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Database - Alliance francophone pour l'accouchement respecté (AFAR)

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https://afar.info/id=1999

Created on : 14 Oct 2006
Modified on : 10 Jan 2018

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Bibliographical entry (without author) :

Screening for Down syndrome using first-trimester combined screening followed by second-trimester ultrasound examination in an unselected population. American Journal of Obstetrics and Gynecology, 2006;195:1379–87.

Author(s) :

P. Rozenberg, L. Bussières, S. Chevret, J.-P. Bernard, L. Malagrida, H. Cuckle, C. Chabry, I. Durand-Zaleski, L. Bidat, I. Lacroix, M. Moulis, M. Roger, M.-C. Jacquemot, J.-P. Bault, P. Boukobza, P. Boccara, F. Vialat, Y. Giudicelli, Y. Ville

Year of publication :

2006

URL(s) :

http://www.sciencedirect.com/science?_ob=ArticleUR…
https://doi.org/10.1016/j.ajog.2006.02.046

Résumé (français)  :

(Résumé copié de la fiche 2026 dans cette base de données)

Contexte. – Des études récentes ont montré l’efficacité du dépistage de la trisomie 21 par le test combiné du premier trimestre reposant sur l’âge maternel, les marqueurs sériques (?-HCG libre, PAPP-A) et la mesure échographique de la clarté nucale. Cependant, ces études n’incorporaient pas les performances de l’échographie de routine de 20–22 semaines d’aménorrhée (SA), largement réalisée.

Méthodes. – Nous avons réalisé une étude interventionelle, multicentrique, en population générale dans le département des Yvelines dont le but était d’évaluer la performance du test combiné du premier trimestre, suivi par l’échographie du second trimestre et/ou le dosage des marqueurs sériques maternels (?-HCG libre et alpha-foetoprotéine ou HCG totale, alpha-foetoprotéine et oestriol non conjugué) quand ce dépistage sérique était prescrit incidemment. Les taux de détection et de tests positifs ont été estimés en utilisant une méthode de correction pour les issues non vérifiées. Une analyse des coûts a été également effectuée.

Abstract (English)  :

Objective

Recent studies have reported the efficacy of first-trimester combined screening for Down syndrome based on maternal age, serum markers (human chorionic gonadotropin, pregnancy-associated plasma protein A), and ultrasound measurement of fetal nuchal translucency. However, those do not incorporate the value of the widely accepted routine 20-22 weeks’ anomaly scan.

Study design

We carried out a multicenter, interventional study in the unselected population of a single health authority in order to assess the performance of first-trimester combined screening, followed by routine second trimester ultrasound examination and/or screening by maternal serum markers (free _-hCG and alpha-fetoprotein measurement or total hCG, alpha-fetoprotein, and unconjugated estriol measurement) when incidentally performed. Detection and screen positive rates were estimated using a correction method for nonverified issues. A cost analysis was also performed.

Results

During the study period, 14,934 women were included. Fifty-one cases of Down syndrome were observed, giving a prevalence of 3.4 per 1000 pregnancies. Of these, 46 were diagnosed through first (n = 41) or second (n = 5) trimester screening. Among the 5 screen-negative Down syndrome cases, all were diagnosed postnatally after an uneventful pregnancy. Detection and screen positive rates of first-trimester combined screening were 79.6% and 2.7%, respectively. These features reached 89.7%, and 4.2%, respectively, when combined with second-trimester ultrasound screening. The average cost of the full screening procedure was 108 € ($120) per woman and the cost per diagnosed Down syndrome pregnancy was 7,118 € ($7909).

Conclusion

Our findings suggest that 1 pragmatic interventional 2-step approach using first-trimester combined screening followed by second-trimester detailed ultrasound examination is a suitable and acceptable option for Down syndrome screening in pregnancy.

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Version française de cet article : voir la fiche 2026 dans cette base de données.

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Keywords :

➡ amniocentesis ; screening ; antenatal diagnosis ; trisomy

Author of this record :

Bernard Bel — 14 Oct 2006
➡ latest update : Alison Passieux — 10 Jan 2018

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