6-year experience of prenatal diagnosis in an unselected population in Oxford, UK.
Background: The benefits and harm associated with prenatal diagnosis are open to debate. We give a 6-year overview of the experience of one prenatal-diagnosis unit using a defined, unselected population.Methods: All congenital malformations suspected prenatally and all congenital malformations, incl...
| Published in: | Lancet Vol. 352; no. 9140; pp. 1577 - 1582 |
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| Main Authors: | , , , , , |
| Format: | research tables/charts Journal Article |
| Published: |
Lancet
11/14/1998
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107159044&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 107159044 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01406736 LAN jtl: Lancet issn: 01406736 maglogo: N pubinfo: dt: 11/14/1998 vid: 352 iid: 9140 pid: 1297 pub: Lancet place: Philadelphia, Pennsylvania artinfo: ui: 107159044 107159044 NLM9843102 1999003950 10.1016/s0140-6736(98)03202-4 NLM9843102 107159044 ppf: 1577 ppct: 5 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: 6-year experience of prenatal diagnosis in an unselected population in Oxford, UK. aug: au: Boyd PA Chamberlain P Hicks NR Boyd, P A Chamberlain, P Hicks, N R affil: Prenatal Diagnosis Unit, Women's Centre, Oxford Radcliffe NHS Trust, UK sug: subj: Abnormalities Diagnosis Ultrasonography, Prenatal United Kingdom Predictive Value of Tests False Positive Results Prenatal Diagnosis Data Collection Prospective Studies Funding Source Abortion, Induced Infant, Newborn Pregnancy Female Fetus Human Infant, Newborn: birth-1 month Fetus, conception to birth Female ab: Background: The benefits and harm associated with prenatal diagnosis are open to debate. We give a 6-year overview of the experience of one prenatal-diagnosis unit using a defined, unselected population.Methods: All congenital malformations suspected prenatally and all congenital malformations, including chromosome anomalies, confirmed at birth were identified from the local Congenital Malformation Register. All fetuses or infants of women booked for delivery at the Oxford Women's Centre who had an OX postcode and date of delivery between 1991 and 1996 were eligible for the study.Findings: 725 (2%) of 33,376 babies, were judged abnormal at delivery. 396 (55%) malformed fetuses and infants had been correctly identified prenatally. 174 fetuses had a suspected abnormality identified on scan and subsequently proved to be normal. 160 (92%) of these false-positive results were attributable to the reporting of so called ultrasound soft markers. Accuracy of ultrasound diagnosis was good for structural malformations. Ultrasound soft markers were responsible for a 4% increase in detection of malformations (from 51% to 55%) and a 12-fold increase in false-positive rate (one in 2332 to one in 188). 171 pregnancies (43% of prenatally diagnosed malformed babies) were terminated because of suspected abnormality. Suspicion of abnormality in these cases was first aroused after ultrasound scan in 136 (79%); chromosome analysis because of advanced maternal age, family history, or higher risk in biochemical screening test in 25 (15%); and molecular analysis of single gene defect because of family history in ten (6%). There was a 20% reduction in prevalence of conditions compatible with survival beyond the neonatal period because of termination of such pregnancies.Interpretation: More than half of all malformed fetuses can be identified prenatally in routine practice, mostly following initial suspicion from ultrasound examination. Ultrasound soft markers lead to a small increase in detection of malformations but a large increase in false positives. Further research on the impact, including psychological, and value of markers is required to determine whether the benefits of reporting them exceeds the harm. Because methods and techniques continually change, ongoing surveillance of prenatal diagnostic services is vital. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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