72 research outputs found
Psychological outcomes, knowledge and preferences of pregnant women on first-trimester screening for fetal structural abnormalities:A prospective cohort study
INTRODUCTION: The primary aim of this study is to investigate the impact of a 13-week anomaly scan on the experienced levels of maternal anxiety and well-being. Secondly, to explore women's knowledge on the possibilities and limitations of the scan and the preferred timing of screening for structural abnormalities. MATERIAL AND METHODS: In a prospective-cohort study conducted between 2013-2015, pregnant women in the North-Netherlands underwent a 13-week anomaly scan. Four online-questionnaires (Q1, Q2, Q3 and Q4) were completed before and after the 13- and the 20-week anomaly scans. In total, 1512 women consented to participate in the study and 1118 (74%) completed the questionnaires at Q1, 941 (64%) at Q2, 807 (55%) at Q3 and 535 (37%) at Q4. Psychological outcomes were measured by the state-trait inventory-scale (STAI), the patient's positive-negative affect (PANAS) and ad-hoc designed questionnaires. RESULTS: Nine-nine percent of women wished to be informed as early as possible in pregnancy about the absence/presence of structural abnormalities. In 87% of women levels of knowledge on the goals and limitations of the 13-week anomaly scan were moderate-to-high. In women with a normal 13-week scan result, anxiety levels decreased (P < .001) and well-being increased over time (P < .001). In women with false-positive results (n = 26), anxiety levels initially increased (STAI-Q1: 39.8 vs. STAI-Q2: 48.6, P = 0.025), but later decreased around the 20-week anomaly scan (STAI-Q3: 36.4 vs. STAI-Q4: 34.2, P = 0.36). CONCLUSIONS: The 13-week scan did not negatively impact the psychological well-being of pregnant women. The small number of women with screen-positive results temporarily experienced higher anxiety after the scan but, in false-positive cases, anxiety levels normalized again when the abnormality was not confirmed at follow-up scans. Finally, most pregnant women have moderate-to-high levels of knowledge and strongly prefer early screening for fetal structural abnormalities
ISUOG Practice Guidelines (updated):performance of the routine mid-trimester fetal ultrasound scan
Obtenção de uma estirpe mutante ntrC- de Rhizobium sp. NGR234
Research into fetal development and medicin
Abstracts of the 26th World Congress on Ultrasound in Obstetrics and Gynecology, Rome, Italy, 24-28 September 2016
Multiplex ligation-dependent probe amplification versus karyotyping in prenatal diagnosis: the M.A.K.E. study
Abstract
BACKGROUND:
In the past 30 years karyotyping was the gold standard for prenatal diagnosis of chromosomal aberrations in the fetus. Traditional karyotyping (TKT) has a high accuracy and reliability. However, it is labor intensive, the results take 14-21 days, the costs are high and unwanted findings such as abnormalities with unknown clinical relevance are not uncommon. These disadvantages challenged the practice of karyotyping. Multiplex ligation-dependent probe amplification (MLPA) is a new molecular genetic technique in prenatal diagnosis. Previous preclinical evidence suggests equivalence of MLPA and traditional karyotyping (TKT) regarding test performance.
METHODS/DESIGN:
The proposed study is a multicentre diagnostic substitute study among pregnant women, who choose to have amniocentesis for the indication advanced maternal age and/or increased risk following prenatal screening test. In all subjects, both MLPA and karyotyping will be performed on the amniotic fluid sample. The primary outcome is diagnostic accuracy. Secondary outcomes will be maternal quality of life, women's preferences and costs. Analysis will be intention to treat and per protocol analysis. Quality of life analysis will be carried out within the study population. The study aims to include 4500 women.
DISCUSSION:
The study results are expected to help decide whether MLPA can replace traditional karyotyping for 'low-risk' pregnancies in terms of diagnostic accuracy, quality of life and women's preferences. This will be the first clinical study to report on all relevant aspects of the potential replacement
Fetal megacystis: a lot more than LUTO
ABSTRACT
Objective Fetal megacystis presents a challenge in terms
of counseling and management because of its varied
etiology and evolution. The aim of this study was to
present a comprehensive overview of the underlying
etiologies and structural anomalies associated with fetal
megacystis.
Methods This was a retrospective multicenter study of
cases referred to the fetal medicine unit of one of the eight
academic hospitals in The Netherlands with a diagnosis of
fetal megacystis. For each case, data on and measurements
of fetal urinary tract and associated structural anomalies
were collected. All available postmortem examinations
and postnatal investigations were reviewed in order to
establish the final diagnosis. In the first trimester, fetal
megacystis was defined as longitudinal bladder diameter
(LBD) ≥ 7 mm, and in the second and third trimesters as
an enlarged bladder failing to empty during an extended
ultrasound examination lasting at least 40 min.
Results Of the 541 pregnancies with fetal megacystis,
it was isolated (or solely accompanied by other signs
of lower urinary tract obstruction (LUTO)) in 360
(67%) cases and associated with other abnormal
ultrasound findings in 181 (33%) cases. The most
common associated ultrasound anomaly was an increased
nuchal translucency thickness (22%), followed by single
umbilical artery (10%) and cardiac defect (10%). A
final diagnosis was established in 418 cases, including
222 (53%) cases with isolated LUTO and 60 (14%)
infants with normal micturition or minor isolated
urological anomalies. In the remaining 136 (33%) cases,
concomitant developmental or chromosomal abnormality
or genetic syndrome was diagnosed. Overall, 40
chromosomal abnormalities were diagnosed, including
trisomy 18 (n = 24), trisomy 21 (n = 5), Turner syndrome
(n = 5), trisomy 13 (n = 3) and 22q11 deletion (n = 3).
Thirty-two cases presented with anorectal malformations
involving the anus, rectum and urogenital tract. In cases
with confirmed urethral and anal atresia, megacystis
occurred early in pregnancy and the bladder appeared
severely distended (the LBD (in mm) was equal to or
greater than twice the gestational age (in weeks)). Fetal
macrosomia was detected in six cases and an overgrowth
syndrome was detected in four cases, comprising two
infants with Beckwith–Wiedemann syndrome and two
with Sotos syndrome. Megacystis-microcolon-intestinal
hypoperistalsis syndrome was diagnosed in five (1%) cases
and prenatally suspected only in one case.
Conclusions Although the main cause of fetal megacystis
is LUTO, an enlarged fetal bladder can also be present
as a concomitant finding of miscellaneous genetic syndromes, developmental disturbances and chromosomal
abnormalities. We provide an overview of the structural anomalies and congenital disorders associated with fetal
megacystis and propose a practical guide for the differential diagnosis of genetic syndromes and chromosomal
and developmental abnormalities in pregnancies presenting with fetal megacystis, focusing on the morphological
examination of the fetus
Trial by Dutch Laboratories for Evaluation of Non-Invasive Prenatal Testing.:Part II - Women's Perspectives
Contains fulltext :
171863.pdf (publisher's version ) (Open Access)OBJECTIVE: To evaluate preferences and decision-making among high-risk pregnant women offered a choice between Non-Invasive Prenatal Testing (NIPT), invasive testing or no further testing. METHODS: Nationwide implementation study (TRIDENT) offering NIPT as contingent screening test for women at increased risk for fetal aneuploidy based on first-trimester combined testing (>1:200) or medical history. A questionnaire was completed after counseling assessing knowledge, attitudes and participation following the Multidimensional Measure of Informed Choice. RESULTS: A total of 1091/1253 (87%) women completed the questionnaire. Of these, 1053 (96.5%) underwent NIPT, 37 (3.4%) invasive testing and 1 (0.1%) declined testing. 91.7% preferred NIPT because of test safety. Overall, 77.9% made an informed choice, 89.8% had sufficient knowledge and 90.5% had positive attitudes towards NIPT. Women with intermediate (odds ratio (OR) = 3.51[1.70-7.22], p < 0.001) or high educational level (OR = 4.36[2.22-8.54], p < 0.001) and women with adequate health literacy (OR = 2.60[1.36-4.95], p = 0.004) were more likely to make an informed choice. Informed choice was associated with less decisional conflict and less anxiety (p < 0.001). Intention to terminate the pregnancy for Down syndrome was higher among women undergoing invasive testing (86.5%) compared to those undergoing NIPT (58.4%) (p < 0.001). CONCLUSIONS: The majority of women had sufficient knowledge and made an informed choice. Continuous attention for counseling is required, especially for low-educated and less health-literate women. (c) 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd
Women’s Experience with Non-Invasive Prenatal Testing and Emotional Well-being and Satisfaction after Test-Results
Trial by Dutch laboratories for evaluation of non-invasive prenatal testing.:Part I-clinical impact
textabstractObjective: To evaluate the clinical impact of nationwide implementation of genome-wide non-invasive prenatal testing (NIPT) in pregnancies at increased risk for fetal trisomies 21, 18 and 13 (TRIDENT study). Method: Women with elevated risk based on first trimester combined testing (FCT ≥ 1:200) or medical history, not advanced maternal age alone, were offered NIPT as contingent screening test, performed by Dutch University Medical laboratories. We analyzed uptake, test performance, redraw/failure rate, turn-around time and pregnancy outcome. Results: Between 1 April and 1 September 2014, 1413/23 232 (6%) women received a high-risk FCT result. Of these, 1211 (85.7%) chose NIPT. One hundred seventy-nine women had NIPT based on medical history. In total, 1386/1390 (99.7%) women received a result, 6 (0.4%) after redraw. Mean turn-around time was 14 days. Follow-up was available in 1376 (99.0%) pregnancies. NIPT correctly predicted 37/38 (97.4%) trisomies 21, 18 or 13 (29/30, 4/4 and 4/4 respectively); 5/1376 (0.4%) cases proved to be false positives: trisomies 21 (n = 2), 18 (n = 1) and 13 (n = 2). Estimated reduction in invasive testing was 62%. Conclusion: Introduction of NIPT in the Dutch National healthcare-funded Prenatal Screening Program resulted in high uptake and a vast reduction of invasive testing. Our study supports offering NIPT to pregnant women at increased risk for fetal trisomy. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd
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