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Teixeira S, Guedes-Martins L. First Trimester Tricuspid Regurgitation: Clinical Significance. Curr Cardiol Rev 2023; 19:e061222211643. [PMID: 36475342 PMCID: PMC10280996 DOI: 10.2174/1573403x19666221206115642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
Tricuspid regurgitation is a cardiac valvular anomaly that consists of the return of blood to the right atrium during systole due to incomplete valve closure. This structure can be visualized on ultrasound between 11 and 14 weeks of gestation in most cases. Despite being a common finding, even in healthy fetuses, the presence of tricuspid regurgitation may be associated with chromosomal and structural abnormalities. The evaluation of tricuspid flow and the presence of regurgitation on first-trimester ultrasound has shown promising results regarding its role in the early detection of aneuploidies, congenital heart defects, and other adverse perinatal outcomes. This review article aims to demonstrate the importance of tricuspid regurgitation as a secondary marker, and consequently, significant benefits of its early detection when added to the combined first-trimester screening. Its value will be discussed, namely its sensitivity and specificity, alone and together with other current markers in the fetal assessment performed in the first-trimester ultrasound.
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Affiliation(s)
- Sofia Teixeira
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto 4050-313, Portugal
- Centro de Medicina Fetal, Medicina Fetal Porto, Serviço de Obstetrícia-Centro Materno Infantil do Norte, Porto 4099-001, Portugal
| | - Luís Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto 4050-313, Portugal
- Centro de Medicina Fetal, Medicina Fetal Porto, Serviço de Obstetrícia-Centro Materno Infantil do Norte, Porto 4099-001, Portugal
- Departamento da Mulher e da Medicina, Reprodutiva, Centro Hospitalar Universitário do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto 4099-001, Portugal
- Unidade de Investigação e Formação-Centro Materno Infantil do Norte, Porto 4099-001, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto 4200-319, Portugal
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Lin Q, Zhou Y, Shi S, Zhang Y, Yin S, Liu X, Peng Q, Huang S, Jiang Y, Cui C, She R, Xu J, Dong F. How much can AI see in early pregnancy: A multi-center study of fetus head characterization in week 10-14 in ultrasound using deep learning. Comput Methods Programs Biomed 2022; 226:107170. [PMID: 36272307 DOI: 10.1016/j.cmpb.2022.107170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To investigate if artificial intelligence can identify fetus intracranial structures in pregnancy week 11-14; to provide an automated method of standard and non-standard sagittal view classification in obstetric ultrasound examination METHOD AND MATERIALS: We proposed a newly designed scheme based on deep learning (DL) - Fetus Framework to identify nine fetus intracranial structures: thalami, midbrain, palate, 4th ventricle, cisterna magna, nuchal translucency (NT), nasal tip, nasal skin, and nasal bone. Fetus Framework was trained and tested on a dataset of 1528 2D sagittal-view ultrasound images from 1519 females collected from Shenzhen People's Hospital. Results from Fetus Framework were further used for standard/non-standard (S-NS) plane classification, a key step for NT measurement and Down Syndrome assessment. S-NS classification was also tested with 156 images from the Longhua branch of Shenzhen People's Hospital. Sensitivity, specificity, and area under the curve (AUC) were evaluated for comparison among Fetus Framework, three classic DL models, and human experts with 1-, 3- and 5-year ultrasound training. Furthermore, 4 physicians with more than 5 years of experience conducted a reader study of diagnosing fetal malformation on a dataset of 316 standard images confirmed by the Fetus framework and another dataset of 316 standard images selected by physicians. Accuracy, sensitivity, specificity, precision, and F1-Score of physicians' diagnosis on both sets are compared. RESULTS Nine intracranial structures identified by Fetus Framework in validation are all consistent with that of senior radiologists. For S-NS sagittal view identification, Fetus Framework achieved an AUC of 0.996 (95%CI: 0.987, 1.000) in internal test, at par with classic DL models. In external test, FF reaches an AUC of 0.974 (95%CI: 0.952, 0.995), while ResNet-50 arrives at AUC∼0.883, 95% CI 0.828-0.939, Xception AUC∼0.890, 95% CI 0.834-0.946, and DenseNet-121 AUC∼0.894, 95% CI 0.839-0.949. For the internal test set, the sensitivity and specificity of the proposed framework are (0.905, 1), while the first-, third-, and fifth-year clinicians are (0.619, 0.986), (0.690, 0.958), and (0.798, 0.986), respectively. For the external test set, the sensitivity and specificity of FF is (0.989, 0.797), and first-, third-, and fifth-year clinicians are (0.533, 0.875), (0.609, 0.844), and (0.663, 0.781), respectively.On the fetal malformation classification task, all physicians achieved higher accuracy and F1-Score on Fetus selected standard images with statistical significance (p < 0.01). CONCLUSION We proposed a new deep learning-based Fetus Framework for identifying key fetus intracranial structures. The framework was tested on data from two different medical centers. The results show consistency and improvement from classic models and human experts in standard and non-standard sagittal view classification during pregnancy week 11-13+6. CLINICAL RELEVANCE/APPLICATION With further refinement in larger population, the proposed model can improve the efficiency and accuracy of early pregnancy test using ultrasound examination.
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Affiliation(s)
- Qi Lin
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yuli Zhou
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Siyuan Shi
- Illuminate, LLC, Shenzhen, Guangdong, China; Microport Prophecy, Shanghai, China
| | - Yujuan Zhang
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Shaoli Yin
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Xuye Liu
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Qihui Peng
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Shaoting Huang
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yitao Jiang
- Illuminate, LLC, Shenzhen, Guangdong, China; Microport Prophecy, Shanghai, China
| | - Chen Cui
- Illuminate, LLC, Shenzhen, Guangdong, China; Microport Prophecy, Shanghai, China.
| | - Ruilian She
- Department of Obstetric, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China.
| | - Jinfeng Xu
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China.
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China.
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Yoshizato T, Kozuma Y, Horinouchi T, Shinagawa T, Yokomine M, Ushijima K. Diagnosis of Fetal Abnormalities during the First Trimester. Kurume Med J 2021; 66:85-92. [PMID: 34135197 DOI: 10.2739/kurumemedj.ms662002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The quality of prenatal diagnosis of fetal abnormalities has advanced with improved resolution of ultrasound imaging and cytogenetic/molecular analysis. In this article, we briefly review the history of diagnosing fetal abnormalities and the current status of prenatal diagnosis during the first trimester (up to the first 14 weeks' gestation), focusing especially on fetal malformations and chromosomal abnormalities. As for detectable morphological abnormalities, roughly half of all major structural anomalies including those in the central nervous system, cardiovascular system and gastrointestinal system can be detected, if not definitely diagnosed. For screening of chromosomal abnormalities, especially for trisomy 21, ultrasound soft markers such as increased nuchal translucency, maternal serum markers and their combinations have been implemented. More recently, non-invasive prenatal testing, by analyzing cell-free DNA in maternal serum, is now available to detect chromosomal abnormalities with higher predictability. Although invasive chorionic villus sampling offers definite diagnosis for chromosomal abnormalities during the first trimester, non-invasive diagnostic techniques are patient-friendly and promising in the future perspectives on prenatal diagnosis for chromosomal abnormalities.
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Affiliation(s)
- Toshiyuki Yoshizato
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Yutaka Kozuma
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Takashi Horinouchi
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Takaaki Shinagawa
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Masato Yokomine
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine
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Ebrashy A, Aboulghar M, Elhodiby M, El-Dessouky SH, Elsirgany S, Gaafar HM, Sheta SS, Kamal R, Negm S, El Sheikhah A, Idris O, Abd-El-Kader M, Ehab M, Momtaz M. Fetal heart examination at the time of 13 weeks scan: a 5 years' prospective study. J Perinat Med 2019; 47:871-878. [PMID: 31494637 DOI: 10.1515/jpm-2019-0222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/26/2019] [Indexed: 12/22/2022]
Abstract
Objective To evaluate our ability in classifying the fetal heart as normal or abnormal during the 1st trimester scan through fetal cardiac examination and determining the best time for this examination. Methods This was a prospective study performed on 3240 pregnant women to examine the fetal heart. Four chambers view and ventricular outflow tracts were mainly examined during the scan. We used grayscale and color mapping in the diagnosis. Color Doppler was used if additional information was needed, and all patients were rescanned during the 2nd trimester to confirm or negate our diagnosis. Results The cardiac findings were normal at both scans in 3108 pregnancies. The same cardiac abnormality was detected at both scans in 79 cases. In 36 cases there was false-positive diagnosis at the early scan; in 20 of these cases, there were mildly abnormal functional findings early in pregnancy with no abnormality found later. In 17 fetuses, there was discordance between the early and later diagnosis due to missed or incorrect diagnoses. The best time to do fetal heart examination during 1st trimester is between 13 and 13 + 6 weeks. Conclusion A high degree of accuracy in the identification of congenital heart disease (CHD) can be achieved by a 1st trimester fetal echocardiography.
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Affiliation(s)
- Alaa Ebrashy
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo 11435, Egypt
| | - Mona Aboulghar
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Mohamed Elhodiby
- Department of Obstetrics and Gynecology, Faculty of Medicine, M.U.S.T. University, Cairo, Egypt
| | - Sara H El-Dessouky
- Prenatal Diagnosis and Fetal Medicine Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Sherif Elsirgany
- Reproductive Health Research Department, National Research Centre, Cairo, Egypt
| | - Hassan M Gaafar
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Sahar S Sheta
- Department of Paediatrics, Cairo University, Cairo, Egypt
| | - Rasha Kamal
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Sherif Negm
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Ahmed El Sheikhah
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Omaima Idris
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Mohamed Abd-El-Kader
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Mohamed Ehab
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Mohamed Momtaz
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
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Garshasbi M, Wang Y, Hantoosh Zadeh S, Giti S, Piri S, Reza Hekmat M. Clinical Application of Cell-Free DNA Sequencing-Based Noninvasive Prenatal Testing for Trisomies 21, 18, 13 and Sex Chromosome Aneuploidy in a Mixed-Risk Population in Iran. Fetal Diagn Ther 2019; 47:220-227. [PMID: 31487708 DOI: 10.1159/000501014] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 05/14/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To report the clinical experience and performance of plasma cell-free DNA sequencing-based noninvasive -prenatal testing (NIPT) as a screening method in detecting trisomy 21, 18, 13 (T21/T18/T13) as well as sex chromosome aneuploidy (SCA) in a mixed-risk population in Iran. METHODS In a 2-year period between January 1, 2015, and December 31, 2016, over 150 medical centers in Iran offered NIPT as clinical screening tests for fetal T21, T18, T13 and SCA. All NIPT positive cases were recommended to undergo invasive prenatal diagnosis. RESULTS 11,414 maternal blood samples were received for NIPT, for which 11,223 samples obtained NIPT results. Among 11,213 cases with confirmatory results, 94 T21, 39 T18, 8 T13, 15 XO, 6 XXX, 3 XYY, 5 XXY and 11,042 euploid cases were detected. The overall sensitivity of NIPT was 98.90, 100.00, 100.00, 90.91, 100.00, 100.00 and 100.00%, and specificities were 99.96, 99.97, 99.99, 99.96, 99.98, 100.00 and 99.99% for detecting T21, T18, T13, XO, XXX, XYY and XXY, respectively. CONCLUSION With a stringent protocol, our prospective large-scale multicentric nationwide study demonstrated that NIPT showed excellent performance as screening test for the detection of fetal T21, T18, T13 and SCA in mixed-risk pregnancies in Iran.
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Affiliation(s)
- Masoud Garshasbi
- Medical Genetics Department, DeNA Laboratory, Tehran, Iran.,Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Yicong Wang
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China
| | | | - Sima Giti
- Medical Genetics Department, DeNA Laboratory, Tehran, Iran
| | - Solmaz Piri
- Private Fetal Medicine Practice, Tehran, Iran
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Lan RY, Chou CT, Wang PH, Chen RC, Hsiao CH. Trisomy 21 screening based on first and second trimester in a Taiwanese population. Taiwan J Obstet Gynecol 2018; 57:551-554. [PMID: 30122577 DOI: 10.1016/j.tjog.2018.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE This study investigates the performance of first- and second-trimester screening tests for detecting fetal trisomy 21 in a Taiwanese population. MATERIALS AND METHODS This multicenter study 29,137 cases enrolled the chromosomal abnormality screening between 2013 and 2014 two years period from Taipei city. There were 23,990 was done the first trimester screening using a combination of fetal nuchal translucency, maternal serum β-human chorionic gonadotropin, and pregnancy-associated plasma protein-A between 11+0 and 13+6 weeks of gestation age. Second-trimester screening was done for 5149 cases using a double test (β-human chorionic gonadotropin and serum alpha fetoprotein) between 15 and 20 weeks of gestation. The cut-off risk for both is 1:270 or higher. RESULTS This multicenter study 29,137 cases that completed first- and second-trimester screening, and the outcome was available in 28,726 cases. The mean maternal age of the screen-positive group was 34.6 ± 4.2 years. The first-trimester had 891 cases screening positive with a detection rate of 97.5% for fetal trisomy 21, and false positive rate of 3.5%. In the second-trimester had 334 cases screening positive, the detection rate and false positive rate were 33.3% and 6.4% for trisomy 21, respectively. CONCLUSION The first-trimester screening had higher performance with a lower false positive rate than the second-trimester screening. First-trimester screening could reduce the rate of unnecessary invasive testing for all pregnant women.
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Affiliation(s)
- Ruei-Yu Lan
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Taipei, Taiwan
| | - Chen-Te Chou
- Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Taipei, Taiwan; Department of Medical Imaging, Changhua Christian Hospital, Changhua, Chinese Taipei
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ran-Chou Chen
- Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Taipei, Taiwan; Health Promotion Administration, Ministry of Health and Welfare, Taiwan.
| | - Ching-Hua Hsiao
- Department of Gynecology and Obstetrics, Women and Children Branch, Taipei City Hospital, Taipei, Taiwan; Department of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan.
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D'ambrosio V, Squarcella A, Vena F, Di Mascio D, Corno S, Pajno C, Piccioni MG, Brunelli R, Pizzuti A, Benedetti Panici P, Giancotti A. Update in non-invasive prenatal testing. ACTA ACUST UNITED AC 2018; 71:44-53. [PMID: 30318870 DOI: 10.23736/s0026-4784.18.04306-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Non-invasive prenatal testing (NIPT) has revolutionized the approach to prenatal diagnosis and, to date, it is the most superior screening method for the common autosomal aneuploidies, mostly trisomy 21. This screening is having a significant population-wide impact on the uptake of conventional screening and diagnostic testing. In recent years, emerging genomic technologies, largely based around next generation sequencing, have expanded the analyses to the sub-chromosomal aneuploidies. However, further clinical validation studies are needed to better characterize this technology. These tests bring advantage through providing a higher diagnostic yield, without risks of miscarriage than previously available diagnostic test, but also raise the question of harms related to an increase in uncertain and unknown results. In view of the revolution brought about by the NIPT, numerous scientific societies have published recommendations regarding the appropriate application of cell-free DNA screening in pregnancy. In this review, we discuss the progress that has been made to date in NIPT.
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Affiliation(s)
- Valentina D'ambrosio
- Department of Gynecological, Obstetrical, and Urological Sciences, Sapienza University, Rome, Italy
| | - Antonia Squarcella
- Department of Gynecological, Obstetrical, and Urological Sciences, Sapienza University, Rome, Italy - .,Department of Experimental Medicine, Sapienza University, Umberto I Polyclinic Hospital, Rome, Italy
| | - Flaminia Vena
- Department of Gynecological, Obstetrical, and Urological Sciences, Sapienza University, Rome, Italy
| | - Daniele Di Mascio
- Department of Gynecological, Obstetrical, and Urological Sciences, Sapienza University, Rome, Italy
| | - Sara Corno
- Department of Gynecological, Obstetrical, and Urological Sciences, Sapienza University, Rome, Italy
| | - Cristina Pajno
- Department of Gynecological, Obstetrical, and Urological Sciences, Sapienza University, Rome, Italy
| | - Maria G Piccioni
- Department of Gynecological, Obstetrical, and Urological Sciences, Sapienza University, Rome, Italy
| | - Roberto Brunelli
- Department of Gynecological, Obstetrical, and Urological Sciences, Sapienza University, Rome, Italy
| | - Antonio Pizzuti
- Department of Experimental Medicine, Sapienza University, Umberto I Polyclinic Hospital, Rome, Italy
| | | | - Antonella Giancotti
- Department of Gynecological, Obstetrical, and Urological Sciences, Sapienza University, Rome, Italy
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Younesi S, Savad S, Ghafouri-fard S, Taheri-amin MM, Saadati P, Jamali S, Balvayeh P, Delshad S, Navidpour F, Adiban F, Amidi S, Modarressi MH. First-Trimester Contingent Screening for Trisomy 21 by Fetal Nuchal Translucency and Maternal Serum Biomarkers and Maternal Blood Cell-Free DNA Testing. J Fetal Med 2018; 5:139-143. [DOI: 10.1007/s40556-018-0177-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Ayesha A, Aruna N, Saloni A, Smriti P. Screening chromosomal anomalies in early pregnancy: When and why. Indian Journal of Medical Specialities 2018; 9:86-93. [DOI: 10.1016/j.injms.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kaul A, Singh C, Gupta R, Arora N, Gupta A. Observational study comparing the performance of first-trimester screening protocols for detecting trisomy 21 in a North Indian population. Int J Gynaecol Obstet 2017; 137:14-19. [PMID: 28099747 DOI: 10.1002/ijgo.12087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/01/2016] [Accepted: 12/19/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate first-trimester screening protocols for detecting trisomy 21 in an Indian population. METHODS The present prospective study collected data from women with singleton pregnancies and a crown-to-rump length of 45-84 mm who presented at the fetal medicine unit of a tertiary care center in North India between June 1, 2006, and December 31, 2015, for combined first-trimester screening. Maternal age, nuchal translucency, nasal bone, and maternal serum levels of free beta human chorionic gonadotropin and pregnancy-associated plasma protein A were assessed for calculating the risk of trisomy 21. Tricuspid regurgitation and qualitative analysis of ductus venosus data were available from June 2010, and were included where available. Trisomy-21 detection rates were calculated for various screening protocols and were compared. RESULTS There were 4523 women screened and 24 records of trisomy 21. Combined screening with maternal age, nuchal translucency, nasal bone, tricuspid regurgitation, and ductus venosus demonstrated optimal detection and false-positive rates of 93.8% and 1.9%, respectively. Screening using only maternal age yielded a detection rate of 37.5%; using fixed nuchal translucency cut-off values of 2.5 and 3 mm resulted in detection rates of 66.7% and 37.5%, respectively. CONCLUSION Combined first-trimester screening performed well in an Indian population; combining maternal age, nuchal translucency, nasal bone, ductus venosus, and tricuspid regurgitation yielded the most accurate screening.
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Affiliation(s)
- Anita Kaul
- Apollo Centre for Fetal Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Chanchal Singh
- Apollo Centre for Fetal Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Rachna Gupta
- Apollo Centre for Fetal Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Nidhi Arora
- Apollo Centre for Fetal Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Abha Gupta
- Department of Biochemistry, Indraprastha Apollo Hospitals, New Delhi, India
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Colosi E, D'Ambrosio V, Periti E. First trimester contingent screening for trisomies 21,18,13: is this model cost efficient and feasible in public health system? J Matern Fetal Neonatal Med 2017; 30:2905-2910. [PMID: 27915499 DOI: 10.1080/14767058.2016.1268593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the effectiveness of three different first trimester screening models for trisomies 21, 18 and 13, in terms of detection rate, invasive test rate and final costs. MATERIAL AND METHODS We analyzed the distribution of risk for trisomies 21, 18 and 13 in a population of 20,831 singleton pregnancies based on maternal age, fetal heart rate, nuchal translucency, free beta human chorionic gonadotropin and pregnancy-associated plasma protein A (Combined test). On the basis of our data, we estimated the performance and cost of screening for trisomies using three different models at specific cutoffs: Combined test; Cell free DNA test and Contingent screening test. RESULTS Using Combined test, DR for major trisomies was estimated to be 94.92%, invasive test rate was 6.3%. cfDNA would result in a DR of 97.92%, with an invasive test rate of 3.64%. Contingent screening approach would result in an overall DR of 97.82, with a rate for invasive procedure of 1.36% and a final cost lower than other screening policies (2,338,433 euro vs 5,796,060 of cfDNA and 2,385,473 of Combined test). CONCLUSIONS Contingent screening test could be a cost-efficient and feasible first trimester screening test for aneuploidies in public health system.
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Affiliation(s)
- Enrico Colosi
- a Center for Reproductive Medicine and BirthCare Program, Hospital Misericordia, Azienda USL Toscana Sud Est , Grosseto , Italy
| | - Valentina D'Ambrosio
- b Department of Experimental Medicine , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Enrico Periti
- c Prenatal Diagnosis Unit , Palagi Hospital , Florence , Italy
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Togrul C, Ozaksit GM, Seckin KD, Baser E, Karsli MF, Gungor T. Is there a role for fetal ductus venosus and hepatic artery Doppler in screening for fetal aneuploidy in the first trimester? J Matern Fetal Neonatal Med 2016; 28:1716-9. [PMID: 25231598 DOI: 10.3109/14767058.2014.966676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the utility of ductus venosus (DV) and hepatic artery (HA) doppler in pregnant women who have high risk for aneuploidy in first trimester combined screening. METHODS This prospective study was performed between February 2011 and February-2012, at a tertiary referral hospital. Singleton pregnancies with high risk for aneuploidy in combined screening test and normal nuchal translucency (NT) measurements were included in the study group. Measurements of DV Pulsatility Index of Veins (PIV) and HA Pulsatility Index (PI) were compared between the study group and controls. RESULTS Within the study period, 104 women with singleton pregnancies were evaluated for DV and HA measurements and among these, 64 women met the inclusion criteria. A control group that comprised 40 women with similar gestational age, normal NT measurements and low-risk in first trimester combined tests was generated. DV-PIV measurements were significantly higher (p = 0.03), whereas HA-PI measurements were similar (p > 0.05) in women who had high-risk for aneuploidy in first trimester combined test. CONCLUSION We concluded that the addition of DV-PIV and HA-PI measurements to the first trimester combined screening might increase the accuracy for Down syndrome detection.
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Abstract
Aneuploidy is a major cause of perinatal morbidity and mortality and can have a significant impact on expecting parents and their families. With early screening and diagnosis it is important to be able to educate parents regarding the potential impact of the diagnosis. This knowledge allows parents the opportunity to consider management options early in the pregnancy, permitting more time to mentally and emotionally prepare both for the course of the pregnancy, and after the birth of the child should the pregnancy continue. Prenatal screening provides pregnant women a non-invasive risk assessment for the most common aneuploidies. Those who are considered "high-risk" then have the option for additional diagnostic (invasive) testing. Prior to the 1980s, prenatal screening consisted of risk assessment through maternal age; however, with the advent of maternal serum biochemical analysis and ultrasound, the field of prenatal screening developed significantly. As biochemical and sonographic advances continued into the 1990s, the emphasis shifted to risk assessment in the first trimester, with the combination of maternal serum analytes and sonographic evaluation of the nuchal translucency.(1) Within the last decade, the introduction of non-invasive screening (NIPT/S) has shown great impact on the expansion and evolving practice of prenatal screening. Although in many places the standard for prenatal testing continues to include maternal serum analytes and sonographic evaluation, the role of each marker alone and in combination remains important. In the era of increasingly available screening tests, especially with NIPT/(NIPS), this article attempts to review the current role of ultrasound in prenatal care and elucidate the role of ultrasound markers in prenatal screening.
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Affiliation(s)
- Rashmi Rao
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of California, 6310 S San Vicente Blvd # 520, Los Angeles, CA 90048.
| | - Lawrence D Platt
- The Center for Fetal Medicine and Women's Ultrasound, Los Angeles, CA
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Abstract
Screening is currently recommended in pregnancy for a number of genetic disorders, chromosomal aneuploidy, and structural birth defects in the fetus regardless of maternal age or family history. There is an overwhelming array of sonographic and maternal serum-based options available for carrying out aneuploidy risk assessment in the first and/or second trimester. As with any screening test, the patient should be made aware that a "negative" test or "normal" ultrasound does not guarantee a healthy baby and a "positive" test does not mean the fetus has the condition. The woman should have both pre- and post-test counseling to discuss the benefits, limitations, and options for additional testing. Rapid advancements of genetic technologies have made it possible to screen for the common aneuploidies traditionally associated with advanced maternal age with improved levels of accuracy beyond serum and ultrasound based testing. Prenatal screening for fetal genetic disorders with cell-free DNA has transformed prenatal care with yet unanswered questions related to the financial, ethical, and appropriate application in the provision of prenatal risk assessment.
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Affiliation(s)
- Britton D Rink
- Department of Maternal Fetal Medicine, Mount Carmel Health Systems, 6001 East Broad St, Office 3044, Columbus, OH 43213-1502.
| | - Mary E Norton
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA
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Abele H, Wagner P, Sonek J, Hoopmann M, Brucker S, Artunc-Ulkumen B, Kagan KO. First trimester ultrasound screening for Down syndrome based on maternal age, fetal nuchal translucency and different combinations of the additional markers nasal bone, tricuspid and ductus venosus flow. Prenat Diagn 2015. [DOI: 10.1002/pd.4664] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Harald Abele
- Department of Obstetrics and Gynaecology; University of Tuebingen; Tübingen Germany
| | - Philipp Wagner
- Department of Obstetrics and Gynaecology; University of Tuebingen; Tübingen Germany
| | - Jiri Sonek
- Fetal Medicine Foundation USA; Dayton OH USA
- Division of Maternal Fetal Medicine; Wright State University; Dayton OH USA
| | - Markus Hoopmann
- Department of Obstetrics and Gynaecology; University of Tuebingen; Tübingen Germany
| | - Sara Brucker
- Department of Obstetrics and Gynaecology; University of Tuebingen; Tübingen Germany
| | | | - Karl Oliver Kagan
- Department of Obstetrics and Gynaecology; University of Tuebingen; Tübingen Germany
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Wiechec M, Knafel A, Nocun A, Matyszkiewicz A, Juszczak M, Wiercinska E, Latała E. How Effective Is First-Trimester Screening for Trisomy 21 Based on Ultrasound Only? Fetal Diagn Ther 2015; 39:105-12. [DOI: 10.1159/000434632] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/27/2015] [Indexed: 11/19/2022]
Abstract
Objective: To evaluate the most common first-trimester ultrasound features of fetuses with trisomy 21 (T21) and to examine the screening performance for Down syndrome (DS) using only ultrasound-based protocols. To investigate whether maternal age (MA) has an impact on the efficacy of the ultrasound-based screening methods. Methods: In a prospective study, 6,265 patients were examined. Two ultrasound-based risk calculation protocols were applied: ‘NT' (based on nuchal translucency) and ‘NT+' (based on NT and secondary markers). Results: A total of 5,696 patients were enrolled for analysis; 84 subjects with T21 were identified. Combinations of abnormal ultrasound markers were observed in only 1.2% of euploid fetuses compared to 71.5% of fetuses with T21. Among 17.9% of DS cases with cardiac anomaly, 14.3% comprised atrioventricular septal defects. For a false-positive rate of 3%, the detection rates of T21 were 73.8 and 91.7% for the ‘NT' and ‘NT+' protocols, respectively. The efficacy of both methods was affected by MA. Conclusions: Most of the fetuses with DS demonstrate a combination of ultrasound markers of aneuploidy in the first trimester. The ‘NT+' protocol is efficient and provides comparable performance as a combined screening test. It is a valuable method, especially when the access to biochemical analysis is restricted.
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Liu Y, Ye X, Zhang N, Zhang B, Guo C, Huang W, Jing L, Wang M, Yang G, Wei X, Jing C. Diagnostic value of ultrasonographic combining biochemical markers for Down syndrome screening in first trimester: a meta-analysis. Prenat Diagn 2015; 35:879-87. [DOI: 10.1002/pd.4626] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yang Liu
- Department of Epidemiology, School of Medicine; Jinan University; Guangzhou Guangdong Province China
| | - Xingguang Ye
- Department of Epidemiology, School of Medicine; Jinan University; Guangzhou Guangdong Province China
| | - Na. Zhang
- Department of Epidemiology, School of Medicine; Jinan University; Guangzhou Guangdong Province China
| | - Baohuan Zhang
- Department of Epidemiology, School of Medicine; Jinan University; Guangzhou Guangdong Province China
| | - Congcong Guo
- Department of Epidemiology, School of Medicine; Jinan University; Guangzhou Guangdong Province China
| | - Weihuang Huang
- Department of Epidemiology, School of Medicine; Jinan University; Guangzhou Guangdong Province China
| | - Lipeng Jing
- Department of Epidemiology, School of Medicine; Jinan University; Guangzhou Guangdong Province China
| | - Man Wang
- Department of Epidemiology, School of Medicine; Jinan University; Guangzhou Guangdong Province China
| | - Guang Yang
- Department of Parasitology, School of Medicine; Jinan University; Guangzhou Guangdong Province China
| | - Xiangcai Wei
- Family Planning Research Institute of Guangdong; Guangzhou Guangdong Province China
| | - Chunxia Jing
- Department of Epidemiology, School of Medicine; Jinan University; Guangzhou Guangdong Province China
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Calkoen E, Adriaanse B, Haak M, Bartelings M, Kolesnik A, Niszczota C, van Vugt J, Roest A, Blom N, Gittenberger-de Groot A, Jongbloed M. How Normal is a 'Normal' Heart in Fetuses and Infants with Down Syndrome? Fetal Diagn Ther 2015; 39:13-20. [PMID: 26112974 DOI: 10.1159/000381710] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/12/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Congenital heart disease is present in 44-56% of fetuses with Down syndrome (DS). There are, however, signs that hearts in DS without apparent structural heart defects also differ from those in the normal population. We aimed to compare the atrioventricular (AV) septum and valves in 3 groups: DS without AV septal defect (DS no-AVSD), DS with AVSD (DS AVSD) and control hearts. METHODS The ventricular septum, membranous septum and AV valves were examined and measured in histological sections of 15 DS no-AVSD, 8 DS AVSD and 34 control hearts. In addition, the ventricular septum length was measured on ultrasound images of fetal (6 DS AVSD, 9 controls) and infant (10 DS no-AVSD, 10 DS AVSD, 10 controls) hearts. RESULTS The membranous septum was 3 times larger in DS no-AVSD fetuses compared to control fetuses, and valve dysplasia was frequently (64%) observed. The ventricular septum was shorter in patients with DS both with and without AVSD, as compared to the control group. CONCLUSION DS no-AVSD hearts are not normal as they have a larger membranous septum, shorter ventricular septum and dysplasia of the AV valves as compared to control hearts.
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Affiliation(s)
- Emmeline Calkoen
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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Daniilidis A, Balaouras D, Chitzios D, Balaouras G, Capilna M, Asimakopoulos E. Variation of ultrasound findings in the first trimester examination of recurrent cases with trisomy 21. J Clin Med Res 2015; 7:495-8. [PMID: 25883716 PMCID: PMC4394926 DOI: 10.14740/jocmr2138w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 11/11/2022] Open
Abstract
Increased nuchal translucency (NT) is present in about 50% of cases with trisomy 21. Very often the nuchal edema evolves in hydrops fetalis until the second trimester. Furthermore, a small amount of cases with a normal NT and trisomy 21 exhibit anatomical anomalies. We present a case of a 21-year-old woman, nulliparous, with a history of one termination of pregnancy and a smoking quitter. The prenatal control was negative for TORCH. During the first trimester scan on the 13th week, the NT was found 2.7 mm, the ductus venosus Doppler was normal, and the nasal bone was present. Hydrops fetalis was present though, and the parents were advised for chorionic villus sampling (CVS), but they opted for termination of pregnancy. The molecular control by QF-PCR showed normal karyotype for 13 and 18, a male fetus, but non-dysjunction trisomy 21 was present. Parental karyotype was advised, but they refused to perform it. One year later, the couple had another pregnancy. On the 12th week scan, the NT was found 1.0 mm, the ductus venosus Doppler was normal, and the nasal bone was present, but encephalocele was also found, and the parents consented again for termination of pregnancy. The new molecular control showed the same results. This time parental karyotype was performed. The father had a normal one, whereas the mother showed reversed p11 and q13 zones in chromosome 2. Genetical consulting and prenatal cytological control was advised in before next pregnancy.
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Affiliation(s)
- Aggelos Daniilidis
- The 2nd University Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - Dimitrios Balaouras
- The 2nd University Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - Dimitrios Chitzios
- The 2nd University Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - Georgios Balaouras
- Department of Medical Biopathology, University Hospital of Thessalia, Larisa, Greece
| | - Mihai Capilna
- University Department of Obstetrics and Gynecology, Tirgu Mures, Romania
| | - Efstratios Asimakopoulos
- The 2nd University Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
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Davis C, Cuckle H, Yaron Y. Screening for Down syndrome - incidental diagnosis of other aneuploidies. Prenat Diagn 2014; 34:1044-8. [DOI: 10.1002/pd.4420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/19/2014] [Accepted: 05/19/2014] [Indexed: 12/22/2022]
Affiliation(s)
| | - Howard Cuckle
- Obstetrics and Gynecology; Medical College of Columbia University; New York NY USA
| | - Yuval Yaron
- Prenatal Genetic Diagnosis Unit, Genetic Institute; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
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21
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Metcalfe A, Hippman C, Pastuck M, Johnson JA. Beyond Trisomy 21: Additional Chromosomal Anomalies Detected through Routine Aneuploidy Screening. J Clin Med 2014; 3:388-415. [PMID: 26237381 DOI: 10.3390/jcm3020388] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 02/06/2014] [Accepted: 02/18/2014] [Indexed: 01/28/2023] Open
Abstract
Prenatal screening is often misconstrued by patients as screening for trisomy 21 alone; however, other chromosomal anomalies are often detected. This study aimed to systematically review the literature and use diagnostic meta-analysis to derive pooled detection and false positive rates for aneuploidies other than trisomy 21 with different prenatal screening tests. Non-invasive prenatal testing had the highest detection (DR) and lowest false positive (FPR) rates for trisomy 13 (DR: 90.3%; FPR: 0.2%), trisomy 18 (DR: 98.1%; FPR: 0.2%), and 45,X (DR: 92.2%; FPR: 0.1%); however, most estimates came from high-risk samples. The first trimester combined test also had high DRs for all conditions studied (trisomy 13 DR: 83.1%; FPR: 4.4%; trisomy 18 DR: 91.9%; FPR: 3.5%; 45,X DR: 70.1%; FPR: 5.4%; triploidy DR: 100%; FPR: 6.3%). Second trimester triple screening had the lowest DRs and highest FPRs for all conditions (trisomy 13 DR: 43.9%; FPR: 8.1%; trisomy 18 DR: 70.5%; FPR: 3.3%; 45,X DR: 77.2%; FPR: 9.3%). Prenatal screening tests differ in their ability to accurately detect chromosomal anomalies. Patients should be counseled about the ability of prenatal screening to detect anomalies other than trisomy 21 prior to undergoing screening.
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Hartwig TS, Sørensen S, Jørgensen FS. Are there characteristics of the false-negative cases from the first trimester combined screening programme for Down syndrome? Curr Opin Obstet Gynecol 2014; 26:110-6. [DOI: 10.1097/gco.0000000000000054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hsiao CH, Cheng PJ, Shaw SS, Hsu JJ, Chen RC, Tseng YJ, Chu WC. Extended First-Trimester Screening Using Multiple Sonographic Markers and Maternal Serum Biochemistry: A Five-Year Prospective Study. Fetal Diagn Ther 2014; 35:296-301. [DOI: 10.1159/000357564] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 11/19/2013] [Indexed: 11/19/2022]
Abstract
<b><i>Objective:</i></b> To examine the performance of first-trimester screening test combining several fetal sonographic and maternal biochemical markers for major aneuploidy in a Chinese population. <b><i>Methods:</i></b> This was a prospective study performed over 5 years between January 2005 and December 2010 in Taiwan, with 20,586 cases that had a combination of a variety of sonographic markers and maternal serological β-human chorionic gonadotropin and pregnancy-associated plasma protein-A levels assessed at first trimester screening between 11<sup>+0</sup> and 13<sup>+6</sup> weeks of gestation. The risk of aneuploidy was calculated using algorithm software developed by Fetal Medicine Foundation, London. Fetal karyotyping was performed when the prenatal screening showed a risk of 1/300 or higher. All cases were followed for fetal outcome. <b><i>Results:</i></b> The study population was divided into four groups according to the screening strategy performed. The combination of maternal serological biochemistry and nuchal translucency measurement had a 66.7% detection rate of trisomy 21. Addition of nasal bone status increased the detection rate of trisomy 21 to 88.2%. Inclusion of tricuspid regurgitation flow showed an 87.5% detection rate of trisomy 21. Further inclusion of ductus venosus flow increased the detection rate of trisomy 21 to 100%. Incorporating more markers greatly increased the detection rate and decreased the false-positive rate (FPR). <b><i>Conclusion:</i></b> Extension of first-trimester screening to include more sonographic markers greatly increased the sensitivity and decreased FPR for detection of chromosomal abnormalities. Such screening strategy is effective in clinical practice for the Chinese ethnic population.
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Illa M, Mula R, Arigita M, Grande M, Gonce A, Borobio V, Borrell A. Likelihood ratios to apply for nasal bone, ductus venosus and tricuspid flow at the 11-13 weeks' scan in down syndrome screening. Fetal Diagn Ther 2013; 34:116-20. [PMID: 23817147 DOI: 10.1159/000351854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 04/23/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the feasibility of nasal bone (NB), ductus venosus (DV) and tricuspid flow (TF) at the 11-13 weeks' scan, calculate likelihood ratios for each of the markers and evaluate their efficacy in expanded and contingent screening strategies for Down syndrome. MATERIAL AND METHODS NB, DV and TF were assessed in 11,261 singleton fetuses undergoing first trimester combined screening. For each marker, Down syndrome detection rate (DR), false positive rate (FPR), positive, negative and isolated likelihood ratios (PLR, NLR and iLR) were calculated. Likelihood ratios were multiplied to the combined test risk either to the entire population or to the intermediate risk group (expanded and sequential strategies, respectively). RESULTS Down syndrome was diagnosed in 101 pregnancies. Feasibility for marker assessment ranged from 71 to 97%, DRs for isolated markers from 20 to 54% and FPRs from 1.3 to 5.3%. PLR ranged from 10 to 15, NLR from 0.5 to 0.8 and iLR from 3.9 to 5.6. When ultrasound markers were added to both strategies, a significant FPR reduction was observed. CONCLUSION The application of NB, DV and TF likelihood ratios to the combined test risk, either in an expanded or contingent strategy, result in a FPR reduction.
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Affiliation(s)
- Miriam Illa
- Department of Maternal-Fetal Medicine (Institut Clínic de Ginecologia, Obstetrícia i Neonatologia), Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
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Dan S, Wang W, Ren J, Li Y, Hu H, Xu Z, Lau TK, Xie J, Zhao W, Huang H, Xie J, Sun L, Zhang X, Wang W, Liao S, Qiang R, Cao J, Zhang Q, Zhou Y, Zhu H, Zhong M, Guo Y, Lin L, Gao Z, Yao H, Zhang H, Zhao L, Jiang F, Chen F, Jiang H, Li S, Li Y, Wang J, Wang J, Duan T, Su Y, Zhang X. Clinical application of massively parallel sequencing-based prenatal noninvasive fetal trisomy test for trisomies 21 and 18 in 11,105 pregnancies with mixed risk factors. Prenat Diagn 2012; 32:1225-32. [PMID: 23138752 DOI: 10.1002/pd.4002] [Citation(s) in RCA: 163] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To report the performance of massively parallel sequencing (MPS) based prenatal noninvasive fetal trisomy test based on cell-free DNA sequencing from maternal plasma in a routine clinical setting in China. METHOD The MPS-based test was offered as a prenatal screening test for trisomies 21 and 18 to pregnant women in 49 medical centers over 2 years. A total of 11,263 participants were recruited and the MPS-based test was performed in 11,105 pregnancies. Fetal outcome data were obtained after the expected date of confinement. RESULTS One hundred ninety cases were classified as positive, including 143 cases of trisomy 21 and 47 cases of trisomy 18. With the karyotyping results and the feedback of fetal outcome data, we observed one false positive case of trisomy 21, one false positive case of trisomy 18 and no false negative cases, indicating 100% sensitivity and 99.96% specificity for the detection of trisomies 21 and 18. CONCLUSION Our large-scale multicenter study proved that the MPS-based test is of high sensitivity and specificity in detecting fetal trisomies 21 and 18. The introduction of this screening test into a routine clinical setting could avoid about 98% of invasive prenatal diagnostic procedures.
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Ekelund CK, Petersen OB, Sundberg K, Pedersen FH, Vogel I, Tabor A. Screening performance for trisomy 21 comparing first trimester combined screening and a first trimester contingent screening protocol including ductus venosus and tricuspid flow. Prenat Diagn 2012; 32:783-8. [PMID: 22605406 DOI: 10.1002/pd.3902] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the standard first trimester combined risk assessment for trisomy 21 with a contingent screening protocol including tricuspid flow and ductus venosus flow. MATERIAL AND METHOD Women with singleton pregnancies and a first trimester combined risk assessment>1:1000 were included. They all had additional assessment of the ductus venosus and the tricuspid flow. We compared screening performance in two screening strategies: (a) First trimester combined screening strategy based on the individual risk results from the routine screening test and (b) Contingent screening strategy based on a combination of the routine test results and additional ultrasound markers. RESULTS We included 917 women in the study, 894 in the euploid group and 23 in the trisomy 21 group. Using a contingent screening strategy resulted in a significant decrease in screen positive rate from 48.3% to 17.7% (p<0.001) in the studied population. There was no statistical difference in detection rate between the two screening strategies. CONCLUSION There is increasing evidence in favour of using additional ultrasound markers as part of contingent screening protocols in the first trimester. We do suggest performing further studies in routine clinical settings to provide validation of the available risk algorithms.
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Affiliation(s)
- C K Ekelund
- Department of Fetal Medicine, Rigshospitalet, Copenhagen University Hospital, Denmark.
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