ROLE OF PRENATAL ULTRASONOGRAPHY IN WOMEN WITH POSITIVE SCREEN FOR DOWN-SYNDROME ON THE BASIS OF MATERNAL SERUM MARKERS

被引:71
|
作者
NYBERG, DA
LUTHY, DA
CHENG, EY
SHELEY, RC
RESTA, RG
WILLIAMS, MA
机构
[1] UNIV WASHINGTON,DEPT OBSTET & GYNECOL,SEATTLE,WA 98195
[2] SWEDISH MED CTR,MED CTR,CTR PERINATAL STUDIES,SEATTLE,WA
关键词
FETUS; CHROMOSOME ABNORMALITIES; PRENATAL ULTRASONOGRAPHY; PRENATAL DIAGNOSIS; DOWN SYNDROME; ALPHA-FETOPROTEIN; TRIPLE SCREEN;
D O I
10.1016/0002-9378(95)91322-X
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: Our purpose was to evaluate the usefulness of prenatal ultrasonography among women with a positive screen for fetal Down syndrome on the basis of three biochemical markers - maternal serum ol-fetoprotein, human chorionic gonadotropin, and unconjugated estriol. STUDY DESIGN: A total of 395 women underwent prenatal ultrasonography at a single institution after being identified as screen positive (midtrimester risk greater than or equal to 1:195) on the basis of triple-marker screening between 15 and 18 weeks. Ultrasonographic findings were compared with the biochemical markers and the eventual fetal outcome for these patients. Ultrasonographic abnormalities that were evaluated included structural defects, nuchal thickening or cystic hygroma, echogenic bowel, cerebral ventricular dilatation, pylectasis, and shortened femur. RESULTS: Among 395 patients, 374 (94.7%) had normal karyotype by genetic amniocentesis (n = 232) or postnatal follow-up (n = 142), 18 (4.5%) proved to have Down syndrome, and three had other karyotypic abnormalities. One or more ultrasonographic abnormalities were found in nine of 18 (50%) with Down syndrome compared to 27 of 377 (7.2%) other fetuses (p < 0.001). Fetuses with abnormal ultrasonography results included three with other chromosome abnormalities and five with nonchromosomal anomalies. An abnormal ultrasonography result increased the risk of Down syndrome by 5.6-fold (25% from 4.5%) and a negative result reduced the risk by 45% (2.5% from 4.5%). The value of ultrasonography is further enhanced when all chromosome abnormalities and nonchromosomal anomalies are considered. CONCLUSION: Abnormal ultrasonographic findings increase the risk for Down syndrome, whereas normal findings are less predictive of normalcy. After correction for inaccurate menstrual dates, genetic amniocentesis should be offered in spite of a normal ultrasonography result among women with positive triple screen.
引用
收藏
页码:1030 / 1035
页数:6
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