Üçlü test ile Down sendromu taraması yapılan gebelerde yanlış pozitiflik ve obstetrik komplikasyon ilişkisi

Bu çalışmada, gebeliğin ikinci trimesterinde üçlü tarama testinde [alfa fetoprotein (AFP), human korionik gonodotropin (hCG), ankonjuge estriol (uE3)] Down sendromu riski 1/270 eşik değerinin üzerinde olan ve amniosentez sonrası normal karyotip saptanan olgularda obstetrik komplikasyonların değerlendirilmesi amaçlanmıştır. Üçlü tarama testinde Down sendromu riski 1/270 üzerinde olan ve normal fetal karyotip saptanan 47 gebe, Down sendromu riski 1/270'den az olan 80 gebe ile obstetrik komplikasyonlar açısından karşılaştırıldı. Aynı zamanda AFP, hCG, uE3 seviyeleri ile komplikasyonlar arasındaki ilişki değerlendirildi. Down sendromu için üçlü tarama testi yanlış pozitif bulunan olgularda kontrol gurubuna oranla erken doğum (%21.3 - %8.7, sırasıyla, p

Anahtar Kelimeler:

Down sendromu, Gebelik trimester, ikinci, Amniyosentez, Gebelik komplikasyonları, Karyotipleme, alfa-Fetoproteinler, Yanlış pozitif reaksiyonlar, Preeklampsi, Nöral tüp defektleri, Fetal gelişim geriliği

The relation of false positivity and obstetric complications in pregnant patients screened for Down syndrome risk by triple test

Evaluation of obstetric complications of pregnant patients in second trimester, whose Down syndrome risk is higher than 1/270 cut off value in the triple test [alpha fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3)] and whose karyotype is found to be normal by amniocentesis. 47 pregnant woman with normal karyotype and Down syndrome risk higher than 1/270 in the triple test were compared with 80 pregnant woman with low Down Syndrome risk, in terms of obstetric complications. The relation of AFP, hCG and u E3 levels with obstetric complications were also evaluated. Higher risk for premature labor (%21.3 - %8.7, respectively, p<0.05), preeclampsia (%6.3 - %0, respectively, p<0.01), low fetal birth weigh (%4.3 - %1.3, respectively, p>0.05), intrauterine growth retardation (%4.3 - %0, respectively, p<0.01) and perinatal fetal death (%4.3-%1.3, respectively, p>0.05) was detected in patients with false positive Down syndrome risk in the triple test when compared with the control group. 40.42% (19/47) of the pregnancies in the study group was complicated while complicated pregnancies were detected in 8.7% (7/80) of the control group. hCG of 2.5 MoM (multiples of the median) or higher was significantly associated with complicated pregnancies. Obstetric complication risk is increased in pregnant patients with false positive Down Syndrome risk detected in the triple test. Detection of hCG levels was found to be more effective in predicting obstetric complications than AFP and uE3.

Keywords:

Down Syndrome, Pregnancy Trimester, Second, Amniocentesis, Pregnancy Complications, Karyotyping, alpha-Fetoproteins, False Positive Reactions, Pre-Eclampsia, Neural Tube Defects, Fetal Growth Retardation,

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1. Crandall BF, Robınson , Grau P. Risks associated with an elevated maternal serum alpha-fetoprotein .Am J Obstet Gynecol 1991;165:581-6.
2. Burton BK. Outcome of pregnancy in patient with unexplained elevated or low levels of maternal serum alpha -fetoprotein. Obstet Gynecol 1988:72:709-13.
3. Milunsky A, Jick SS, Brull C. Predictive values, relative risks, and overall benefits of high and low maternal serum alpha-fetoprotein screening in singleton pregnancies: New epidemiologıc data. Am J Obstet Gynecol 1989:161:291-7.
4. Robinson L, Crau P, Crandell BF. Pregnancy outcome after increasing maternal serum alpha-fetoprotein levels. Obstet Gynecol 1989:74:17-20.
5. Pergament E, Stein AK, Fiddler M, Kupferminc MJ. Adverse pregnancy outcome after a false positive screen for Down Syndrome using multiple markers. Obstet Gynecol 1995:86:255-258.
6. Dungan JS, Shulman LP, Philips OP, et al. Positive serum screening for fetal Dovvn syndrome does not predict adverse pregnancy outcome in absence of fetal aneuploidy J Soc Gynecol Invest 1994;1:55-8.
7. Hsieh TT, Hung TH, Hsu JJ, et al. Prediction of adverse perinatal outcome by maternal serum screening for Dovvn syndrome in an Asian population. Obstet Gynecol 1997:89:937-40.
8. Lieppman RE, Wİlliams MA, Cheng EY, et al. An association betvveen elevated levels of human chorionic gonadotropin in the midtrimester and adverse pregnancy outcome. Am J Obstet Gynecol 1993:168:1852-7.
9. Beckhuis JR, Van Lith JMM, De Wolf BTHM, Mantingh A. increased maternal serum alpha-fetoprotein and human chorionic gonadotropin in compromised pregnancies otherthan for neural tube defects or Dovvn syndrome. Prenat Diagn 1992;2:643-8.
10. Chappman Pregnancy outcomes follovving false-positive multiple marker screening tests. Am J Perinatol. 1997; 14:475-8.