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Khalil A, Sotiriadis A, Baschat A, Bhide A, Gratacós E, Hecher K, Lewi L, Salomon LJ, Thilaganathan B, Ville Y. ISUOG Practice Guidelines (updated): role of ultrasound in twin pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2025; 65:253-276. [PMID: 39815396 PMCID: PMC11788470 DOI: 10.1002/uog.29166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Accepted: 12/06/2024] [Indexed: 01/18/2025]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK
| | - A Sotiriadis
- Second Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Baschat
- The Johns Hopkins Center for Fetal Therapy, Baltimore, MD, USA
| | - A Bhide
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK
| | - E Gratacós
- BCNatal, Hospital Clinic and Hospital Sant Joan de Deu, University of Barcelona, IDIBAPS and CIBERER, Barcelona, Spain
| | - K Hecher
- Department of Obstetrics and Fetal Medi- cine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Lewi
- Department of Obstetrics and Gynecology, Uni- versity Hospitals Leuven, Leuven, Belgium
| | - L J Salomon
- Hopital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
| | - B Thilaganathan
- Fetal Medicine Unit, St George's Hos- pital, St George's University of London, London, UK
| | - Y Ville
- Hospital Necker-Enfants Malades, AP-HP, Uni- versité Paris Descartes, Paris, France
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2
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Khier S, Gahan PB. Hepatic Clearance of Cell-Free DNA: Possible Impact on Early Metastasis Diagnosis. Mol Diagn Ther 2021; 25:677-682. [PMID: 34427906 DOI: 10.1007/s40291-021-00554-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Circulating DNA in the bloodstream has been studied since the 1940s, leading to its identification as a possible early marker for the presence of a primary tumor. Recently, it has been more successfully employed in liquid biopsies to determine the early presence of a metastatic tumor arising after chemotherapy, radiotherapy, and surgery. The appearance of such circulating tumor DNA permits the identification of the metastatic tumor before it is detected by either palpation or radiological analysis. Nevertheless, the liquid biopsy may possibly be affected by the removal of circulating tumor DNA via the kidneys and spleen as it is released. Furthermore, the liver removal of cell-free DNA has not yet been considered to be involved in this process. Here, we review the literature on the removal of free single- and double-stranded DNA and nucleosomal, vesicular, and exosomal DNA via the liver and examine its possible impact on circulating DNA levels. The removal of all forms of DNA by the liver, together with that removed by the kidneys and spleen, may delay the timing of positive results from liquid biopsies.
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Affiliation(s)
- Sonia Khier
- Pharmacokinetic Modeling Department, School of Pharmacy, Montpellier University, 15 Avenue Charles Flahault, 34000, Montpellier, France. .,Department of Probabilities and Statistics, Institut Montpellierain Alexander Grothendieck (IMAG), UMR 5149, CNRS, Montpellier University, Montpellier, France.
| | - Peter B Gahan
- Fondazione Enrico Puccinelli Onlus, 06126, Perugia, Italy
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Capriglione S, Plotti F, Terranova C, Gulino FA, Di Guardo F, Lopez S, Scaletta G, Angioli R. Preeclampsia and the challenge of early prediction: reality or utopia? State of art and critical review of literature. J Matern Fetal Neonatal Med 2018; 33:677-686. [PMID: 29954233 DOI: 10.1080/14767058.2018.1495191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: The challenge to obtain improved predictive tools, able to identify women destined to develop preeclampsia (PE), is raising the interest of researchers for the attractive chance to allow for timely initiation of prophylactic therapy, appropriate antenatal surveillance, and better-targeted research into preventive interventions. We aimed to gather all the evidence reported up to now in scientific literature relating to all prediction tests for PE.Materials and methods: We searched articles on conventional literature platforms from January 1952 to August 2016, using the terms "preeclampsia," "gestational preeclampsia," and "gestational hypertensive disorders" combined with "predictive test" and "risk assessment." Abstracts/titles identified by the search were screened by three investigators.Results: The search identified 203 citations, of which 154 potentially relevant after the initial evaluation. Among these studies, 20 full articles were excluded, therefore, 134 primary studies met the criteria for inclusion and were analyzed.Conclusions: Current evidence suggests that a combination of several features may provide the best predictive accuracy for the identification of PE. Large-scale, multicenter, multiethnic, prospective trials are required to propose an ideal combination of markers for routine screening.
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Affiliation(s)
- Stella Capriglione
- Department of Obstetrics and Gynaecology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Francesco Plotti
- Department of Obstetrics and Gynaecology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Corrado Terranova
- Department of Obstetrics and Gynaecology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Ferdinando Antonio Gulino
- Center of Physiopathology of Human Reproduction, Department of Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Federica Di Guardo
- Center of Physiopathology of Human Reproduction, Department of Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Salvatore Lopez
- Department of Obstetrics and Gynaecology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Giuseppe Scaletta
- Department of Obstetrics and Gynaecology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynaecology, Campus Bio-Medico, University of Rome, Rome, Italy
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4
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Chan WV, Johnson JA, Wilson RD, Metcalfe A. Obstetrical provider knowledge and attitudes towards cell-free DNA screening: results of a cross-sectional national survey. BMC Pregnancy Childbirth 2018; 18:40. [PMID: 29361931 PMCID: PMC5781306 DOI: 10.1186/s12884-018-1662-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/08/2018] [Indexed: 01/05/2023] Open
Abstract
Background Cell-free DNA (cfDNA) screening has recently acquired tremendous attention, promising patients and healthcare providers a more accurate prenatal screen for aneuploidy than other current screening modalities. It is unclear how much knowledge regarding cfDNA screening obstetrical providers possess which has important implications for the quality and content of the informed consent patients receive. Methods A survey was designed to assess obstetrical provider knowledge and attitudes towards cfDNA screening and distributed online through the Society of Obstetricians & Gynecologists of Canada (SOGC). Chi-squared tests were used to detect differences in knowledge and attitudes between groups. Results 207 respondents completed the survey, composed of 60.6% Obstetricians/Gynecologists (OB/GYN), 15.4% Maternal Fetal Medicine (MFM) specialists, 16.5% General Practitioners (GP), and 7.5% Midwives (MW). MFM demonstrated a significant trend of being most knowledgeable about cfDNA screening followed by OB/GYN, GP, and lastly MW in almost all aspects of cfDNA screening. All groups demonstrated an overall positive attitude towards cfDNA screening; however, OB/GYN and MFM demonstrated a significantly more positive attitude than GP and MW. Despite not yet being a diagnostic test, 19.4% of GP would offer termination of pregnancy immediately following a positive cfDNA screen result compared to none of the MFM and only few OB/GYN or MW. Conclusions We have demonstrated that different types of obstetrical providers possess varying amounts of knowledge regarding cfDNA screening with MFM currently having greater knowledge to all other groups. All obstetrical providers must have adequate prenatal screening understanding so that we can embrace the benefits of this novel and promising technology while protecting the integrity of the informed consent process. Electronic supplementary material The online version of this article (10.1186/s12884-018-1662-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wilson V Chan
- Department of Obstetrics and Gynecology, University of Calgary, 4th Floor North Tower - Foothills Medical Centre, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada.
| | - Jo-Ann Johnson
- Department of Obstetrics and Gynecology, University of Calgary, 4th Floor North Tower - Foothills Medical Centre, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - R Douglas Wilson
- Department of Obstetrics and Gynecology, University of Calgary, 4th Floor North Tower - Foothills Medical Centre, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - Amy Metcalfe
- Department of Obstetrics and Gynecology, University of Calgary, 4th Floor North Tower - Foothills Medical Centre, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
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5
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Lanes A, Huang T, Sprague AE, Leader A, Potter B, Walker M. Maternal serum screening markers and nuchal translucency measurements in in vitro fertilization pregnancies: a systematic review. Fertil Steril 2016; 106:1463-1469.e2. [DOI: 10.1016/j.fertnstert.2016.07.1120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
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6
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Kane SC. First trimester screening for pre-eclampsia. Obstet Med 2016; 9:106-12. [PMID: 27630745 DOI: 10.1177/1753495x16649074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/18/2016] [Indexed: 11/17/2022] Open
Abstract
The commercial availability of tests in the first trimester of pregnancy that predict the later development of pre-eclampsia has prompted considerable debate regarding their clinical utility and the degree to which they fulfil the longstanding principles of screening. Such tests have been shown to achieve detection rates for early pre-eclampsia (requiring delivery prior to 34 weeks) of over 90%, for a false positive rate of 10%. However, their capacity to predict later onset pre-eclampsia, which accounts for the bulk of the disease burden, is much more limited. The relatively few studies validating the performance of these tests in different populations have demonstrated significant variations in performance. Moreover, prospective research confirming that the administration of aspirin to those screened to be high risk reduces the incidence of pre-eclampsia is yet to be completed, and there may be harms in restricting aspirin therapy to this group, given its broader beneficial effect. In light of these limitations, further development of these tests is recommended prior to their introduction to clinical practice.
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Affiliation(s)
- Stefan C Kane
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Pregnancy Research Centre, Department of Maternal-Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia
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7
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Khalil A, Rodgers M, Baschat A, Bhide A, Gratacos E, Hecher K, Kilby MD, Lewi L, Nicolaides KH, Oepkes D, Raine-Fenning N, Reed K, Salomon LJ, Sotiriadis A, Thilaganathan B, Ville Y. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:247-63. [PMID: 26577371 DOI: 10.1002/uog.15821] [Citation(s) in RCA: 378] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/16/2015] [Indexed: 05/27/2023]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George’s Hospital, St George’s University of London, London, UK
| | - M Rodgers
- The Johns Hopkins Center for Fetal Therapy, Baltimore, MD, USA
| | - A Baschat
- The Johns Hopkins Center for Fetal Therapy, Baltimore, MD, USA
| | - A Bhide
- Fetal Medicine Unit, St George’s Hospital, St George’s University of London, London, UK
| | - E Gratacos
- Fetal Medicine Units and Departments of Obstetrics, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germaniy
| | - M D Kilby
- Centre for Women’s and Children's Health, University of Birmingham and Fetal Medicine Centre, Birmingham Women’s Foundation Trust, Birmingham, UK
| | - L Lewi
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, UK
| | - D Oepkes
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - N Raine-Fenning
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - K Reed
- Twin and Multiple Births Association (TAMBA)
| | - L J Salomon
- Hopital Necker-Enfants Malades, AP-HP, Universit´e Paris Descartes, Paris, France
| | - A Sotiriadis
- Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - B Thilaganathan
- Fetal Medicine Unit, St George’s Hospital, St George’s University of London, London, UK
| | - Y Ville
- Hospital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
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8
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Abstract
Genetic carrier screening, prenatal screening for aneuploidy, and prenatal diagnostic testing have expanded dramatically over the past 2 decades. Driven in part by powerful market forces, new complex testing modalities have become available after limited clinical research. The responsibility for offering these tests lies primarily on the obstetrical care provider and has become more burdensome as the number of testing options expands. Genetic testing in pregnancy is optional, and decisions about undergoing tests, as well as follow-up testing, should be informed and based on individual patients' values and needs. Careful pre- and post-test counseling is central to supporting informed decision-making. This article explores three areas of technical expansion in genetic testing: expanded carrier screening, non-invasive prenatal screening for fetal aneuploidies using cell-free DNA, and diagnostic testing using fetal chromosomal microarray testing, and provides insights aimed at enabling the obstetrical practitioner to better support patients considering these tests.
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Affiliation(s)
- Jill Fonda Allen
- Department of Obstetrics and Gynecology, The George Washington University, 2150 Pennsylvania Ave, NW Washington, DC 20037.
| | - Katie Stoll
- Genetic Support Foundation, Olympia, WA; Providence Health & Services, Olympia, WA
| | - Barbara A Bernhardt
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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9
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Park HJ, Shim SS, Cha DH. Combined Screening for Early Detection of Pre-Eclampsia. Int J Mol Sci 2015; 16:17952-74. [PMID: 26247944 PMCID: PMC4581230 DOI: 10.3390/ijms160817952] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 01/23/2023] Open
Abstract
Although the precise pathophysiology of pre-eclampsia remains unknown, this condition continues to be a major cause of maternal and fetal mortality. Early prediction of pre-eclampsia would allow for timely initiation of preventive therapy. A combination of biophysical and biochemical markers are superior to other tests for early prediction of the development of pre-eclampsia. Apart from the use of parameters in first-trimester aneuploidy screening, cell-free fetal DNA quantification is emerging as a promising marker for prediction of pre-eclampsia. This article reviews the current research of the most important strategies for prediction of pre-eclampsia, including the use of maternal risk factors, mean maternal arterial pressure, ultrasound parameters, and biomarkers.
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Affiliation(s)
- Hee Jin Park
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 135-081, Korea.
| | - Sung Shin Shim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 135-081, Korea.
| | - Dong Hyun Cha
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 135-081, Korea.
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Mersy E, de Die-Smulders CEM, Coumans ABC, Smits LJM, de Wert GMWR, Frints SGM, Veltman JA. Advantages and Disadvantages of Different Implementation Strategies of Non-Invasive Prenatal Testing in Down Syndrome Screening Programmes. Public Health Genomics 2015. [PMID: 26202817 DOI: 10.1159/000435780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Implementation of non-invasive prenatal testing (NIPT) in Down syndrome screening programmes requires health policy decisions about its combination with other tests and its timing in pregnancy. AIM Our aim was to aid health policy decision makers by conducting a quantitative analysis of different NIPT implementation strategies. METHODS Decision trees were created to illustrate all plausible alternatives in a theoretical cohort of 100,000 pregnant women in five screening programmes: classical screening by the first-trimester combined test (FCT), pre-selection of high-risk women prior to NIPT by the FCT, NIPT as the first screening test at 10 weeks and at 13 weeks, and the simultaneous conductance of NIPT and the FCT. RESULTS Pre-selection by FCT prior to NIPT reduces the number of amniocenteses to a minimum because of a reduction of false-positive NIPT results. If NIPT is the first screening test, it detects almost all fetal Down syndrome cases. NIPT at 10 weeks reassures women early in pregnancy, while NIPT at 13 weeks prevents unnecessary tests due to spontaneous miscarriages and allows for immediate confirmation by amniocentesis. CONCLUSION Every implementation strategy has its advantages and disadvantages. The most favourable implementation strategy may be NIPT as the first screening test at 13 weeks, offering the most accurate screening test for Down syndrome, when the risk for spontaneous miscarriage has declined remarkably and timely confirmation by amniocentesis can be performed.
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Affiliation(s)
- Elke Mersy
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
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11
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Khalil A, Mahmoodian N, Kulkarni A, Homfray T, Papageorghiou A, Bhide A, Thilaganathan B. Estimation of Detection Rates of Aneuploidy in High-Risk Pregnancy Using an Approach Based on Nuchal Translucency and Non-Invasive Prenatal Testing: A Cohort Study. Fetal Diagn Ther 2015; 38:254-61. [PMID: 25925597 DOI: 10.1159/000381182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/19/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim was to investigate aneuploidy detection using an approach based on nuchal translucency (NT) and non-invasive prenatal testing (NIPT). METHODS This was a cohort study including 5,306 high-risk pregnancies with NT measurements and chorionic villus samples (CVS) tested for full karyotype. RESULTS The fetal karyotype was normal in 4,172 (78.6%) cases and abnormal in 1,134 (21.4%), including 1,009 with a likely clinically significant adverse outcome. Universal CVS with full karyotyping would lead to the diagnosis of all clinically significant abnormalities. A policy of relying solely on NIPT would have led to the diagnosis of 88.9% of clinically significant abnormalities. A strategy whereby NIPT is the main method, with CVS reserved for cases with NT ≥3.0 mm, would require CVS in 21.7% of cases, identify 94.8% of significant abnormalities and avoid miscarriage in 41 pregnancies compared to CVS for all. CONCLUSIONS A policy of NIPT for increased-risk cases and CVS with full karyotype if the NT was ≥3.0 mm reduced the risk of miscarriage yet still identified 95% of clinically significant aneuploidy.
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Affiliation(s)
- Asma Khalil
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, London, UK
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12
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Lau TK, Cheung SW, Lo PSS, Pursley AN, Chan MK, Jiang F, Zhang H, Wang W, Jong LFJ, Yuen OKC, Chan HYC, Chan WSK, Choy KW. Non-invasive prenatal testing for fetal chromosomal abnormalities by low-coverage whole-genome sequencing of maternal plasma DNA: review of 1982 consecutive cases in a single center. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:254-264. [PMID: 24339153 DOI: 10.1002/uog.13277] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 12/06/2013] [Accepted: 12/10/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To review the performance of non-invasive prenatal testing (NIPT) by low-coverage whole-genome sequencing of maternal plasma DNA at a single center. METHODS The NIPT result and pregnancy outcome of 1982 consecutive cases were reviewed. NIPT was based on low coverage (0.1×) whole-genome sequencing of maternal plasma DNA. All subjects were contacted for pregnancy and fetal outcome. RESULTS Of the 1982 NIPT tests, a repeat blood sample was required in 23 (1.16%). In one case, a conclusive report could not be issued, probably because of an abnormal vanished twin fetus. NIPT was positive for common trisomies in 29 cases (23 were trisomy 21, four were trisomy 18 and two were trisomy 13); all were confirmed by prenatal karyotyping (specificity=100%). In addition, 11 cases were positive for sex-chromosomal abnormalities (SCA), and nine cases were positive for other aneuploidies or deletion/duplication. Fourteen of these 20 subjects agreed to undergo further investigations, and the abnormality was found to be of fetal origin in seven, confined placental mosaicism (CPM) in four, of maternal origin in two and not confirmed in one. Overall, 85.7% of the NIPT-suspected SCA were of fetal origin, and 66.7% of the other abnormalities were caused by CPM. Two of the six cases suspected or confirmed to have CPM were complicated by early-onset growth restriction requiring delivery before 34 weeks. Fetal outcome of the NIPT-negative cases was ascertained in 1645 (85.15%). Three chromosomal abnormalities were not detected by NIPT, including one case each of a balanced translocation, unbalanced translocation and triploidy. There were no known false negatives involving the common trisomies (sensitivity=100%). CONCLUSIONS Low-coverage whole-genome sequencing of maternal plasma DNA was highly accurate in detecting common trisomies. It also enabled the detection of other aneuploidies and structural chromosomal abnormalities with high positive predictive value.
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Affiliation(s)
- T K Lau
- Fetal Medicine Centre, Paramount Medical Centre, Hong Kong, China
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13
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Ahman A, Axelsson O, Maras G, Rubertsson C, Sarkadi A, Lindgren P. Ultrasonographic fetal soft markers in a low-risk population: prevalence, association with trisomies and invasive tests. Acta Obstet Gynecol Scand 2014; 93:367-73. [PMID: 24433283 DOI: 10.1111/aogs.12334] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 01/09/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the prevalence of soft markers identified at second trimester ultrasound in a low-risk population and the association of these markers with trisomies and invasive testing. DESIGN Prospective observational study. SETTING Swedish University Hospital. POPULATION All women with fetuses examined by ultrasound at 15(+0) -22(+0) weeks gestation between July 2008 and March 2011. METHODS Cases with soft markers were compared with non-cases with regard to trisomies and invasive testing. MAIN OUTCOME MEASURES Prevalence of soft markers, likelihood ratio for trisomies and risk ratio for invasive tests after detection of soft markers. RESULTS Second trimester ultrasound was performed on 10 710 fetuses. Markers were detected in 5.9% of fetuses. 5.1% were isolated, 0.7% were multiple and 0.1% were combined with an anomaly. Presence of markers showed a positive likelihood ratio for Down syndrome, but the association (likelihood ratio = 7.1) was only statistically significant for the combined category of any marker (isolated, multiple or combined with anomaly). The risk ratio for invasive testing after the second trimester ultrasound was 24.0 in pregnancies with isolated soft markers compared with those without markers. CONCLUSION In a low-risk population, soft markers were found in 5.9% of fetuses at second trimester ultrasound. The likelihood ratio for Down syndrome was significant only for any marker (isolated, multiple or combined with anomaly). The presence of soft markers increased the incidence of invasive procedures substantially. Soft markers should be noted when information on second trimester ultrasound is formulated, and all units performing fetal ultrasound examinations should have established routines concerning information management when soft markers are identified.
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Affiliation(s)
- Annika Ahman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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14
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Placental mosaicism for Trisomy 13: a challenge in providing the cell-free fetal DNA testing. J Assist Reprod Genet 2014; 31:589-94. [PMID: 24497298 DOI: 10.1007/s10815-014-0182-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 01/22/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE We investigated the disagreement between the positive cell-free fetal DNA test for trisomy 13 and the standard cytogenetic diagnosis of one case. METHODS Cell-free fetal DNA testing was performed by massively parallel sequencing. We used conventional cytogenetic analysis to confirm the commercial cell-free fetal DNA testing. Additionally, postnatal fluorescent in situ hybridization (FISH) testing was performed on placental tissues. RESULTS The cell-free fetal DNA testing result was positive for trisomy 13. G-banded analysis of amniotic fluid was normal, 46, XY. FISH testing of tissues from four quadrants of the placenta demonstrated mosaicism for trisomy 13. CONCLUSIONS A positive cell-free fetal DNA testing result may not be representative of the fetal karyotype because of placental mosaicism. Cytogenetic analysis should be performed when abnormal cell-free fetal DNA test results are obtained.
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15
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Okun N, Teitelbaum M, Huang T, Dewa CS, Hoch JS. The price of performance: a cost and performance analysis of the implementation of cell-free fetal DNA testing for Down syndrome in Ontario, Canada. Prenat Diagn 2014; 34:350-6. [PMID: 24395030 DOI: 10.1002/pd.4311] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 12/13/2013] [Accepted: 12/19/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the cost and performance implications of introducing cell-free fetal DNA (cffDNA) testing within modeled scenarios in a publicly funded Canadian provincial Down syndrome (DS) prenatal screening program. METHOD Two clinical algorithms were created: the first to represent the current screening program and the second to represent one that incorporates cffDNA testing. From these algorithms, eight distinct scenarios were modeled to examine: (1) the current program (no cffDNA), (2) the current program with first trimester screening (FTS) as the nuchal translucency-based primary screen (no cffDNA), (3) a program substituting current screening with primary cffDNA, (4) contingent cffDNA with current FTS performance, (5) contingent cffDNA at a fixed price to result in overall cost neutrality,(6) contingent cffDNA with an improved detection rate (DR) of FTS, (7) contingent cffDNA with higher uptake of FTS, and (8) contingent cffDNA with optimized FTS (higher uptake and improved DR). RESULTS This modeling study demonstrates that introducing contingent cffDNA testing improves performance by increasing the number of cases of DS detected prenatally, and reducing the number of amniocenteses performed and concomitant iatrogenic pregnancy loss of pregnancies not affected by DS. Costs are modestly increased, although the cost per case of DS detected is decreased with contingent cffDNA testing. CONCLUSION Contingent models of cffDNA testing can improve overall screening performance while maintaining the provision of an 11- to 13-week scan. Costs are modestly increased, but cost per prenatally detected case of DS is decreased.
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Affiliation(s)
- N Okun
- Maternal Fetal Medicine Program, Mt. Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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16
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Thilaganathan B. Ultrasound in obstetrics & gynecology. Editor's note. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:1-2. [PMID: 24395684 DOI: 10.1002/uog.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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17
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Kane SC, Da Silva Costa F, Brennecke SP. New directions in the prediction of pre-eclampsia. Aust N Z J Obstet Gynaecol 2013; 54:101-7. [PMID: 24358966 DOI: 10.1111/ajo.12151] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 10/09/2013] [Indexed: 12/16/2022]
Abstract
Pre-eclampsia remains an important worldwide cause of maternal and perinatal morbidity and mortality. Improved prediction of those destined to develop this condition would allow for timely initiation of prophylactic therapy, appropriate antenatal surveillance and better targeted research into preventive interventions. This paper reviews recent research into strategies for the prediction of pre-eclampsia, including the use of maternal risk factors, mean maternal arterial pressure, ultrasound parameters and biomarkers. The most promising strategies involve multiparametric approaches, which use a variety of individual parameters in combination, as has been established in first-trimester aneuploidy screening. The paper concludes with a discussion of the issues around the introduction of such testing into clinical practice.
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Affiliation(s)
- Stefan C Kane
- Department of Perinatal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia
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18
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Gardiner HM. First-trimester fetal echocardiography: routine practice or research tool? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:611-612. [PMID: 24273198 DOI: 10.1002/uog.13235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- H M Gardiner
- Texas Fetal Center, University of Texas at Houston, UT Professional Building, 6410 Fannin, Suite 700, Houston, TX, 77030, USA.
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19
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Sillence KA, Madgett TE, Roberts LA, Overton TG, Avent ND. Non-Invasive Screening Tools for Down's Syndrome: A Review. Diagnostics (Basel) 2013; 3:291-314. [PMID: 26835682 PMCID: PMC4665531 DOI: 10.3390/diagnostics3020291] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/14/2013] [Accepted: 05/16/2013] [Indexed: 01/16/2023] Open
Abstract
Down's syndrome (DS) is the most common genetic cause of developmental delay with an incidence of 1 in 800 live births, and is the predominant reason why women choose to undergo invasive prenatal diagnosis. However, as invasive tests are associated with around a 1% risk of miscarriage new non-invasive tests have been long sought after. Recently, the most promising approach for non-invasive prenatal diagnosis (NIPD) has been provided by the introduction of next generation sequencing (NGS) technologies. The clinical application of NIPD for DS detection is not yet applicable, as large scale validation studies in low-risk pregnancies need to be completed. Currently, prenatal screening is still the first line test for the detection of fetal aneuploidy. Screening cannot diagnose DS, but developing a more advanced screening program can help to improve detection rates, and therefore reduce the number of women offered invasive tests. This article describes how the prenatal screening program has developed since the introduction of maternal age as the original "screening" test, and subsequently discusses recent advances in detecting new screening markers with reference to both proteomic and bioinformatic techniques.
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Affiliation(s)
- Kelly A Sillence
- School of Biomedical and Biological Sciences, Plymouth University Peninsula School of Medicine and Dentistry, Plymouth University, Plymouth, PL4 8AA, UK.
| | - Tracey E Madgett
- School of Biomedical and Biological Sciences, Plymouth University Peninsula School of Medicine and Dentistry, Plymouth University, Plymouth, PL4 8AA, UK.
| | - Llinos A Roberts
- School of Biomedical and Biological Sciences, Plymouth University Peninsula School of Medicine and Dentistry, Plymouth University, Plymouth, PL4 8AA, UK.
| | - Timothy G Overton
- Department of Obstetrics, St Michael's Hospital, Southwell Street, Bristol, BS2 8EG, UK.
| | - Neil D Avent
- School of Biomedical and Biological Sciences, Plymouth University Peninsula School of Medicine and Dentistry, Plymouth University, Plymouth, PL4 8AA, UK.
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