[Analysis of cell-free DNA in maternal blood for detection of fetal trisomy 21 in high-risk population: Couples acceptance and grounds for refusal]. / Étude de l'ADN fœtal dans le sang maternel pour la détection de la trisomie 21 en population à risque accru : adhésion des couples et motifs de refus.

OBJECTIVES: To assess the determinants associated with the use of analysis of cell-free DNA in maternal blood for detection of trisomy 21 in high-risk women. MATERIALS AND METHODS: Prospective study conducted in a single center between July 15, 2014 and December 15, 2014 on 99 consecutive women with increased risk of trisomy 21 above 1/250. RESULTS: Analysis of cell-free DNA in maternal blood for detection of fetal trisomy 21 was proposed to 95 women out of 99, among them, 43 women (45.3%) required the test. Among these 43 women, 17 (38.6%) had a higher socio-economic status versus 10 (19.2%) among the women who did not request the test (P=0.03). The most common reason given by the 52 women who did not request the analysis of cell-free DNA was the cost, for 30 of them (57.7%), then because the test was not providing certainty for the diagnostic of trisomy 21 for 23 women (44.2%). CONCLUSION: Analysis of cell-free DNA on maternal blood for detection of trisomy 21 does not seem accepted by the majority of women. The cost is probably the main reason for not using this test, but it seems that the lack of diagnostic certainty is also an obstacle for some women.

[Comparison of two bedside tests performed on cervicovaginal fluid to diagnose premature rupture of membranes]. / Analyse comparative de deux tests diagnostiques de rupture prématurée des membranes dans les sécrétions cervico-vaginales.

OBJECTIVE: To compare the performance of two rapid tests for the diagnosis of premature rupture of membranes (PROM) based on the detection of the insulin-like growth factor-binding protein-1 (IGFBP-1) and placental α-microglobulin-1 (PAMG-1) in cervicovaginal secretions. METHODS: A case-control prospective study. Pregnant women between 24 and 41(6/7) weeks' of gestation, consulting for profuse amniotic fluid loss (group 1) or for other reasons without any rupture of membrane (group 2) were included in the study. Successively, AmniSure(®) test (PAMG-1) without speculum, and then Actim™Prom test (IGFBP-1) during speculum examination were performed during the same visit. RESULTS: Eighty subjects (40 in each group) were included between 25(1/7) to 41(1/7) weeks of gestation. AmniSure(®) diagnostic test demonstrated a sensitivity and specificity of 95 % (82.4-99.4) and 94.8 % (79.3-98) respectively and a positive and negative predictive value of 95 % (84.7-100) and 94.8 % (87.9-100) respectively. Actim™Prom diagnostic test demonstrated a sensitivity and specificity of 97.5 % (85.7-100) and 97.4 % (82.4-99.4) respectively and a positive and negative predictive value of 97.5 % (88.5-100) and 97.4 % (92.5-100) respectively. CONCLUSION: Both tests have similar performance to diagnose premature rupture of membranes.