[Suspicion of Down's syndrome based on patients obstetrical history and clinical data (author's transl)]

At the university women's clinic Zurich between 1963 and 1974, 29 babies in a total of 32255 babies were born with Down's syndrome. 11 of these had a cardiac vitium and 2 an intestinal malformation. 5 babies died during the first year of life. This high morbidity demands an analysis of the criteria in the obstetrical history and clinical picture in order to reach a diagnosis in those cases which would otherwise not be diagnosed if one used the normal criteric for amniocentesis in early pregnancy. Maternal age was the only relevant factor to emerge. In 6 pregnancies a tentative diagnosis for poor intrauterine growth was made in which only one case showed a retarded growth of the bipariental diameter. In all 7 cases in which cephalometry was performed after the 24 week of pregnancy, the concurrent hormonal parameters showed significantly lowered oestriol levels with normal HPL levels. From this information we draw the conclusion that transabdominal amniocentesis should be performed in in pregnancies with permanently low oestriol levels and normal HPL levels; especially in cases which clinically appear "small for dates" and for which there is no other explanation such as anencephaly for the low maternal oestriol levels.