Evaluation of Triple Test Results and Determining the Median of Serum Markers for Early Diagnosis of First-Trimester Congenital Anomalies

Document Type : Original Article

Authors

1 Professor of Obstetrics & Gynecology, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Gynecologist, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Associate Professor of Social Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Professor of Immunology, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction:Early diagnosis and termination of the pregnancies with abnormal fetuses in early stages of pregnancy can prevent from giving birth to disabled infants who will impose burden to their family and community. The aim of this study was to determine the median of serum markers in order to identify the congenital anomalies in the first trimester through performing triple tests screening.
 
Methods: In this prospective study, 127 pregnant women referring in their first trimester to obstetric clinic of Omul-Banin Hospital (Mashhad, Iran, Feb 2009-May 2010) were enrolled whose gestational age ranged between 11 weeks and 13 weeks + 6 days. All patients were evaluated with a single sonologist. In each case, fetal nuchal translucency (NT) thickness and CRL were measured and recorded in specific questionnaire designed for triple test results. Maternal serum free beta-human chorionic gonadotropin (Freeβ-HCG) and pregnancy- associated plasma protein-A (PAPP-A) were afterwards measured and recorded in the questionnaire.
 
Results: Our measurements showed that NTs ranged from 1.1 to 2.7mm (Mean=1.62mm). In older mothers (³35 years) the rate of NT was higher than those of other ages. The serum free β-HCG and PAPP-A had no relation with the maternal age. Based on laboratory results of serum markers, median index was determined for free β-HCG and PAPP-A. This index was 127.30 ng/mL for free β-HCG and 24.688 mg/L for PAPP-A, respectively.
 
Conclusion: According to the results of present study, the basic risk for developing fetal anomalies can be achieved by having determined medians (for free b-hCG and PAPP-A), NT, MoM, maternal age, gestational age and other relevant variables. Using specified softwares, these anomalies would be, thus, diagnosed in the first trimester of pregnancy.

Keywords

References

1. Simpson JL. Genetic counseling and prenatal diagnosis. In: Gabbe SG, Niebyi JR, Simpson JL. Obstetrics:
normal and problem pregnancies. 5th ed. New York: Churchil Livingston;2007. p. 187-219.
2. Farndon PA, Kilby MD. Genetics, risks, and genetics counseling. In: James DK, Steer PJ, Weiner CP,
Gonik B. High risk pregnancy. 3rd ed. Philadelphia: Elsevier Saunders; 2005. p. 43-63. 
 
3. Schmidt P, Hormansdorfer C, Staboulidou I, Hillemanns P, Schart A. Using "Degree of Extremeness"
instead of "Multiples of Median" in first trimester risk assessment for Down syndrome-an improved
method or just a gimmick in face of political motivations?. Arch Gynecol Obstet 2008;278(2):119-24.
4. Kagan KO, Wright D, Baker A, Sahota D, Nicolaides KH. Screening for trisomy 21 by maternal age, fetal
nuchal translucency thickness, free beta-human chorionic gonadotropin and pregnancy-associated plasma
protein-A. Ultrasound Obstet Gynecol 2008;31(6):618-24.
5. Cowans NJ, Stamatopoulou A, Spencer K. The effect of Rhesus status on first-trimester pregnancy
screening markers free beta human chorionic gonadotropin, pregnancy-associated plasma protein-A and
nuchal translucency. Ultrasound Obstet Gynecol 2008;31(5):493-502.
6. Conner P, Marsk A, Kublickas M, Almström H, Gustafsson S, Westgren M. Prenatal screening for
chromosome abnormalities--time to change strategy. Lakartidningen 2006;103(41):3060-1. [Article in
Swedish]
7. Canick JA, Lambert-Messerlian GM, Palomaki GE, Neveux LM, Malone FD, Ball RH, et al. Comparison
of serum markers in first-trimester down syndrome screening. Obstet Gynecol 2006;108(5):1192-9.
8. Tul N, Novak-Antolic Z. Serum PAPP-A levels at 10-14 weeks of gestation are altered in women after
assisted conception. Prenat Diagn 2006;26(13):1206-11.
9. Kagan KO, Wright D, Spencer K, Molina FS, Nicolaides KH. First-trimester screening for trisomy 21 by
free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A: impact of maternal
and pregnancy characteristics. Acta Obstet Gynecol Scand 2008;87(9):975-8.
10. Gjerris AC, Loft A, Pinborg A, Christiansen M, Tabor A. The effect of a 'vanishing twin' on biochemical
and ultrasound first trimester screening markers for Down's syndrome in pregnancies conceived by assisted
reproductive technology. Eur J Obstet Gynecol Reprod Biol 2009;144(2):140-5.
11. Harðardóttir H. Fetal nuchal translucency measurements in women aged 35 and older. Results from 1.1.99-
31.12.00. Laeknabladid 2001;87(5):455-7. [Article in Icelandic]
12. Bestwick JP, Huttly WJ, Wald NJ. First trimester Down's syndrome screening marker values and cigarette
smoking: new data and a meta-analysis on free beta human chorionic gonadotophin, pregnancy-associated
plasma protein-A and nuchal translucency. Prenat Diagn 2009;29(5):505-7.
13. Gajewska J, Ceran A, Chełchowska M, Borowski D, Ambroszkiewicz J, Jaczyńska R, et al. Effect of
maternal smoking on concentrations of the pregnancy-associated plasma protein A (PAPP-A) and free
beta subunit of chorionic gonadotropin (beta hCG) in the first trimester of pregnancy. Przegl Lek
2008;65(10):479-82. [Article in Polish]
14. Schiøtt KM, Christiansen M, Petersen OB, Sørensen TL, Uldbjerg N. The Consecutive Combined
Test--using double test from week 8 + 0 and nuchal translucency scan, for first trimester screening for
Down syndrome. Prenat Diagn 2006;26(12):1105-9.
15. Barken SS, Skibsted L, Jensen LN, Sperling L, Zingenberg H, Brøndum-Nielsen K. Diagnosis and
prediction of parental origin of triploidies by fetal nuchal translucency and maternal serum free beta-hCG
and PAPP-A at 11-14 weeks of gestation. Hum Reprod 2009;24(1):55-62.
16. Harðardóttir H. Risk assessment for fetal trisomy 21 based on nuchal translucency measurement and
biochemical screening at 11-13 weeks. Laeknabladid 2001;87(5):443-5. [Article in Icelandic]
17. Haraldsdóttir KR. Risk assessment for fetal aneuploidy after nuchal translucency measurement.
Laeknabladid 2001;87(5):422-3. [Article in Icelandic]
18. Schaelike M, Kossakiewicz M, Kossakiewicz A, Schild RL. Examination of a first-trimester Down
syndrome screening concept on a mix of 11,107 high- and low-risk patients at a private center for prenatal
medicine in Germany. Eur J Obstet Gynecol Reprod Biol 2009;144(2):140-5.
19. Cowans NS, Stamitorulou A, Mai ZN, Spencerk, Nice lialdes KH. The impact of fetal gender on first
trimester nuchal translucency and maternal serum free beta-hCG and PAPP-A MoM in normal and trisomy
21 pregnancies. Prenat Diagn 2009;29(6):578-81. 

Files

Share

How to cite

Statistics