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Adiyaman D, Atakul BK, Kuyucu M, Sahingoz Yildirim AG, Pala HG. Termination of pregnancy following a Down Syndrome diagnosis: decision-making process and influential factors in a Muslim but secular country, Turkey. J Perinat Med 2021; 49:170-177. [PMID: 32920541 DOI: 10.1515/jpm-2020-0147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/22/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aims to present the termination of pregnancy (TOP) rates and elucidate the decision-making process following a prenatal diagnosis of Trisomy 21 in Turkey. METHODS This retrospective single-center study was conducted with 146 pregnant women between January 2016 and December 2019 in a tertiary hospital. Data on maternal characteristics, sonographic findings, indications for chromosome analysis, and educational, religious, and economic factors that can influence the parental decision process were collected. RESULTS The TOP rate of Down syndrome (DS) in our center was 78.8%. We concluded that maternal age, earlier diagnosis, indication for chromosome analysis, and previous pregnancies had no effect on the TOP decision. On the other hand, not having a minor or a major sonographic sign, employed mothers, middle- and high-income families, and families having a secondary or higher education tended to terminate the pregnancy affected by DS at statistically higher rates. CONCLUSIONS There are many studies worldwide investigating the TOP preferences for DS. However, there is limited data about TOP rates and influential factors affecting the decision-making process in Muslim countries. This study contributes by clarifying the factors in the decision-making process and elucidating perspectives about TOP in a Muslim country with a unique status: Turkey.
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Affiliation(s)
- Duygu Adiyaman
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Bahar Konuralp Atakul
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Melda Kuyucu
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Alkim Gulsah Sahingoz Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Halil Gursoy Pala
- Department of Obstetrics and Gynecology, Division of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
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Mack LM, Lee W, Mastrobattista JM, Belfort MA, Van den Veyver IB, Shamshirsaz AA, Ruano R, Sanz Cortes M, Espinoza A, Thiam Diouf A, Espinoza J. Are First Trimester Nuchal Septations Independent Risk Factors for Chromosomal Anomalies? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:155-161. [PMID: 27925703 DOI: 10.7863/ultra.16.01066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES There is conflicting information regarding the role of nuchal septations during first-trimester genetic screening. This study was designed to determine whether nuchal septations are risk factors for chromosomal anomalies, independent of increased nuchal translucency (NT), in the first trimester of pregnancy. METHODS This retrospective cohort study included all women who underwent first-trimester genetic screening between November 2011 and December 2014. The 95th percentile for the NT measurement was calculated for each gestational week. A multivariable logistic regression analysis was performed to determine whether the visualization of nuchal septations was an independent risk factor for chromosomal analysis while controlling for confounding variables. P < .05 was considered significant. RESULTS Chromosomal abnormalities were present in 1.0% of the population (33 of 3275). The prevalence of chromosomal abnormalities was significantly higher among fetuses with nuchal septations compared to fetuses with normal NT without septations (P < .001) and those with NT above the 95th percentile without septations (P < .001). The sonographic evidence of septations was associated with high risk of chromosomal abnormalities (odds ratio, 40.0; 95% confidence interval, 9.1-174.0) after controlling for NT measurements and other confounding variables. CONCLUSIONS Visualization of nuchal septations during first-trimester genetic screening is a powerful risk factor for chromosomal anomalies, independent of increased NT.
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Affiliation(s)
- Lauren M Mack
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas, USA
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas, USA
| | - Joan M Mastrobattista
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas, USA
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas, USA
| | - Ignatia B Van den Veyver
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas, USA
| | - Alireza A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas, USA
| | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas, USA
| | - Magdalena Sanz Cortes
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas, USA
| | | | | | - Jimmy Espinoza
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas, USA
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Bromley B, Shipp TD, Lyons J, Groszmann Y, Navathe RS, Benacerraf BR. What is the importance of second-trimester "soft markers" for trisomy 21 after an 11- to 14-week aneuploidy screening scan? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1747-1752. [PMID: 25253820 DOI: 10.7863/ultra.33.10.1747] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the importance of second-trimester "soft markers" for trisomy 21 after an 11- to 14-week aneuploidy screening scan. METHODS We conducted a retrospective cohort study of consecutive patients referred for measurement of the nuchal translucency (NT) as part of a screening protocol for aneuploidy. Patients who returned for an anatomic survey between 16 and 20 weeks' gestation were evaluated. The sonographic markers and anomalies associated with the detection of trisomy 21 in the second trimester were analyzed. RESULTS There were 42 fetuses (0.4%) with trisomy 21 identified in the study cohort of 9692 patients. Trisomy 21 was suspected at the NT scan in 28 fetuses (67%) and at the second-trimester anatomic survey in 14 (33%). In fetuses first suspected of having trisomy 21 in the second trimester, 9 of 14 had normal anatomic survey results, and 5 of 14 had congenital malformations. All 14 fetuses had soft markers for aneuploidy. A thickened nuchal fold was identified in 5 of 9 fetuses with trisomy 21 and normal anatomic survey results, all of whom had an NT of less than 3.0 mm at the initial screening scan. CONCLUSIONS Second-trimester soft markers, especially a thickened nuchal fold, remain important observations in the detection of trisomy 21 by sonography among fetuses who have had first-trimester sonographic screening for aneuploidy.
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Affiliation(s)
- Bryann Bromley
- Diagnostic Ultrasound Associates, PC, Boston, Massachusetts USA (B.B., T.D.S., Y.G., B.R.B.); Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.); Departments of Obstetrics and Gynecology (B.B., T.D.S., Y.G., R.S.N., B.R.B.) and Radiology (B.B., T.D.S., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts USA (J.L.); and Harvard Vanguard Medical Associates, Boston Massachusetts USA (R.S.N.).
| | - Thomas D Shipp
- Diagnostic Ultrasound Associates, PC, Boston, Massachusetts USA (B.B., T.D.S., Y.G., B.R.B.); Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.); Departments of Obstetrics and Gynecology (B.B., T.D.S., Y.G., R.S.N., B.R.B.) and Radiology (B.B., T.D.S., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts USA (J.L.); and Harvard Vanguard Medical Associates, Boston Massachusetts USA (R.S.N.)
| | - Jennifer Lyons
- Diagnostic Ultrasound Associates, PC, Boston, Massachusetts USA (B.B., T.D.S., Y.G., B.R.B.); Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.); Departments of Obstetrics and Gynecology (B.B., T.D.S., Y.G., R.S.N., B.R.B.) and Radiology (B.B., T.D.S., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts USA (J.L.); and Harvard Vanguard Medical Associates, Boston Massachusetts USA (R.S.N.)
| | - Yvette Groszmann
- Diagnostic Ultrasound Associates, PC, Boston, Massachusetts USA (B.B., T.D.S., Y.G., B.R.B.); Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.); Departments of Obstetrics and Gynecology (B.B., T.D.S., Y.G., R.S.N., B.R.B.) and Radiology (B.B., T.D.S., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts USA (J.L.); and Harvard Vanguard Medical Associates, Boston Massachusetts USA (R.S.N.)
| | - Reshama S Navathe
- Diagnostic Ultrasound Associates, PC, Boston, Massachusetts USA (B.B., T.D.S., Y.G., B.R.B.); Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.); Departments of Obstetrics and Gynecology (B.B., T.D.S., Y.G., R.S.N., B.R.B.) and Radiology (B.B., T.D.S., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts USA (J.L.); and Harvard Vanguard Medical Associates, Boston Massachusetts USA (R.S.N.)
| | - Beryl R Benacerraf
- Diagnostic Ultrasound Associates, PC, Boston, Massachusetts USA (B.B., T.D.S., Y.G., B.R.B.); Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B., B.R.B.); Departments of Obstetrics and Gynecology (B.B., T.D.S., Y.G., R.S.N., B.R.B.) and Radiology (B.B., T.D.S., B.R.B.), Brigham and Women's Hospital, Boston, Massachusetts USA; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts USA (J.L.); and Harvard Vanguard Medical Associates, Boston Massachusetts USA (R.S.N.)
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