Opća bolnica Nova Gradiška
Sažetak
Objective: To evaluate the performance of screening tests for aneuploidy in the first and second trimesters of pregnancy in Croatian pregnant women. Study Design and Methods: Study population comprised 374 pregnant women who underwent the combined ultrasound-biochemical in the first and double-test in the second trimester of pregnancy, respectively. All were singleton pregnancies with normal outcomes. The first-trimester screening was performed combining serum markers, pregnancy associated plasma protein-A (PAPP-A) and free B-subunit of human chorionic gonado¬tropin (free B-hCG) with fetal nuchal translucency thickness (NT) and crown-rump length (CRL), measured by ultrasound. For the second-trimester screening, maternal serum alpha-fetoprotein and free B-hCG were used as biochemical markers in relation to fetal biometry diagnosed by ultrasound. Results: In 30 pregnant women (8.0%) elevated risk for trisomy 21 was found after combined ultrasound-biochemical screening. Out of total, 70 pregnant women (18.7%) were classified ’at risk’ on the basis of biochemical markers in the first and 56 (15.0%) in the second trimester. In 30 pregnant women amniocentesis was performed. In 19 cases (63.3%) the indication was elevated risk in the first-trimester combined test. In 11 women (28.2%) amniocentesis is recommended because of the elevated second-trimester biochemical risk. The proportion of false-positive results in combined first-trimester screening test was significantly lower than with second-trimester biochemical markers (B2=12.02, p=0.0005). We found the significant positive relationship between log10 MoM F B-hCG in the first and second trimester (r2=0.403, p<0.0001). There was no significant relationship between PAPP-A and second-trimester biochemical markers. Conclusion: Results of this preliminary study confirmed better specificity of the combined first-trimester screening in relation to biochemical screening in the second trimester of pregnancy. The decision and choice of the most appropriate screening test should consider woman’s personal attitude and preferences, as well as follow the guidelines recommended by the competent associations for the fetal medicine.
Ključne riječi
Down’s syndrome; prenatal screening; double biochemical screening; combined screening; alpha-fetoprotein; PAPP-A; free B-hCG; nuchal translucency
Hrčak ID:
65955
URI
Datum izdavanja:
1.9.2009.
Posjeta: 5.303 *