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Choice of second-trimester genetic sonogram for detection of trisomy 21
A M Vintzileos1, E R Guzman, J C Smulian
1Department of Obstetrics, Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School/St. Peter's Medical Center, New Brunswick, USA. vintziam@umdnj.edu
Objective:
To determine the utilization rate of second-trimester genetic sonogram and its role in influencing the decision for amniocentesis in women at increased risk for fetal trisomy 21.
Methods:
From November 1, 1993, to December 31, 1996, a second-trimester genetic sonogram or only genetic amniocentesis (as a first choice) were offered to pregnant women referred to our institution who were at increased risk for fetal trisomy 21.
Results:
During the study period, 2089 women were referred to our unit for genetic prenatal diagnosis; of these, 1426 (68%) chose only genetic amniocentesis, and 663 (32%) chose a genetic sonogram as their first option. The yearly utilization rates of genetic sonogram were two of 477 or 0.4% for 1993, 82 of 495 or 16.6% for 1994, 251 of 523 or 48.0% for 1995, and 328 of 594 or 55.2% for 1996. Adjusting for potential confounders, multivariable logistic regression analysis showed that the most important factors associated with the women's decision to undergo genetic amniocentesis were three or more ultrasound markers present (relative risk [RR] 189.5, 95% confidence interval [CI] 37.1, 980.0), two ultrasound markers present (RR 47.2, 95% CI 9.8, 267.8), one ultrasound marker present (RR 12.7, 95% CI 5.5, 29.7), and abnormal serum biochemistry (RR 3.0, 95% CI 1.0, 8.9).
Conclusion:
The increasing utilization trend, in conjunction with the fact that an abnormal sonogram was the most influential factor in women's decision to undergo genetic amniocentesis, suggests that genetic sonogram services for detection of trisomy 21 should be added to the armamentarium of all prenatal diagnostic centers.