Difference of the Results of Two Visits in Down Syndrome Screening Test / 임상검사와정도관리

INTRODUCTION: Estimation of the risk of Down syndrome pregnancy by the triple marker test is performed on women once at anytime during the 15-21 weeks of gestational age. The triple marker test is based on the distribution of the alpha-fetoprotein (AFP), chorionic gonadotropin (CG) and unconjugated estriol (uE3) of the different pregnancy. In spite of the logical excellencies, various factors can affect the result of the test in practical field. We compared differences of the risk of Down syndrome pregnancy based on the specimen obtained from two visits during the 15-21 weeks of gestational age. METHOD: We measured the AFP, CG and uE3 with Access (Beckman Coulter, USA) from the sera of 104 pregnant women who visited two times about 2 weeks of interval during 15-21 weeks of gestational age. We calculated log (MoM) of AFP, CG and uE3 of each marker between two visits, and compared differences of each biochemical marker and difference of risk of Down syndrome pregnancy between two visits. RESULT: Mean+/-SD of log (MoM) of AFP, CG, uE3 of the 1st visit were 0.019+/-0.156, -0.016+/-0.224, 0.002+/-0.138, respectively, and those of AFP, CG, uE3 of the 2nd visit were 0.010+/-0.140, -0.076+/-0.205, 0.057+/-0.138, respectively. CG and uE3 showed statistically significant difference (P<0.001, P<0.001, respectively) but AFP did not (P=0.328). Risk of Down syndrome pregnancy of the 1st visit was 8.017x10(-4)+/-1.6241x10(-3), and that of the 2nd visit was 5.667x10(-4)+/-1.6241x10(-3), with no significant difference statistically (P=0.094). CONCLUSION: The risk of Down syndrome based on the sera of woman who visited two times about 2 weeks of interval between 15-21 weeks of gestational age did not show significant difference. It is resonable that triple marker test is performed on women once at anytime during the 15-21 weeks of gestational age in practical base.

A Clinical Study of 1,064 Cases of Midtrimester Genetic Amnicentesis / 대한산부인과학회잡지

Midtrimester genetic amniocentesis has been a gold standard for prenatal diagnosis in antenatal care since last 25 years. After the triple serum marker test was introduced as a prenatal screening method for Down syndrome, the frequency of genetic amniocentesis was increased. OBJECTIVE: To determine the complication, risk of amniocentesis and detection rate of chromosomal abnormality. MATERIAL AND METHODS: A retrospective clinical analysis of 1,064 midtrimester genetic amnicentesis in IL Sin Christian Hospital antenatal clinic from Jan 1995 to Dec 1997. Chi square test was used for the statistical analysis and p value < 0.05 was considered significant. RESULTS: Amnicentesis were significantly increased in the age of 35-39 yrs and 40yrs over. And also the incidence of chromosomal abnormality was higher than younger age group. The indications of amnicentesis were screen positive of triple marker test(43%), advanced maternal age(20.8%), abnormal beta-hCG level, past history of chromosome abnormality or malformed baby and abnormal alpha-FP level in order. Total number of chromosomal abnormalities was 30 and the incidence of chromosomal abnormalities was 2.8%(30/1,064). The complications were developed in 13 cases and fetal loss rate was 0.78%(9/1,064). CONCLUSION: The detection rate of chromosomal abnormality in midtrimester amnicentesis for prenatal diagnosis was high and relatively safe procedure but, we should be attention to more careful manipulation.

Analysis of 200 Cases of Midtrimesteric Amniocentesis / 대한산부인과학회잡지

OBJECTIVE: We analyzed 200 cases of prenatal amniocentesis and compared them with other reported studies. Thus we propose the necessity of metanalysis for prenatal amniocentesis. METHOD: We analyzed 200 cases that have undergone amniocentesis at Masan Samsung hospital from January 1996 to December 1997. The results of our study was compared with other reported studies of amniocentesis by indication and maternal age. The proportion of age-class and indication are compared between previous study subjects and our 200 cases. RESULTS: Triple marker abnormality was the most common indication of amniocentesis(51%) and the most common age distribution was 25-29 years (43.5%). Chromosomal aberration was diagnosed in 20 cases (10%) of which the numerical aberration was 9 cases (4.5%) and the structural aberration was 11 cases (5.5%). 5 cases (2.5%) out of ll cases of the structural aberration were normal variant. There were 7 cases (trisomy 21) of autosomal aberration and 2 cases (Turner syndrome) of sex chromosome aberration. Arnong the structural aberration, there was only one reported case of 46, t(7:10) reciprocal translocation. There were no cases of fetal death except for a little self limited preterm labor. There were no neonatal complications. In the comparison of indication and maternal age with other studies, abnormal triple test was the most common indication of amniocentesis. The number of young pregnant women under 35 years old who underwent genetic amniocentesis was increased year by year. CONCLUSION: Triple maker screening test and genetic amniocentesis become popular method of antenatal diagnosis in Korea. Now, it is the proper time to establish standard indication of prenatal amniocentesis in this country by systemic and objective statistic examination. So we address the need for metanalysis in our country as comparing with other studies.