Advances in prenatal screening for XXXX : II first trimester testing, integrated testing, and future directions.

@entity1 @entity2208 @entity1467 @entity15714 @entity2241
BACKGROUND: The acceptability of prenatal screening and diagnosis of @entity1467 is dependent, in part, on the gestational age at which the testing is offered. First trimester screening could be advantageous if it has sufficient efficacy and can be effectively delivered. ISSUES: Two first trimester maternal serum screening markers, @entity15714 ( @entity15714 ) and free beta- @entity1 chorionic gonadotropin (beta-hCG), are useful for identifying @entity1 at increased risk for fetal @entity1467 . In addition, measurement of an enlarged thickness of the subcutaneous fluid-filled space at the back of the neck of the developing fetus (referred to as nuchal translucency or NT) has been demonstrated to be an indicator for these high-risk pregnancies. When these three parameters are combined, estimates for @entity1467 efficacy exceed those currently attainable in the second trimester. @entity1 who are screen-positive in the first trimester can elect to receive cytogenetic testing of a chorionic villus biopsy. The first trimester tests could also, theoretically, be combined with the second trimester maternal serum screening tests (integrated screening) to obtain even higher levels of efficacy. There are, however, several practical limitations to first trimester and integrated screening. These include scheduling of testing within relatively narrow gestational age intervals, availability of appropriately trained ultrasonographers for NT measurement, risks associated with chorionic villus biopsy, and costs. There is also increasing evidence that an enlarged NT measurement is indicative of a high risk for @entity2208 and for fetal abnormalities that are not detectable by cytogenetic analysis. @entity1 whose fetuses show enlarged NT, therefore, need first trimester counseling regarding their @entity1467 risks and the possibility of other adverse pregnancy outcomes. Follow-up ultrasound and fetal echocardiography in the second trimester are also indicated. CONCLUSION: First trimester screening appears to be a highly effective method to screen for @entity1467 . @entity1 with screen-positive results based on NT measurement appear to be at increased risk for @entity2241 . The finding of a normal fetal karyotype may not, therefore, carry a high level of reassurance for a normal baby.
