ABSTRACT
BACKGROUND: Recent studies have reported the efficacy of first trimester combined screening for Down Syndrome based on maternal age, serum markers (human chorionic gonadotropin, pregnancy-associated plasma protein A), and ultrasound measurement of fetal nuchal translucency. However, those do not incorporate the value of the widely accepted routine 20-22 week anomaly scan. STUDY DESIGN: We carried out a multi-centre, interventional study in the unselected population of a single health authority in order to assess the performance of first trimester combined screening, followed by routine second trimester ultrasound examination and/or screening by maternal serum markers (free beta-hCG and alpha-fetoprotein measurement or total hCG, alpha-fetoprotein and unconjugated estriol measurement) when incidentally performed. Detection and screen positive rates were estimated using a correction method for non verified issues. A cost analysis was also performed. RESULTS: During the study period, 14,934 women were included. Fifty-one cases of Down Syndrome were observed, giving a prevalence of 3.4 per 1000 pregnancies. Of these, 46 were diagnosed through first (N=41) or second (N=5) trimester screening. Among the 5 screen-negative Down syndrome cases, all were diagnosed postnatally after an uneventful pregnancy. Detection and screen positive rates of first trimester combined screening were 79.6% and 2.7%, respectively. These features reached 89.7 and 4.2%, respectively when combined with second trimester ultrasound screening. The average cost of the full screening procedure was 108 euro (120 $) per woman and the cost per diagnosed Down syndrome pregnancy was 7,118 euro (7,909 $). CONCLUSION: Our findings suggest that one pragmatic interventional two-step approach using first-trimester combined screening followed by second trimester detailed ultrasound examination is a suitable and acceptable option for Down syndrome screening in pregnancy.
Subject(s)
Down Syndrome/diagnosis , Prenatal Diagnosis , Ultrasonography, Prenatal , Adult , Biomarkers/blood , Costs and Cost Analysis , Diagnosis, Differential , Female , Humans , Maternal Age , Nuchal Translucency Measurement , Pregnancy , Pregnancy Trimester, First , Pregnancy Trimester, Second , Prenatal Diagnosis/economics , Prenatal Diagnosis/methods , Risk FactorsABSTRACT
This enquiry was carried out to evaluate the measures of secondary prevention at 6 months and over of myocardial infarction in the ile de France region with respect to the recommendations of scientific societies and results of large scale therapeutic trials. A questionnaire was completed for the 1,215 patients selected from data obtained from the hospital discharge summary, interrogation and examination of the patient, and a telephone conversation with the attending physician. The data covered cardiovascular risk factors, the main clinical parameters, the results of biological tests and investigations carried out for risk stratification, plus different elements of therapeutic management. Compared with previous studies of the same type, this enquiry showed a favourable tendency towards the prescription of antithrombotic drugs and betablockers (98.3% and 82.4% of patients, respectively), and to patients with reputedly normal blood pressure values (84.7%). A positive result concerning the reduction in the number of smokers (17.4%) and the increase in lipid lowering prescriptions should be tempered by the fact that advice about stopping smoking was rarely given and that the quantitative target of LDL cholesterol was often ignored. Finally, the prescriptions of ACE inhibitors, physical exercise and cardiac rehabilitation remained well below the recommendations or recent scientific data.
