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- Marsk, A, et al.
(författare)
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If nuchal translucency screening is combined with first-trimester serum screening the need for fetal karyotyping decreases
- 2006
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 85:5, s. 534-538
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Tidskriftsartikel (refereegranskat)abstract
- Background. This case-control study was performed to evaluate whether adding first-trimester maternal serum testing to nuchal translucency measurement would improve the antenatal detection of Down's syndrome and decrease the number of women offered fetal karyotyping. Methods. In the Swedish Nuchal Translucency Trial 39,572 pregnant women were randomized to a routine scan at 12-14 gestational weeks including nuchal translucency screening for Down's syndrome, or a routine scan at 16-18 gestational weeks. From the early scan group 47 pregnancies with Down's syndrome were identified and for each case three controls were chosen. Of 189 women asked to participate, 31 cases and 108 controls with a singleton pregnancy and frozen sample from 8-14 gestational weeks available for analysis accepted participation. Maternal sera were analyzed for free beta human chorionic gonadotrophin and pregnancy-associated plasma protein A. The risk for Down's syndrome was calculated using combinations of maternal age, crown-rump length, nuchal translucency, and biochemistry. A risk >= 1/250 was considered increased and an indication for fetal karyotyping. Results. Risk calculated on the basis of maternal age alone would have identified 21 of the 31 Down's syndrome cases by karyotyping 61 of the 139 fetuses. Maternal age and nuchal translucency would have identified 29 cases by karyotyping 51 fetuses. Maternal age, nuchal translucency, and biochemistry would also have identified 29 cases by karyotyping 37 fetuses. Conclusions. By adding first trimester biochemistry to nuchal translucency measurement the detection rate of fetuses with Down's syndrome seems to remain unchanged whereas the antenatal risk group to be offered fetal karyotyping decreases.
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- Saltvedt, S, et al.
(författare)
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Detection of malformations in chromosomally normal fetuses by routine ultrasound at 12 or 18 weeks of gestation - a randomised controlled trial in 39 572 pregnancies
- 2006
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 113:6, s. 664-674
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Tidskriftsartikel (refereegranskat)abstract
- Objective To compare the antenatal detection rate of malformations in chromosomally normal fetuses between a strategy of offering one routine ultrasound examination at 12 gestational weeks (gws) and a strategy of offering one routine examination at 18 gws. Design Randomised controlled trial. Setting Multicentre trial including eight hospitals. Population A total of 39 572 unselected pregnant women. Methods Women were randomised either to one routine ultrasound scan at 12 (12-14) gws including nuchal translucency (NT) measurement or to one routine scan at 18 (15-22) gws. Anomaly screening was performed in both groups following a check-list. A repeat scan was offered in the 12-week scan group if the fetal anatomy could not be adequately seen at 12-14 gws or if NT was >= 3.5 mm in a fetus with normal or unknown chromosomes. Main outcome measures Antenatal detection rate of malformed fetuses. Results The antenatal detection rate of fetuses with a major malformation was 38% (66/176) in the 12-week scan group and 47% (72/152) in the 18-week scan group (P = 0.06). The corresponding figures for detection at < 22 gws were 30% (53/176) and 40% (61/152) (P = 0.07). In the 12-week scan group, 69% of fetuses with a lethal anomaly were detected at a scan at 12-14 gws. Conclusions None of the two strategies for prenatal diagnosis is clearly superior to the other. The 12-week strategy has the advantage that most lethal malformations will be detected at < 15 gws, enabling earlier pregnancy termination. The 18-week strategy seems to be associated with a slightly higher detection rate of major malformations, although the difference was not statistically significant.
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- Saltvedt, S, et al.
(författare)
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Screening for Down syndrome based on maternal age or fetal nuchal translucency: a randomized controlled trial in 39572 pregnancies
- 2005
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 25:6, s. 537-545
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Nuchal translucency (NT) screening increases antenatal detection of Down syndrome (DS) compared to maternal age-based screening. We wanted to determine if a change in policy for prenatal diagnosis would result in fewer babies born with DS. Methods A total of 39572 pregnant women were randomized to a scan at 12-14 gestational weeks including NT screening for DS (12-week group) or to a scan at 15-20 weeks with screening for DS based on maternal age (18-week group). Fetal karyotyping was offered if risk according to NT was >= 1 :250 in the 12-week group and if maternal age was >= 35 years in the 18-week group. Both policies included the offer of karyotyping in cases of fetal anomaly detected at any scan during pregnancy or when there was a history of fetal chromosomal anomaly. The number of babies born with DS and the number of invasive tests for fetal karyotyping were compared. Results Ten babies with DS were born alive with the 12-week policy vs. 16 with the 18-week policy (P = 0.25). More fetuses with DS were spontaneously lost or terminated in the 12-week group (45119 796) than in the 18-week group (27119 776; P = 0.04). All women except one with an antenatal diagnosis of DS at < 22 weeks terminated the pregnancy. For each case of DS detected at < 22 weeks in a living fetus there were 16 invasive tests in the 12-week group vs. 89 in the 18-week group. NT screening detected 71% of cases of DS for a 3.5% test-positive rate whereas maternal age had the potential of detecting 58% for a test-positive rate of 18%. Conclusions The number of newborns with DS differed less than expected between pregnancies that had been screened at 12-14 weeks' gestation by NT compared with those screened at IS-20 weeks by maternal age. One explanation could be that NT screening - because it is performed early in pregnancy - results in the detection and termination of many pregnancies with a fetus with DS that would have resulted in miscarriage without intervention, and also by many cases of DS being detected because of a fetal anomaly seen on an 18-week scan. The major advantage of the 1.2-week scan policy is that many fewer invasive tests for fetal karyotyping are needed per antenatally detected case of DS.
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- Saltvedt, S, et al.
(författare)
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Ultrasound dating at 12-14 or 15-20 weeks of gestation? A prospective cross-validation of established dating formulae in a population of in-vitro fertilized pregnancies randomized to early or late dating scan
- 2004
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 24:1, s. 42-50
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To determine the accuracy of established ultrasound dating formulae when used at 12-14 and 15-20 gestational weeks. Methods A total of 363 singleton pregnancies conceived after in-vitro fertilization (IVF) and randomized to a dating scan at 12-14 or 15-20 gestational weeks were studied. 'True' gestational age was calculated on the basis of the day of oocyte retrieval and was compared to gestational age calculated on the basis of seven dating formulae including the fetal biparietal diameter (BPD) and three dating formulae including BPD and fetal femur length (FL). The mean of the differences between estimated and true gestational age (systematic measurement error) and their SD (random measurement error) were calculated for each formula. Results Three formulae showed systematic errors of less than -0.7 days at both early and late scanning. Two formulae overestimated gestational age at both early and late scanning by 5.7 and 3.1 vs. 2.3 and 2.8 days, respectively, while five formulae manifested very different systematic errors at early and late scanning. The formulae used for clinical management underestimated gestational age by a mean of 3 days when dating was performed at 12-14 weeks, and by a mean of 0.8 days when dating was done at 15-20 weeks. The random error was on average 1 day less when the scan was carried out early (2 vs. 3 days; P < 0.0005). Mean true gestational age at delivery in IVF pregnancies with spontaneous start of labor was 279 days (SD 12.9); excluding preterm deliveries it was 2 81 days (SD 8.1). Conclusions Ultrasound dating formulae originally intended for use in the middle of the second trimester do not necessarily perform well when used for dating earlier in gestation. The systematic and random error of any dating formula must be assessed for the gestational age interval in which the formula is intended to be used. Copyright (C) 2004 ISUOG. Published by John Wiley & Sons, Ltd.
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- Thorsell, M, et al.
(författare)
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Large fetal size in early pregnancy associated with macrosomia
- 2010
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Ingår i: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. - : Wiley. - 1469-0705. ; 35:4, s. 390-394
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Tidskriftsartikel (refereegranskat)
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- Westin, Maria-Dorothea, et al.
(författare)
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By how much does increased nuchal translucency increase the risk of adverse pregnancy outcome in chromosomally normal fetuses? A study of 16 260 fetuses derived from an unselected pregnant population.
- 2007
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 29:2, s. 150-158
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Tidskriftsartikel (refereegranskat)abstract
- Objective: In this study we aimed to estimate the magnitude of a possible increase in risk of adverse outcome in fetuses with normal karyotype and increased nuchal translucency (NT), and to determine bow well NT measurements can distinguish between fetuses with normal and adverse outcome. Methods: We studied 16260 consecutive fetuses with normal karyotype derived from an unselected pregnant population. The following cut-offs for increased risk of adverse outcome were chosen a priori: NT >= 95(th) percentile, >= 3 mm, >= 3.5 mm, and >= 4.5 mm. The positive and negative likelihood ratios (+LR, -LR) of the risk cut-offs with regard to fetal malformation, miscarriage, perinatal death, termination of pregnancy and total adverse outcome were calculated, and receiver-operating characteristics (ROC) curves were drawn. Results: The total rate of adverse outcome was 2.7%. +LR and -LR of NT >= 3.0 mm were: for lethal or severe malformation, +LR 15.0 (95% CI 7.0-28.6), -LR 0.89 (95% CI 0.81-0.9S); for malformation of at least intermediate severity, +LR 8.1 (95% CI 4.3-14.0), -LR 0.95 (95% CI 0.92-0.97); for termination of pregnancy, +LR 41.6 (95% CI 17.1-86.6), -LR 0.67 (95% CI 0.41-0.85); for any adverse outcome, +LR 6.4 (95% CI 3.4-11), -LR 0.96 (95% CI 0.94-0.98). The odds for these adverse outcomes increased with increasing NT. NT >= 3 mm did not significantly increase the risk of miscarriage or perinatal death. Areas under ROC curves for NT were small, with 95% CI below or only slightly above 0.5. Conclusion: Our likelihood ratios can be used to calculate the individual risk of unfavorable outcome, but NT screening cannot reliably distinguish between normal and adverse outcome in fetuses with normal karyotype. Copyright (c) 2007 ISUOG. Published by John Wiley & Sons, Ltd.
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- Westin, Maria-Dorothea, et al.
(författare)
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Routine ultrasound examination at 12 or 18 gestational weeks for prenatal detection of major congenital heart malformations? A randomised controlled trial comprising 36 299 fetuses.
- 2006
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 113:6, s. 675-682
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Tidskriftsartikel (refereegranskat)abstract
- Objective To compare the rate of prenatal diagnosis of heart malformations between two policies of screening for heart malformations. Design Randomised controlled trial. Setting Six university hospitals, two district general hospitals. Sample A total of 39 572 unselected pregnancies randomised to either policy. Methods The 12-week policy implied one routine scan at 12 weeks including measurement of nuchal translucency (NT), and the 18 week policy implied one routine scan at 18 weeks. Fetal anatomy was scrutinised using the same check-list in both groups, and in both groups, indications for fetal echocardiography were ultrasound findings of any fetal anomaly, including abnormal four-chamber view, or other risk factors for heart malformation. In the 12-week scan group, NT 3.5 mm was also an indication for fetal echocardiography. Main outcome measure Prenatal diagnosis of major congenital heart malformation. Results In the 12-week scan group, 7 (11%) of 61 major heart malformations were prenatally diagnosed versus 9 (15%) of 60 in the 18-week scan group (P = 0.60). In four (6.6%) women in the 12-week scan group, the routine scan was the starting point for investigations resulting in a prenatal diagnosis versus in 9 (15%) women in the 18-week scan group (P = 0.15). The diagnosis was made <= 22 weeks in 5% (3/61) of the cases in the 12-week scan group versus in 15% (9/60) in the 18-week scan group (P = 0.08). Conclusions The prenatal detection rate of major heart malformations was low with both policies. The 18-week scan policy seemed to be superior to the 12-week scan policy, although the differences in prenatal detection rates were not statistically significant.
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