{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T01:36:51Z","timestamp":1698629811410},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2010,1,5]],"date-time":"2010-01-05T00:00:00Z","timestamp":1262649600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2010,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the relative performance of a multi\u2010stage first\u2010trimester screening protocol for fetal Down syndrome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from 10 767 women who underwent combined ultrasound and biochemistry (BC) screening in the first trimester were reanalyzed using a contingent model approach. Amongst the 10 854 fetuses with known outcome, 32 had Down syndrome, 232 had other abnormalities and 10 590 were unaffected. Nuchal transluceny (NT), BC and combined (NT\u2010BC) gestational age\u2010specific risks were calculated for each individual using The Fetal Medicine Foundation risk calculation algorithms (Mixture Model and Biochemistry). Individual patients were categorized as at low, high or intermediate risk according to one of the following three strategies. In \u2018Strategy\u2010NT\u2010BC\u2019 initial screening was performed using both NT and BC. In \u2018Strategy\u2010BC\u2019 initial screening was undertaken using maternal serum markers followed by NT assessment in those with an intermediate risk (1 : 51 &lt; risk <jats:styled-content>$\\leq 1:1000$<jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"graphic\/tex2gif-ueqn-1.gif\" xlink:title=\"equation image\" \/><\/jats:styled-content>) while in \u2018Strategy\u2010NT\u2019 initial screening was undertaken using NT followed by serum marker assessment in those with an intermediate risk (1 : 51 &lt; risk <jats:styled-content>$\\leq 1:1000$<jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"graphic\/tex2gif-ueqn-2.gif\" xlink:title=\"equation image\" \/><\/jats:styled-content>). The nasal bone was assessed in those with an intermediate risk as the final stage in each of the three strategies. Those with an adjusted risk of 1 in 100 or higher after nasal bone assessment were reclassified as high risk. Detection and false\u2010positive rates were compared between differing strategies in our local population, and this analysis was also performed with the maternal age for our population standardized to the distribution found in England and Wales.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In our local population the detection rate for a 5% false\u2010positive rate using a combined screening policy (NT\u2010BC) was 88% (95% CI, 75.3\u201398.9%), and 2.3% had an absent nasal bone. The respective detection rate and false\u2010positive rate of the three multi\u2010stage screening strategies were: Strategy\u2010NT\u2010BC: 87.5 and 2.5%; Strategy\u2010BC: 87.5 and 5%; Strategy\u2010NT: 84.4 and 2.9%. In the contingent Strategy\u2010BC only 29% of those initially screened using serum markers required an NT scan. If the model were applied to a hypothetical obstetric population standardized to the maternal age distribution in England and Wales, the detection and false\u2010positive rates of the same three screening strategies would be: Strategy\u2010NT\u2010BC: 86.2 and 1.9%; Strategy\u2010BC: 82.8 and 4%; Strategy\u2010NT: 75.8 and 2.3%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>First\u2010trimester contingent screening provides detection and false\u2010positive rates comparable to those achieved using combined screening, but could be used to significantly reduce the number of scans performed. Copyright \u00a9 2010 ISUOG. Published by John Wiley &amp; Sons, Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.7549","type":"journal-article","created":{"date-parts":[[2010,1,5]],"date-time":"2010-01-05T09:56:57Z","timestamp":1262685417000},"page":"286-291","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Comparison of first\u2010trimester contingent screening strategies for Down syndrome"],"prefix":"10.1002","volume":"35","author":[{"given":"D. S.","family":"Sahota","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T. Y.","family":"Leung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. W.","family":"Chan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. W.","family":"Law","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T. 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