The implementation of first‐trimester scanning at 10–13 weeks' gestation and the measurement of fetal nuchal translucency thickness in two maternity units

Pandya, Pranav; Goldberg, H.; Walton, B; Riddle, Andrew; Shelley, Sue A.; Snijders, R. J. M.; Nicolaides, Kypros H.

doi:10.1046/j.1469-0705.1995.05010020.x

Cited by 79 publications

(69 citation statements)

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“…These findings are in keeping with previous studies evaluating implementation of a new screening test. [7][8][9] The population served by UCH is typical of an inner-city population with a multicultural background, and it is therefore not surprising that the uptake is lower than that in some previous studies. 10 In the women not screened at UCH, some would have declined, some would have presented too late and others would have been screened in the private sector.…”

Section: Discussionmentioning

confidence: 87%

Practical issues drawn from the implementation of the integrated test for Down syndrome screening into routine clinical practice

Weisz

Pandya

Chitty

et al. 2007

BJOG

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We have evaluated a cohort of women booked for antenatal care at University College London Hospitals. The uptake of screening was 64.4% and was significantly higher (73 versus 46%) in women who booked before 14 weeks. Of the women who booked before 14 weeks, 96.8% opted for the integrated test (IT). Overall, 5.3% failed to attend for the second blood test. The false-positive rate in the women who had the IT was 2.9%. All 11 cases of Down syndrome were detected prenatally. Our study is the first to evaluate implementation of the IT into routine clinical practice.Keywords Down syndrome, integrated test, nuchal translucency, screening. IntroductionThe Serum, Urine and Ultrasound Screening Study (SURUSS) trial evaluated first-and second-trimester screening markers in the same cohort of women and found that the integrated test (IT) was the most effective screening test. 1 For a fixed detection rate (DR) of 85%, the false-positive rate (FPR) for the IT was estimated to be 1.2% compared with 6.1% for the combined test (maternal age with nuchal translucency [NT], pregnancy-associated plasma protein (PAPP-A) and free ß-human chorionic gonadotrophin [ß-hCG] in the first trimester) or 6.2% for the quadruple test (maternal age with alphafetoprotein [a-FP], unconjugated estriol (uE 3 ), free ß-hCG and inhibin in the second trimester). The First and Second Trimester Evaluation of Risk (FASTER) study found comparable figures. 2 Within the UK, there is significant disparity in screening services between different hospitals and inequity in provision of services. This includes variation in type and quality of service, an absence of performance standards and a lack of capacity to support a nationwide programme. 3 In order to address these issues, the National Institute of Clinical Excellence recommended that screening programmes should have DR of at least 60% for a FPR of 5% or less by April 2005 and that by April 2007 a DR of greater than 75% with a FPR of less than 3%. 4 Currently, the available tests that meet the criteria for 2007 are the combined test, the IT, the serum IT, the contingent and step-wise sequential tests 5,6 and the quadruple test.University College Hospital (UCH) was the first hospital in the UK to introduce the IT into routine practice. This is the first publication evaluating the implementation of this new method of screening. MethodsUCH NHS Foundation Trust is a teaching hospital in central London providing obstetric services for the local population and is a tertiary referral centre for high-risk obstetrics and fetal medicine. We evaluated a cohort of women booked for antenatal care at UCH during a period of 18 months from

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Section: Discussionmentioning

confidence: 87%

Practical issues drawn from the implementation of the integrated test for Down syndrome screening into routine clinical practice

Weisz

Pandya

Chitty

et al. 2007

BJOG

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“…In the general population the percentage of women above 35 years, who deliver, is about 8-15% [Pandya et al, 1995a]. These figures are much higher in women with longstanding infertility.…”

Section: Possible Applications Of Noninvasive Techniques Of Prenatal mentioning

confidence: 99%

Is Intracytoplasmic Sperm Injection Itself an Indication to Perform Preimplantation Genetic Diagnosis (PGD)?

Ludwig¹,

Geipel²,

Berg³

et al. 2001

Fetal Diagn Ther

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Intracytoplasmic sperm injection (ICSI) provides the only sufficient treatment to overcome severe forms of male infertility. However, male infertility is linked to several genetic problems as an increased number of chromosomal aberrations, cystic fibrosis transmembrane conductance regulator gene mutations, Y-chromosome microdeletions, and androgen receptor mutations. Therefore, these couples are at a higher risk of transmitting genetic problems to their offspring compared to the general population. A proposed increased number of gonosomal aberrations in the offspring possibly results from the ICSI technique itself. This led in general to a worldwide agreement to counsel those couples to undergo invasive prenatal diagnosis in order to exclude chromosome abnormalities, especially gonosomal aberrations. In this paper the genetic risks of these couples and the possible implications of ICSI itself are discussed. Preimplantation genetic diagnosis may be considered a procedure of choice in these cases, but substantial ethical problems arise when such a screening is sought. An alternative procedure of prenatal diagnosis in these couples seems to be ‘genetic sonography’, i.e. high-resolution ultrasound with measurement of nuchal translucency at the end of the first trimester, and detailed fetal evaluation at 18–22 weeks of gestation.

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“…Indeed, other authors have questioned the usefulness of this tool in screening the general population for aneuploidy and do not consider this a standard feature of every obstetrical ultrasonographic examination [31][32][33].…”

Section: Ultrasound Screening For Fetal Aneuploidymentioning

confidence: 99%

Debate about Ultrasound Screening Policies

Antsaklis¹

1998

Fetal Diagn Ther

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Routine ultrasound examination is defined as a screening procedure performed on the total obstetric population usually at 18–20 weeks of gestation as opposed to the selective use of ultrasound that might provide more information for a problem that is suspected on clinical grounds. Standard ultrasound examination includes a comprehensive examination of fetal anatomy as part of routine ultrasound. It is important for the clinician to realise that the comprehensive examination of fetal anatomy is an essential, not optional, part of the routine examination. Screening may lead to unnecessary anxiety if there is a false-positive result, or to a false sense of security if there is a false-negative result. The routine offering of obstetric ultrasound screening is the central issue in the general question of whether every woman should receive an obstetric ultrasound examination. The majority of countries have adopted the following diagnostic strategy. All pregnancies must be ultrasonographically tested in accordance with the protocols commonly recommended. The ultrasonography done at 18–20 weeks, which is known to be fundamental for diagnosing prenatal malformations, must always be performed at level II. High-risk pregnancies of malformations are to be selected in the first level of screening and referred to level II for further study. There is extensive literature neither supporting an improvement in perinatal morbidity or mortality nor an overall reduction in unnecessary intervention with routine ultrasound. The role of routine ultrasonography and its validity as a screening test for fetal malformation in a low-risk population is still the object of debate.

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The implementation of first‐trimester scanning at 10–13 weeks' gestation and the measurement of fetal nuchal translucency thickness in two maternity units

Cited by 79 publications

References 0 publications

Practical issues drawn from the implementation of the integrated test for Down syndrome screening into routine clinical practice

Practical issues drawn from the implementation of the integrated test for Down syndrome screening into routine clinical practice

Is Intracytoplasmic Sperm Injection Itself an Indication to Perform Preimplantation Genetic Diagnosis (PGD)?

Debate about Ultrasound Screening Policies

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