title: Comparison and integration of first trimester fetal nuchal translucency and second trimester maternal serum screening for fetal Down syndrome.
abstract: BACKGROUND
  It is uncertain whether first trimester nuchal translucency (NT) is more effective than the well-established second trimester serum screening for fetal Down syndrome or whether their combination works best. We report data from a large multicentre non-interventional trial in which all subjects underwent both first and second trimester screening.
  
  
  METHODS
  All women who attended the obstetric clinic before 15 weeks' gestation were recruited. An ultrasound examination was performed at 10 to 14 weeks to measure the NT. The nuchal measurements were not acted upon unless the fetus showed gross features of hydrops fetalis. All women had serum alpha-fetoprotein (AFP) and human chorionic gonadotrophin (hCG) assay at 15 to 20 weeks. The Down syndrome risk assigned by serum screening was disclosed and amniocentesis was offered if this assigned risk was >or=1:250 or if the women were 35 years and older. The efficacy of different combinations of screening markers was compared.
  
  
  RESULTS
  Between January 1997 and August 2000, 17 590 women were recruited (19% >or=35 years old). After excluding subjects who miscarried, defaulted the serum test and other reasons, 16 237 pregnancies were analysed. Of these, 35 pregnancies were affected by Down syndrome (2.2 cases per 1000 pregnancies). At a false-positive rate of 5%, the detection rate of Down syndrome by NT alone, NT and age, serum hCG, AFP and age, and NT, hCG, AFP and age were 61%, 69%, 73% and 86%, respectively.
  
  
  CONCLUSIONS
  Integration of NT and second trimester serum AFP and hCG assay yielded the best screening efficacy for Down syndrome.
authors.affiliation: Department of Obstetrics and Gynaecology, The University of Hong Kong, Tsan Yuk Hospital, Hong Kong, China. yhlamobgyn@yahoo.com.hk
authors.forename: Yung Hang
authors.initials: YH
authors.lastname: Lam
authors.forename: Chin Peng
authors.initials: CP
authors.lastname: Lee
authors.forename: Sai Yuen
authors.initials: SY
authors.lastname: Sin
authors.forename: Rebecca
authors.initials: R
authors.lastname: Tang
authors.forename: Hong Soo
authors.initials: HS
authors.lastname: Wong
authors.forename: Sai Fun
authors.initials: SF
authors.lastname: Wong
authors.forename: Danial Yee Tak
authors.initials: DY
authors.lastname: Fong
authors.forename: Mary Hoi Yin
authors.initials: MH
authors.lastname: Tang
authors.forename: Hennie Hai Nin
authors.initials: HH
authors.lastname: Woo
mesh_terms: D000649:Amniocentesis; D015415:Biomarkers / Q000097:blood*; D006063:Chorionic Gonadotropin / Q000097:blood; D004314:Down Syndrome / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005189:False Positive Reactions; D005865:Gestational Age; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging; D008423:Maternal Age; D009333:Neck / Q000000981:diagnostic imaging* / Q000196:embryology*; D018566:Pregnancy, High-Risk; D011296:Prenatal Diagnosis; D012372:ROC Curve; D012307:Risk Factors; D016216:Ultrasonography, Prenatal; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D015415:Biomarkers; D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins