title: First trimester screening using ultrasound and serum markers in Panamanians: Factors associated with adverse pregnancy outcomes.
abstract: BACKGROUND
  There is no published data on the association between serum biochemical and ultrasonographic markers and adverse pregnancy outcomes. Therefore, the aim of this study was to determine the factors associated with perinatal outcomes in singleton pregnancies using ultrasound and maternal serum markers during the first trimester in Panamanians.
  
  
  METHODS
  This was a prospective observational study of 468 first trimester singleton pregnancies conducted over a 7-year period. All women attending a prenatal screening clinic during the study period were informed of the study and the option to participate. Two maternal serum markers, free β-human chorionic gonadotropin (β-hCG) and pregnancy associated plasma protein-A (PAPP-A), and four fetal ultrasound markers, nuchal translucency thickness, nasal bone, flow across the tricuspid valve, and flow in the ductus venosus (DV), were measured by certified maternal fetal medicine specialists. Adverse outcomes included miscarriage, major structural defects, genetic disorders, and major fetal cardiac defects.
  
  
  RESULTS
  A total of 454 (97%) pregnancies were unaffected. Median maternal age was 31.5 years (range: 18-50). Maternal age was significantly greater in cases of adverse outcome (P = 0.007). The number of adverse outcomes associated with an absent or hypoplastic nasal bone, tricuspid valve regurgitation, and abnormal flow in the DV were significantly greater relative to unaffected pregnancies (Ps < 0.001). No differences were found in fetal crown-rump length or maternal serum levels of β-hCG or PAPP-A.
  
  
  CONCLUSIONS
  Abnormal ultrasound markers are associated with adverse outcomes. Women with normal ultrasound and serum markers should be reassured of low risk of adverse pregnancy outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, Maternal Fetal Medicine Center, Hospital Punta Pacifica, Affiliate of John Hopkins Medicine International, Panamá
authors.forename: Tania T
authors.initials: TT
authors.lastname: Herrera
authors.affiliation: Pediatric Cardiology Consultant, Hospital Punta Pacifica, Affiliate of John Hopkins Medicine International, Panamá
authors.forename: Scarlett
authors.initials: S
authors.lastname: Sinisterra
authors.affiliation: Department of Obstetrics and Gynecology, Maternal Fetal Medicine Center, Hospital Punta Pacifica, Affiliate of John Hopkins Medicine International, Panamá
authors.forename: Alcibiades
authors.initials: A
authors.lastname: Solis
authors.affiliation: Center for Neuroscience and Clinical Research Unit, Institute for Scientific Research and Technological Services (INDICASAT AIP), Panamá
authors.forename: Gabrielle B
authors.initials: GB
authors.lastname: Britton
keywords: Fetal ultrasonography; nuchal translucency; panama; pregnancy outcome; prenatal screening
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