title: Does vaginal bleeding influence first-trimester markers for Down syndrome?
abstract: OBJECTIVE
  To examine the effect of early vaginal bleeding on first-trimester screening markers for Down syndrome.
  
  
  METHODS
  A retrospective study was conducted on 1755 normal singleton fetuses that underwent first-trimester combined screening for Down syndrome on the basis of ultrasound and maternal serum markers. Fetal delta-nuchal translucency (NT), maternal serum pregnancy-associated plasma protein A (PAPP-A) and free beta-hCG were compared between pregnancies with (n = 252) and without (n = 1503) an episode of vaginal bleeding. Subgroup analysis for the intensity of bleeding (spotting n = 191; light n = 32; heavy n = 29) was performed.
  
  
  RESULTS
  The median +/- SD (log(10)) for delta-NT, multiple of medians (MoM) PAPP-A and MoM free beta-hCG (corrected for maternal weight, smoking and ethnicity) was - 0.17 +/- 0.62, 1.10 +/- 0.28, 1.1 +/- 0.28 and - 0.15 +/- 0.51, 0.98 +/- 0.26, 0.94 +/- 0.3 in pregnancies with and without a history of early vaginal bleeding, which were not significantly different. Exclusion of patients with spotting from the vaginal bleeding group revealed significantly higher maternal serum free beta-hCG MoM values (median +/- SD (log(10))) compared to patients without bleeding, 1.29 +/- 0.27 vs 0.96 +/- 0.3(p = 0.011). Screen-positive (cut off of 1:350) rate after combined first-trimester screening was 28.1% in patients with light vaginal bleeding and 8.4% in patients without bleeding (p = 0.001).
  
  
  CONCLUSIONS
  Light vaginal bleeding before first-trimester combined screening for Down syndrome leads to a higher screen-positive rate after combined first trimester screening, without a significant difference in serum levels of the screening markers.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Münster, Münster, Germany. heinig@uni-muenster.de
authors.forename: J
authors.initials: J
authors.lastname: Heinig
authors.forename: J
authors.initials: J
authors.lastname: Steinhard
authors.forename: R
authors.initials: R
authors.lastname: Schmitz
authors.forename: J R
authors.initials: JR
authors.lastname: Nofer
authors.forename: R
authors.initials: R
authors.lastname: Witteler
authors.forename: A
authors.initials: A
authors.lastname: Mosel
authors.forename: A
authors.initials: A
authors.lastname: Ahrens
authors.forename: L
authors.initials: L
authors.lastname: Kiesel
authors.forename: W
authors.initials: W
authors.lastname: Klockenbusch
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D004314:Down Syndrome / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008875:Middle Aged; D048208:Nuchal Translucency Measurement; D011237:Predictive Value of Tests; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D011296:Prenatal Diagnosis; D020379:Risk Adjustment; D016216:Ultrasonography, Prenatal; D014592:Uterine Hemorrhage / Q000097:blood
chemical_list: D015415:Biomarkers; D018997:Chorionic Gonadotropin, beta Subunit, Human; D011266:Pregnancy-Associated Plasma Protein-A