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Bolat H, Çelebi HBG, Karahanoğlu E. Complementary Approaches in Fetal Genetic Diagnosis: Decision-Making Process and Alternative Choices for Clinicians in a Secondary Health Care Institution. Fetal Pediatr Pathol 2022; 41:944-953. [PMID: 34978258 DOI: 10.1080/15513815.2021.2022818] [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] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The aim of this study was to determine indications of invasive, genetic results of conventional karyotyping and chromosomal microarray analysis and culture failure rates to discuss possible solution options and guide our clinical choices. MATERIALS AND METHODS Fetal samples were analyzed by conventional karyotyping, array comparative genomic hybridization, fluorescence in situ hybridization. RESULTS Failure rates of chorionic villus sampling (CVS) and amniocentesis were as follows, respectively: 4.5% and 0.4%. The rates of abnormal genetic results in fetuses with only thickened nuchal translucency and thickened nuchal translucency + USG abnormality were %4.2 and %40, respectively. CONCLUSIONS Abnormal genetic results showed a significant increase in cases of thickened nuchal translucency accompanied by USG abnormalities. Although culture failure rates in the CVS were higher, none of the cases remained inconclusive. Centers with prenatal invasive genetic diagnosis should offer a wide spectrum of genetic tests by medical genetics specialists.
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Affiliation(s)
- Hilmi Bolat
- Department of Medical Genetics, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | | | - Ertuğrul Karahanoğlu
- Obstetrics and Gynecology Department, Perinatology & High-Risk Pregnancy Clinic, Memorial Hospital, Ankara, Turkey
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Karslı MF, Çakmak B, Şen C. Novel method for trisomy 21 screening in the first trimester of pregnancy: fetal brain angle. J Perinat Med 2022; 50:82-86. [PMID: 34333886 DOI: 10.1515/jpm-2021-0072] [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: 02/07/2021] [Accepted: 06/25/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The present study was performed to examine the utility of a new first trimester marker called the "brain angle" (BA) in screening for trisomy 21. We postulate that differences in the midbrain anatomy between euploid fetuses and those that are affected by trisomy 21 are reflected in changes in BA measurements. METHODS In fetuses at 11+0-13+6 weeks of gestations, which were at high risk for trisomy 21, the angle was measured between the line crossing the thalamus and mesencephalon cranial border tangentially and the line crossing the brainstem lower limit. This angle was compared between fetuses with trisomy 21 (based on karyotyping) and those with a normal karyotype. RESULTS Trisomy 21 was detected in 45 (8%) of 560 fetuses. Receiver operating characteristic analysis showed that, at BA≥94°, the sensitivity and specificity for determining trisomy 21 were 97.8% (95% CI=88.2-99.9%) and 100% (95% CI=99.2-100%), respectively. CONCLUSIONS Fetal BA appears to be a promising new first trimester marker in screening for trisomy 21.
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Affiliation(s)
- Mehmet Fatih Karslı
- Department of Obstetrics and Gynecology, Division of Perinatology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Bülent Çakmak
- Department of Obstetrics and Gynecology, School of Medicine, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Cihat Şen
- Department of Obstetrics and Gynecology, Division of Prenatal Unit, Bahçelievler Memorial Hospital, Istanbul, Turkey.,Perinatal Medicine Foundation, Istanbul, Turkey
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Öztürk FH, Öcal FD, Erol SA, Yakut K, Öztürk M, Oguz Y, Çakar ES, Celen S, Çaglar AT. Fetal Genetic Diagnosis by Chorionic Villus Sampling: Evaluation of the Five-Year Experience from a Single Center. Fetal Pediatr Pathol 2021; 40:281-289. [PMID: 31900003 DOI: 10.1080/15513815.2019.1707919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We summarized our five-year chorionic villus sampling (CVS) experience with indications, detected chromosomal abnormalities and pregnancy outcomes. Materials and Methods: This retrospective study examined 552 patients underwent CVS for prenatal diagnosis between 2014 and 2018. Results: The most frequent patients undergoing CVS indications were abnormal aneuploidy screening results, increased nuchal translucency, and cystic hygroma/edema. Of 552 CVS, 385 were normal, 141 abnormal. Eight were contaminated with maternal cells, 4 were mosaics, in 12 the culture failed, and in 2 there was inadequate sampling. The most frequent chromosomal abnormalities were trisomy 21, trisomy 18 and 45,X. Of 246 followed pregnancies, there were 165 live-births (67,1%), 58 pregnancy terminations (23,6%), and 23 pregnancy losses (9,3%). There were 5 procedure-related losses (2%), 3 of which were chromosomally normal. Conclusion: Although significant advances have been made in noninvasive methods such as NIPT, CVS is still a reliable technique for cytogenetic diagnosis in early gestation.
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Affiliation(s)
- Filiz Halici Öztürk
- Obstetrics and Gynecology Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Fatma Doga Öcal
- Obstetrics and Gynecology Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Seyit Ahmet Erol
- Obstetrics and Gynecology Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Kadriye Yakut
- Obstetrics and Gynecology Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Merve Öztürk
- Obstetrics and Gynecology Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Yüksel Oguz
- Obstetrics and Gynecology Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Esra Sükran Çakar
- Department of Medical Genetics, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Sevki Celen
- Obstetrics and Gynecology Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ali Turhan Çaglar
- Obstetrics and Gynecology Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
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Vičić A, Hafner T, Bekavac Vlatković I, Korać P, Habek D, Stipoljev F. Prenatal diagnosis of Down syndrome: A 13-year retrospective study. Taiwan J Obstet Gynecol 2018; 56:731-735. [PMID: 29241910 DOI: 10.1016/j.tjog.2017.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The aim of this study is to summarize the experience on prenatal diagnosis of Down syndrome. MATERIALS AND METHODS The study includes a retrospective data analysis of 157 prenatally detected cases of Down syndrome, routinely diagnosed among 6448 prenatal investigations performed during a 13-year period (2002-2014) in a single tertiary center. RESULTS The prevalence of diagnosed Down syndrome cases was 2.4%. Maternal age alone was indication for prenatal diagnosis in 47 cases (45.2%), increased first-/second-trimester biochemical screening test in 34 cases (21.7%), abnormal ultrasound examination in 69 cases (43.9%), positive familial history for chromosomal abnormalities in four cases, and high risk for trisomy 21 revealed by cell-free DNA testing in three cases. Ultrasound anomalies were present in total of 94 fetuses (59.8%). The most common abnormality was cystic hygroma found in 46 cases (29.3%). A regular form of Down syndrome (trisomy 21) was found in 147 cases (93.6%), Robertsonian translocation in six cases (3.8%), and mosaic form in four cases (2.6%). CONCLUSION In prenatal diagnosis of Down syndrome noninvasive screening methods are important for estimation of individual risks, in both, young population of woman and older mothers, while conventional and molecular cytogenetic methods are essential for definite diagnosis and proper genetic counseling.
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Affiliation(s)
- Ana Vičić
- Department of Obstetrics and Gynecology, Clinical Hospital "Sveti Duh", Zagreb, Croatia.
| | - Tomislav Hafner
- Department of Obstetrics and Gynecology, Clinical Hospital "Sveti Duh", Zagreb, Croatia
| | | | - Petra Korać
- Division of Molecular Biology, Department of Biology, Faculty of Science, University of Zagreb, Zagreb, Croatia
| | - Dubravko Habek
- Department of Obstetrics and Gynecology, Clinical Hospital "Sveti Duh", Zagreb, Croatia
| | - Feodora Stipoljev
- Department of Obstetrics and Gynecology, Clinical Hospital "Sveti Duh", Zagreb, Croatia; Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Awomolo A, Palomares K, Garcia GH, Rosen T, Duzyj C, Ashkinadze E. Trends in invasive prenatal diagnostic testing at a single institution. Prenat Diagn 2018; 38:735-739. [PMID: 29845619 DOI: 10.1002/pd.5290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE As diagnostic methodologies evolve, we sought to determine whether invasive testing rates would decline, whether there would be a shift in indications for invasive testing, and whether the diagnostic yield would increase. METHODS We conducted a retrospective, observational study from 2006 through 2015. We quantified the number of invasive procedures per year and examined what percentage of these procedures yielded abnormal results. We also examined the indications for testing and determined the trend of these indications during the study period. RESULTS The number of amniocenteses showed a steady decline (P < .05). The number of CVS procedures has increased and was recently equivalent to amniocentesis. The percentage of abnormal results steadily increased from 11.4% to 27.0% (P < .001). The abnormal aneuploidy screening indication remained constant over time. Advanced maternal age (AMA) as the sole indication substantially declined from 42.3% to 15.52% (P < .001). Testing for a known single gene disorder steadily increased from 3.0% to 9.20% (P = .018). CONCLUSION Our study showed a significant decline in the number of amniocenteses, a steady increase in the percentage of abnormal results from invasive testing, and a decline in AMA as the sole indication for invasive testing.
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Affiliation(s)
- Adeola Awomolo
- Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Kristy Palomares
- Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Guadalupe Herrera Garcia
- Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Todd Rosen
- Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Christina Duzyj
- Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Elena Ashkinadze
- Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Hui L, Muggli EE, Halliday JL. Population-based trends in prenatal screening and diagnosis for aneuploidy: a retrospective analysis of 38 years of state-wide data. BJOG 2015; 123:90-7. [PMID: 26108969 DOI: 10.1111/1471-0528.13488] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To analyse population-based trends over the entire history of prenatal testing for aneuploidy. DESIGN Retrospective analysis of state-wide data sets. SETTING Australian state of Victoria with ~70 000 annual births. POPULATION All pregnant women undergoing invasive prenatal testing at <25 weeks' gestation from 1976 to 2013. METHODS Analysis of three state-wide data sets: (1) Prenatal diagnosis data set of 119 404 amniocenteses and chorionic villus samplings from 1976 to 2013; (2) central serum screening laboratory data set from 1996 to 2013; (3) government birth statistics from 1976 to 2013. MAIN OUTCOME MEASURES Annual numbers and uptake rates of invasive prenatal tests and serum screening, indications for invasive prenatal testing, prenatal diagnoses of aneuploidy, diagnostic yield of invasive tests. RESULTS Annual numbers of invasive prenatal tests climbed steadily from 1976, then declined from 2000. In 2013, the number of invasive prenatal tests was the lowest in 25 years, while the number of trisomy 21 diagnoses was the highest ever recorded. Annual uptake of serum screening climbed from 1.6 to 83% over 1996-2013. Results from 2013 showed a high diagnostic yield (15.8%) for a low rate of invasive testing (3.4% of births). Over four decades, the number of invasive procedures performed for each diagnosis of major chromosome abnormality declined from 100 to six. CONCLUSIONS This study demonstrates historic reductions in the proportion of women undergoing invasive testing and dramatic improvements in diagnostic yield. Monitoring the impact of new prenatal technologies on this progress remains an important research priority. TWEETABLE ABSTRACT Invasive prenatal testing has reached historic lows due to dramatic improvements in Down syndrome screening.
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Affiliation(s)
- L Hui
- Public Health Genetics, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic., Australia.,Department of Perinatal Medicine, The Mercy Hospital for Women, Heidelberg, Vic., Australia
| | - E E Muggli
- Public Health Genetics, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
| | - J L Halliday
- Public Health Genetics, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
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Jorge P, Mota-Freitas MM, Santos R, Silva ML, Soares G, Fortuna AM. A 26-Year Experience in Chorionic Villus Sampling Prenatal Genetic Diagnosis. J Clin Med 2014; 3:838-48. [PMID: 26237480 PMCID: PMC4449647 DOI: 10.3390/jcm3030838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 06/20/2014] [Accepted: 06/23/2014] [Indexed: 12/04/2022] Open
Abstract
This report describes the trends of chorionic villus sampling (CVS) referred for prenatal genetic diagnosis in the past two and a half decades in a Portuguese Center. Our cohort of 491 CVS was mostly performed by the transcervical method at the 12th gestational week. Data collected within the framework of this study relate to the following: sampling method, referral reason versus abnormality and incidence of procedure-related pregnancy loss, that declined to about 0.5% over the last 15 years. The year 2000 represented a change in referral reasons for chorionic tissue collection, shifting from almost exclusively for cytogenetic testing to an increasing number of molecular tests for monogenic disorders. Herein, success rates as well as cytogenetic and/or molecular DNA results are presented. These latter include not only tests for several monogenic disorders, but also aneuploidy and maternal cell contamination screening. This retrospective analysis reiterates that CVS is a safe and reliable first trimester technique for prenatal diagnosis in high genetic risk pregnancies.
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Affiliation(s)
- Paula Jorge
- Center of Medical Genetics Doutor Jacinto Magalhães, Oporto Hospital Center, C.H.P., EPE, Praça Pedro Nunes, 88, 4099-028 Porto, Portugal.
- Unit for Multidisciplinary Research in Biomedicine, UMIB, ICBAS-UP, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal.
| | - Maria Manuela Mota-Freitas
- Center of Medical Genetics Doutor Jacinto Magalhães, Oporto Hospital Center, C.H.P., EPE, Praça Pedro Nunes, 88, 4099-028 Porto, Portugal.
- Unit for Multidisciplinary Research in Biomedicine, UMIB, ICBAS-UP, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal.
| | - Rosário Santos
- Center of Medical Genetics Doutor Jacinto Magalhães, Oporto Hospital Center, C.H.P., EPE, Praça Pedro Nunes, 88, 4099-028 Porto, Portugal.
- Unit for Multidisciplinary Research in Biomedicine, UMIB, ICBAS-UP, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal.
| | - Maria Luz Silva
- Center of Medical Genetics Doutor Jacinto Magalhães, Oporto Hospital Center, C.H.P., EPE, Praça Pedro Nunes, 88, 4099-028 Porto, Portugal.
| | - Gabriela Soares
- Center of Medical Genetics Doutor Jacinto Magalhães, Oporto Hospital Center, C.H.P., EPE, Praça Pedro Nunes, 88, 4099-028 Porto, Portugal.
| | - Ana Maria Fortuna
- Center of Medical Genetics Doutor Jacinto Magalhães, Oporto Hospital Center, C.H.P., EPE, Praça Pedro Nunes, 88, 4099-028 Porto, Portugal.
- Unit for Multidisciplinary Research in Biomedicine, UMIB, ICBAS-UP, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal.
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