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Screening for trisomy 21 based on maternal age, nuchal translucency measurement, first trimester biochemistry and quantitative and qualitative assessment of the flow in the DV — the assessment of efficacy
Affiliations- Department of Obstetrics and Gynecology in Ruda Slaska, Medical University of Silesia, Poland
- The Rafal Czerwiakowski Gynecological-Obstetrical Hospital, Krakow, Poland
- Department of Maternal-Fetal Medicine and Gynecology, Chair of Obstetrics, Bydgoszcz, Poland
- 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw, Poland, Poland
- Department of Obstetrics and Perinatology, Medical University of Warsaw, Zwirki i Wigury Str 63a, 02-091 Warsaw, Poland
- Gynecological-Obstetrical Hospital in Opole, Poland
- Department of Obstetrics, Gynecology and Oncology, The Gabiel Narutowicz Hospital, Krakow, Poland
- Department of the Perinatology and Gynecology, Poznan University of Medical Sciences, Poland
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Abstract
Objectives: The aim of the study was to compare effects of addition of two methods of ductus venosus (DV) flow assessment: qualitative — the assessment of shape of the A-wave (positive or negative), and quantitative — based on the pulsatility index for veins (DVPI) to the basic screening for trisomy 21 at 11 to 13 + 6 weeks of pregnancy.
Material and methods: The ultrasound examination was performed in 8230 fetuses in singleton pregnancies at 11– –13 + 6 wks, as a part of a routine screening for chromosomal defects. In DV A-wave was assessed and DVPI was calculated. After the scan blood sample was taken for first trimester biochemistry (BC). Risk for chromosomal defects was calculated and high-risk patients were offered an invasive test for karyotyping.
Results: Basic screening with following combination of markers: MA, NT and BC provided lowest detection rate (DR) 87.50% for FPR = 6.94%. After adding qualitative DV A-wave assessment DR increased to 88.75% for FPR = 5.65%. The best DR = 93.75% for FPR = 5.55% was achieved when quantitative DVPI was added. The application of the Receiver Operating Curves curve confirmed validity of the addition of DV flow assessment to the screening model. The highest diagnostic power of the test was achieved when DVPI was added, with the ROC AUC of 0.974.
Conclusions: The assessment of DV flow performed at 11–13 + 6 weeks increases DR for trisomy 21 and reduces FPR. The screening model based on the quantitative DV flow analysis (DVPI) gives better results compared to the qualitative flow assessment.
Abstract
Objectives: The aim of the study was to compare effects of addition of two methods of ductus venosus (DV) flow assessment: qualitative — the assessment of shape of the A-wave (positive or negative), and quantitative — based on the pulsatility index for veins (DVPI) to the basic screening for trisomy 21 at 11 to 13 + 6 weeks of pregnancy.
Material and methods: The ultrasound examination was performed in 8230 fetuses in singleton pregnancies at 11– –13 + 6 wks, as a part of a routine screening for chromosomal defects. In DV A-wave was assessed and DVPI was calculated. After the scan blood sample was taken for first trimester biochemistry (BC). Risk for chromosomal defects was calculated and high-risk patients were offered an invasive test for karyotyping.
Results: Basic screening with following combination of markers: MA, NT and BC provided lowest detection rate (DR) 87.50% for FPR = 6.94%. After adding qualitative DV A-wave assessment DR increased to 88.75% for FPR = 5.65%. The best DR = 93.75% for FPR = 5.55% was achieved when quantitative DVPI was added. The application of the Receiver Operating Curves curve confirmed validity of the addition of DV flow assessment to the screening model. The highest diagnostic power of the test was achieved when DVPI was added, with the ROC AUC of 0.974.
Conclusions: The assessment of DV flow performed at 11–13 + 6 weeks increases DR for trisomy 21 and reduces FPR. The screening model based on the quantitative DV flow analysis (DVPI) gives better results compared to the qualitative flow assessment.
Keywords
screening for chromosomal defects, 11 to 13 + 6 weeks scan, trisomy 21, ductus venosus
About this articleTitle
Screening for trisomy 21 based on maternal age, nuchal translucency measurement, first trimester biochemistry and quantitative and qualitative assessment of the flow in the DV — the assessment of efficacy
Journal
Issue
Article type
Research paper
Pages
481-485
Published online
2017-09-29
Page views
1400
Article views/downloads
1550
DOI
Pubmed
Bibliographic record
Ginekol Pol 2017;88(9):481-485.
Keywords
screening for chromosomal defects
11 to 13 + 6 weeks scan
trisomy 21
ductus venosus
Authors
Bartosz Czuba
Dariusz Zarotyński
Mariusz Dubiel
Dariusz Borowski
Piotr Węgrzyn
Wojciech Cnota
Małgorzata Reska-Nycz
Marek Mączka
Mirosław Wielgoś
Krzysztof Sodowski
Dawid Serafin
Anna Kubaty
Grzegorz H. Bręborowicz
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