Additional benefits of first trimester screening.

The goal of first trimester screening for aneuploidy is to provide patients their risk assessment for fetal Down syndrome. Nonetheless, it has been noted that combined screening offers physicians and patients other important pregnancy information. For example, first trimester ultrasound results in accurate pregnancy dating and enables the early diagnosis of multiple gestations during the period when amnionicity and chorionicity is best discerned.

Education and quality review for nuchal translucency ultrasound.

First trimester nuchal translucency ultrasound has evolved from an ultrasound measurement used only in a research setting to a screening tool which is being offered to the general obstetric population. Studies of nuchal translucency suggest great variation in Down syndrome detection rates which may be secondary to significant differences in sonographic training and nuchal translucency image quality. Inaccurate screening has the potential to adversely impact patients.

Down syndrome screening in the first and second trimesters: what do the data show?

Recent advances in Down syndrome screening are providing women with additional options in how they are assessed for this condition. First trimester screening tests are at least as accurate as traditional second trimester testing and provide results earlier in a woman's pregnancy. Combining first and second trimester results increases the sensitivity and specificity of screening and reduce the number of women requiring invasive testing.

Aneuploidy screening: what test should I use?

Screening for the risk of fetal aneuploidy can be effectively performed in either the first or second trimester. When obtained independently, the interpretation of those data is straightforward. However, the effectiveness of screening can be enhanced by combining studies performed in each trimester in a variety of ways.

Early access to prenatal care: implications for racial disparity in perinatal mortality.

Objective: To investigate racial disparities in perinatal mortality in women with early access to prenatal care.

Methods: A prospectively collected database from a large, multicenter investigation of singleton pregnancies, the FASTER trial, was queried. Patients were recruited from an unselected obstetric population between 1999 and 2002.

Postterm pregnancy: practice patterns of contemporary obstetricians and gynecologists.

The purpose of this study was to determine the management of postterm pregnancy by contemporary practicing obstetricians. A questionnaire investigating practice patterns pertaining to postterm pregnancy was mailed to 1000 randomly selected American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in March 2004. The response rate was 52.

Screening for Down syndrome: practice patterns and knowledge of obstetricians and gynecologists.

Objective: To assess obstetricians' practice patterns and knowledge regarding screening for Down syndrome.

Methods: A questionnaire was mailed to 1,105 American College of Obstetricians and Gynecologists Fellows and Junior Fellows in 2004.

Results: Sixty percent of questionnaires were returned.

Stability of first- and second-trimester serum markers after storage and shipment.

Objective: The purpose of this study was to examine the levels of first- and second-trimester maternal serum markers used in Down syndrome screening in relation to the time between sample collection and arrival at the laboratory.

Methods: The FASTER trial, designed to compare first- and second-trimester screening tests for aneuploidy, has recently been completed, having recruited more than 38,000 patients. According to the trial protocol, all blood samples were drawn in serum separator tubes, centrifuged within 30 min and stored at 4 degrees C until shipment by air express.

Prenatal diagnosis and multiple pregnancy.

The incidence of twins, triplets, and high-order multiples has increased dramatically in the last two decades secondary to greater reliance on fertility treatments and to delayed childbearing. Offspring of a multiple gestation are at increased risk for both chromosomal and structural abnormalities. Prenatal diagnosis in these patients is challenging.

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

Background: 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.

Methods: 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).

Assisted reproductive technology and pregnancy outcome.

Objective: To determine whether the use of assisted reproductive technology (ART) is associated with an increase in chromosomal abnormalities, fetal malformations, or adverse pregnancy outcomes.

Methods: A prospective database from a large multicenter investigation of singleton pregnancies, the First And Second Trimester Evaluation of Risk trial, was examined. Subjects were divided into 3 groups: no ART use, use of ovulation induction (with or without intrauterine insemination), and use of in vitro fertilization (IVF).

First trimester uterine artery Doppler abnormalities predict subsequent intrauterine growth restriction.

Objective: This study was undertaken to evaluate the association between uterine artery Doppler velocimetry performed between 10 and 14 weeks gestation and intrauterine growth restriction (IUGR).

Study Design: Uterine artery Doppler velocimetry data were collected on 1067 women enrolled in the FASTER trial at the University of Colorado site. The data were analyzed by using univariate and multivariable logistic regression analysis.

First-trimester septated cystic hygroma: prevalence, natural history, and pediatric outcome.

Objective: To estimate prevalence, natural history, and outcome of septated cystic hygroma in the first trimester in the general obstetric population, and to differentiate this finding from simple increased nuchal translucency.

Methods: Patients at 10.3-13.

Quad screen as a predictor of adverse pregnancy outcome.

Objective: To estimate the effect of second-trimester levels of maternal serum alpha-fetoprotein (AFP), human chorionic gonadotrophin (hCG), unconjugated estriol (uE3), and inhibin A (the quad screen) on obstetric complications by using a large, prospectively collected database (the FASTER database).

Methods: The FASTER trial was a multicenter study that evaluated first- and second-trimester screening programs for aneuploidy in women with singleton pregnancies. As part of this trial, patients had a quad screen drawn at 15-18 6/7 weeks.

Uncomplicated monochorionic diamniotic twins and the timing of delivery.

Cleary-Goldman and d'Alton discuss the implications of a new study in PLoS Medicine examining the risk of fetal death in uncomplicated monochorionic diamnotic twin pregnancies.

First-trimester nasal bone evaluation for aneuploidy in the general population.

Objective: To evaluate the role of fetal nasal bone imaging at 10 3/7 to 13 6/7 weeks as a screening tool for aneuploidy, in a prospective multicenter trial.

Methods: Unselected patients from the general population with viable singleton pregnancies at 10 3/7 to 13 6/7 weeks were recruited at 15 U.S.

First-trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications: a population-based screening study (the FASTER Trial).

Objective: The purpose of this study was to determine whether maternal serum levels of pregnancy-associated plasma protein A, free-beta subunit human chorionic gonadotropin, or nuchal translucency size are associated with obstetric complications.

Study Design: Data were obtained from the First and Second Trimester Evaluation of Risk trial. Pregnancy-associated plasma protein A and free-beta subunit human chorionic gonadotropin levels were analyzed, and nuchal translucency was measured between 10 weeks 3 days and 13 weeks 6 days of gestation in 34,271 pregnancies.

Multiple pregnancy: knowledge and practice patterns of obstetricians and gynecologists.

Objective: We sought to assess knowledge and practices of obstetricians regarding multiple gestation.

Methods: A questionnaire investigating knowledge and practice patterns pertaining to multiple gestation was mailed to randomly selected American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in January 2003. Fifty-one percent (589/1,146) of the surveys were returned.

Obesity, obstetric complications and cesarean delivery rate--a population-based screening study.

Objective: This study was undertaken to determine whether obesity is associated with obstetric complications and cesarean delivery.

Methods: A large prospective multicenter database was studied. Subjects were divided into 3 groups: body mass index (BMI) less than 30 (control), 30 to 34.

Threatened abortion: A risk factor for poor pregnancy outcome, a population-based screening study.

Objective: The purpose of this study was to determine whether patients with first-trimester threatened abortion are at increased risk for poor pregnancy outcome.

Study Design: A large prospective multicenter database was studied. Subjects were divided into three groups: (1) no bleeding, (2) light bleeding, and (3) heavy bleeding.

Radiofrequency ablation in a monochorionic twin discordant for fetal anomalies.

Radiofrequency ablation is a minimally invasive technique that has been used in selective reduction of acardiac twins. We report a case in which radiofrequency ablation was used to selectively reduce a monochorionic twin discordant for an abnormality.

Multicystic encephalomalacia after first-trimester intrauterine fetal death in monochorionic twins.

Multicystic encephalomalacia occurs in approximately 20% of surviving cotwins after second- and third-trimester intrauterine fetal death of one twin in monochorionic pregnancies. We report a case of multicystic encephalomalacia after the demise of a cotwin in the first trimester diagnosed by magnetic resonance imaging and confirmed pathologically.

Pitfalls in management of shoulder dystocia with occiput-posterior position.

Background: The protocol for shoulder dystocia assumes an anterior shoulder entrapped above the pubic symphysis. If the shoulders lie in a different position, a different strategy is required. Such a situation can occur in shoulder dystocia with an occipito-posterior position.

First-trimester sonographic screening for Down syndrome.

Screening for Down syndrome is an important part of routine antenatal care. The most common screening method in the United States involves the assessment of a combination of factors: maternal age, multiple second-trimester serum markers, and second-trimester ultrasonography (as a so-called "genetic sonogram"). More recently, however, there has been significant interest in first-trimester methods of screening, including screening for first-trimester serum markers and the sonographic measurement of fetal nuchal translucency.

Prospective risk of fetal death in singleton, twin, and triplet gestations: implications for practice.

Objective: To evaluate the prospective risk of fetal death in singleton, twin, and triplet pregnancies and to compare this risk with fetal and neonatal death rates.

Methods: We analyzed 11,061,599 singleton, 297,622 twin, and 15,375 triplet gestations drawn from the 1995-1998 National Center for Health Statistics linked birth and death files. Prospective risk of fetal death was expressed as a proportion of all fetuses still at risk at a given gestational age and compared with fetal death rate.