Is routine amniocentesis for advanced maternal age still indicated?
OBJECTIVE
To evaluate a policy of selective rather than routine use of amniocentesis for advanced maternal age.


METHODS
A consecutive series of 359 pregnant women aged 38-47 underwent nuchal translucency measurement (NTM) at 10-14 weeks, maternal serum screening (MSS) by alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) at 15-17 weeks, and second trimester ultrasound at 21-23 weeks. Women with NTM <3 mm, MSS-derived risk <1/250, and a normal second trimester sonography were considered at low risk and were suggested not to have an amniocentesis.


RESULTS
Either the NTM or MSS test was positive in 130 women; 105 (81%) of them elected to have an amniocentesis, versus 122 (53%) of 229 in whom both tests were negative (p < 0.001). Nineteen (5%) of 359 patients had NTM > or =3 mm; all 7 cases of Down's syndrome were in this group; 122 (34%) of 359 patients had a MSS-derived risk > or =1/250; 6 of the 7 cases of Down's syndrome were in this group: Ten patients had an abnormal second trimester ultrasound, 1 of which had trisomy 18. Of the 219 patients with MSS-derived risk <1/250, a NTM <3 mm, and a normal second trimester ultrasound, none had a baby with a chromosomal abnormality (95% confidence interval: 0-1.4%).


CONCLUSIONS
Amniocentesis may be offered on a selective rather than routine basis in women over 38, based upon the results of noninvasive screening tests.
Dommergues
M
M
Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, AP-HP and Université Paris XI, Clamart, France.
Audibert
F
F
Benattar
C
C
Champagne
C
C
Gomel
V
V
Frydman
R
R
D000328:Adult; D000649:Amniocentesis / Q000706:statistics & numerical data*; D000782:Aneuploidy; D006063:Chorionic Gonadotropin / Q000097:blood; D004314:Down Syndrome / Q000175:diagnosis; D005260:Female; D005865:Gestational Age; D006801:Humans; D007621:Karyotyping; D008423:Maternal Age; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging / Q000196:embryology; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D012307:Risk Factors; D016216:Ultrasonography, Prenatal; D000509:alpha-Fetoproteins / Q000032:analysis
D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins