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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Greenough, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, M.J.M.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

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Estimating the effect of gestational age on test performance of combined first-trimester screening for Down syndrome: a preliminary study

Peter N. van Heesch1, 2 / Pieter C. Struijk1 / Jaqueline A.M. Laudy1, 2 / Eric A.P. Steegers1 / Hajo I.J. Wildschut1

1Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

2Prenatal Center Rijnmond, STAR Medical Diagnostic Center, Rotterdam, The Netherlands

Corresponding author: Peter N. van Heesch Division of Obstetrics and Prenatal Medicine Department of Obstetrics and Gynecology Erasmus MC University Medical Center Rotterdam PO Box 2040 3000 CA Rotterdam The Netherlands Tel.: +31107033917 Fax: +31107035826

Citation Information: Journal of Perinatal Medicine. Volume 38, Issue 3, Pages 305–309, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: 10.1515/jpm.2010.033, February 2010

Publication History

Received:
2009-07-12
Revised:
2009-10-15
Accepted:
2009-10-20
Published Online:
2010-02-02

Abstract

Objective: To establish how different methods of estimating gestational age (GA) affect reliability of first-trimester screening for Down syndrome.

Methods: Retrospective single-center study of 100 women with a viable singleton pregnancy, who had first-trimester screening. We calculated multiples of the median (MoM) for maternal-serum free beta human chorionic gonadotropin (free β-hCG) and pregnancy associated plasma protein-A (PAPP-A), derived from either last menstrual period (LMP) or ultrasound-dating scans.

Results: In women with a regular cycle, LMP-derived estimates of GA were two days longer (range –11 to 18), than crown-rump length (CRL)-derived estimates of GA whereas this discrepancy was more pronounced in women who reported to have an irregular cycle, i.e., six days (range –7 to 32). Except for PAPP-A in the regular-cycle group, all differences were significant. Consequently, risk estimates are affected by the mode of estimating GA. In fact, LMP-based estimates revealed ten “screen-positive” cases compared to five “screen-positive” cases where GA was derived from dating-scans.

Conclusion: Provided fixed values for nuchal translucency are applied, dating-scans reduce the number of screen-positive findings on the basis of biochemical screening. We recommend implementation of guidelines for Down syndrome screening based on CRL-dependent rather than LMP-dependent parameters of GA.

Keywords: CRL; dating; Down syndrome; first-trimester screening; free β-hCG; LMP; PAPP-A; trisomy 21

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[1]
Diego Sbardella, Giovanni Francesco Fasciglione, Magda Gioia, Chiara Ciaccio, Grazia Raffaella Tundo, Stefano Marini, and Massimo Coletta
Molecular Aspects of Medicine, 2012, Volume 33, Number 2, Page 119
[2]
Cheryl A. Conover
Aging Cell, 2010, Volume 9, Number 6, Page 942

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