Second-trimester genetic sonography in patients with advanced maternal age and normal triple screen.
OBJECTIVE
To estimate the value of second-trimester genetic sonography in detecting fetal Down syndrome in patients with advanced maternal age (at least 35 years) and normal triple screen.


METHODS
Since July 1999, a prospective collection and recording of all individual triple screen risks for fetal Down syndrome was initiated for all patients with advanced maternal age presenting in our ultrasound unit for second-trimester genetic sonography. Genetic sonography evaluated the presence or absence of multiple aneuploidy markers. Outcome information included the results of genetic amniocentesis, if performed, and the results of pediatric assessment and follow-up after birth.


RESULTS
By June 2001, 959 patients with advanced maternal age and normal triple screen were identified. Outcome information was obtained in 768 patients. The median risk for fetal Down syndrome based on maternal age was 1:213 (range 1:37-1:274). The median risk for fetal Down syndrome based on triple screen results was 1:1069 (range 1:275-1:40,000). A total of 673 patients had normal genetic sonography, and none (0%) had Down syndrome; 95 had one or more aneuploidy markers present, and four (4.2%) had fetuses with Down syndrome. The triple screen risks for these four fetuses ranged from 1:319 to 1:833.


CONCLUSIONS
This study suggests that patients with advanced maternal age and normal genetic sonography carried very little risk for Down syndrome. The use of genetic sonography may increase the detection rate of fetal Down syndrome in this group of pregnant women.
Vintzileos
Anthony M
AM
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School/Saint Peter's University Hospital, New Brunswick, New Jersey 08903-0591, USA. vintziam@umdnj.edu
Guzman
Edwin R
ER
Smulian
John C
JC
Yeo
Lami
L
Scorza
William E
WE
Knuppel
Robert A
RA
D000328:Adult; D004314:Down Syndrome / Q000000981:diagnostic imaging*; D005260:Female; D005820:Genetic Testing / Q000379:methods; D006801:Humans; D008423:Maternal Age; D008875:Middle Aged; D009515:New Jersey; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D018566:Pregnancy, High-Risk; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal / Q000592:standards*