[Alternatives to amniocentesis for maternal age]

Screening strategies of Down's syndrome should be re-evaluated. Amniocentesis for advanced maternal age has been proposed in the 70's because no other screening test was available. Maternal serum screening and first trimester nuchal translucency are now well validated, including in women over 38. The sequential and independent use of different screening tests leads to a dramatic increase of the false positive rate and thus of iatrogenic fetal losses. Maternal age remains the major risk factor for chromosomal anomalies, but it should be included in risk calculation strategies (ideally combining serum screening and nuchal translucency), and not taken as an isolated information. These screening strategies require strict quality control and audit, which is currently better achieved with serum screening than ultrasound screening. A complete information about Down's syndrome screening strategies should be given to women, regardless of their age, and their personal choice should be respected. For women of advanced maternal age, a policy of selective rather than routine amniocentesis is likely to reduce the risk of iatrogenic fetal loss and yet to allow for a reasonable sensitivity.