Screening for trisomy 18 by maternal age, fetal nuchal translucency, free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A

Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology
Karl Oliver KaganKypros H Nicolaides

Abstract

To derive a model and examine the performance of first-trimester screening for trisomy 18 by maternal age, fetal nuchal translucency (NT) thickness, and maternal serum free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A). Prospective combined screening for trisomy 21 was performed at 11 + 0 to 13 + 6 weeks in 56 893 singleton pregnancies, including 56 376 cases of euploid fetuses, 395 with trisomy 21 and 122 with trisomy 18. The measured free beta-hCG and PAPP-A were converted into a multiple of the median (MoM) and then into likelihood ratios (LR). Similarly, the measured NT was transformed into LRs using the mixture model of NT distributions. In each case the LRs for NT and the biochemical markers were multiplied by the age and gestation-related risk to derive the risk for trisomy 21 and trisomy 18. Detection rates (DRs) and false-positive rates (FPRs) were calculated by taking the proportions with risks above a given risk threshold. In screening with the algorithm for trisomy 21, at a FPR of 3%, the estimated DRs of trisomies 21 and 18 were 89% and 82%, respectively. The use of an algorithm for trisomy 18 identified 93% of affected fetuses at a FPR of 0.2%. When the algorithm f...Continue Reading

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