{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T08:06:21Z","timestamp":1763366781168},"reference-count":16,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2006,4,24]],"date-time":"2006-04-24T00:00:00Z","timestamp":1145836800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Prenatal Diagnosis"],"published-print":{"date-parts":[[2006,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To demonstrate the potential value of three\u2010stage sequential screening for Down syndrome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Protocols were considered in which maternal serum pregnancy associated plasma protein\u2010A (PAPP\u2010A) and free \u03b2\u2010human chorionic gonadotropin (hCG) measurements were taken on all women in the first trimester. Those women with very low Down syndrome risks were screened negative at that stage and nuchal translucency (NT) was measured on the remainder and the risk reassessed. Those with very low risk were then screened negative and those with very high risk were offered early diagnostic testing. Those with intermediate risks received second\u2010trimester maternal serum \u03b1\u2010fetoprotein, free \u03b2\u2010hCG, unconjugated estriol and inhibin\u2010A. Risk was then reassessed and those with high risk were offered diagnosis. Detection rates and false\u2010positive rates were estimated by multivariate Gaussian modelling using Monte\u2010Carlo simulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The modelling suggests that, with full adherence to a three\u2010stage policy, overall detection rates of nearly 90% and false\u2010positive rates below 2.0% can be achieved. Approximately two\u2010thirds of pregnancies are screened on the basis of first\u2010trimester biochemistry alone, five out of six women complete their screening in the first trimester, and the first\u2010trimester detection rate is over 60%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Three\u2010stage contingent sequential screening is potentially highly effective for Down syndrome screening. The acceptability of this protocol and its performance in practice, should be tested in prospective studies. Copyright \u00a9 2006 John Wiley &amp; Sons, Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pd.1451","type":"journal-article","created":{"date-parts":[[2006,4,24]],"date-time":"2006-04-24T11:22:20Z","timestamp":1145877740000},"page":"528-534","source":"Crossref","is-referenced-by-count":21,"title":["Three\u2010stage contingent screening for Down syndrome"],"prefix":"10.1002","volume":"26","author":[{"given":"Dave","family":"Wright","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Bradbury","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard","family":"Cuckle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Gardosi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann","family":"Tonks","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sue","family":"Standing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Benn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2006,4,24]]},"reference":[{"key":"e_1_2_1_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.1215"},{"key":"e_1_2_1_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.336"},{"key":"e_1_2_1_4_1","first-page":"387","volume-title":"Early Prenatal Diagnosis, Fetal Cells and DNA in the Mother: Proceedings of the 12th Fetal Cell Workshop","author":"Cuckle H","year":"2002"},{"key":"e_1_2_1_5_1","volume-title":"Genetic Disorders and the Fetus: Diagnosis, Prevention and Treatment","author":"Cuckle H","year":"2004"},{"key":"e_1_2_1_6_1","first-page":"252","article-title":"Down syndrome screening in the first and\/or second trimester: model predicted performance using meta\u2010analysis parameters","volume":"29","author":"Cuckle H","year":"2005","journal-title":"Semin Neonatol"},{"key":"e_1_2_1_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0009-9163.2004.00209.x"},{"key":"e_1_2_1_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.1256"},{"key":"e_1_2_1_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.1275"},{"key":"e_1_2_1_10_1","first-page":"16","volume-title":"Vital Statistics of the United States. 2002. 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