First-trimester or second-trimester screening, or both, for Down's syndrome.

It is uncertain how best to screen pregnant women for the presence of fetal Down's syndrome: to perform first-trimester screening, to perform second-trimester screening, or to use strategies incorporating measurements in both trimesters. Women with singleton pregnancies underwent first-trimester combined screening (measurement of nuchal translucency, pregnancy-associated plasma protein A [PAPP-A], and the free beta subunit of human chorionic gonadotropin at 10 weeks 3 days through 13 weeks 6 days of gestation) and second-trimester quadruple screening (measurement of alpha-fetoprotein, total human chorionic gonadotropin, unconjugated estriol, and inhibin A at 15 through 18 weeks of gestation). We compared the results of stepwise sequential screening (risk results provided after each test), fully integrated screening (single risk result provided), and serum integrated screening (identical to fully integrated screening, but without nuchal translucency). First-trimester screening was performed in 38,167 patients; 117 had a fetus with Down's syndrome. At a 5 percent false positive rate, the rates of detection of Down's syndrome were as follows: with first-trimester combined screening, 87 percent, 85 percent, and 82 percent for measurements performed at 11, 12, and 13 weeks, respectively; with second-trimester quadruple screening, 81 percent; with stepwise sequential screening, 95 percent; with serum integrated screening, 88 percent; and with fully integrated screening with first-trimester measurements performed at 11 weeks, 96 percent. Paired comparisons found significant differences between the tests, except for the comparison between serum integrated screening and combined screening. First-trimester combined screening at 11 weeks of gestation is better than second-trimester quadruple screening but at 13 weeks has results similar to second-trimester quadruple screening. Both stepwise sequential screening and fully integrated screening have high rates of detection of Down's syndrome, with low false positive rates.

Malone FD ，Canick JA ，Ball RH ，Nyberg DA ，Comstock CH ，Bukowski R ，Berkowitz RL ，Gross SJ ，Dugoff L ，Craigo SD ，Timor-Tritsch IE ，Carr SR ，Wolfe HM ，Dukes K ，Bianchi DW ，Rudnicka AR ，Hackshaw AK ，Lambert-Messerlian G ，Wald NJ ，D'Alton ME ，First- and Second-Trimester Evaluation of Risk (FASTER) Research Consortium ... -  《-》

First- and second-trimester screening: detection of aneuploidies other than Down syndrome.

Breathnach FM ，Malone FD ，Lambert-Messerlian G ，Cuckle HS ，Porter TF ，Nyberg DA ，Comstock CH ，Saade GR ，Berkowitz RL ，Klugman S ，Dugoff L ，Craigo SD ，Timor-Tritsch IE ，Carr SR ，Wolfe HM ，Tripp T ，Bianchi DW ，D'Alton ME ，First and Second Trimester Evaluation of Risk (FASTER) Research Consortium ... -  《OBSTETRICS AND GYNECOLOGY》

Dimeric inhibin A as a marker for Down's syndrome in early pregnancy.

Aitken DA ，Wallace EM ，Crossley JA ，Swanston IA ，van Pareren Y ，van Maarle M ，Groome NP ，Macri JN ，Connor JM ... -  《NEW ENGLAND JOURNAL OF MEDICINE》

SURUSS in perspective.

Wald NJ ，Rodeck C ，Hackshaw AK ，Rudnicka A ... -  《SEMINARS IN PERINATOLOGY》

Integrated screening for Down's syndrome based on tests performed during the first and second trimesters.

Wald NJ ，Watt HC ，Hackshaw AK 《NEW ENGLAND JOURNAL OF MEDICINE》