Integrated test

This is the integration of different screening markers measured at different stages of pregnancy into a single test result. Unless otherwise qualified, 'Integrated test' refers to the integration of NT measurement and PAPP-A in the first trimester with serum a-fetoprotein, f-hCG and uE3 in the second.

The NICE Guideline - Antenatal Care, Routine Care for the Healthy Pregnant Woman [1] stated that by April 2007, pregnant women should be offered screening for Down's Syndrome with a test which provides a detection rate of >75% and a false-positive rate of <3%. These performance measures should be age-standardized and based on cutoff of 1 in 250 at term. These guidelines were based on the SURUSS report [2], which was a multicentre study of nearly 50,000 singleton pregnancies in women where the most effective, safe and cost-effective method of screening for Down's syndrome using NT, maternal serum and urine markers in the first and second trimester of pregnancy and maternal age in various combinations were analysed. The authors concluded that the Integrated test was the best performing with the highest detection and lowest false-positive rates at any given risk cut-off (Table 17.1). Subsequently the National Screening Committee Model of Best Practice in the UK also concluded that the Integrated test resulted in the lowest loss rate of unaffected fetuses (Table 17.2).

Table 17.1 Data from the SURUSS [2] study of screening performance with a constant early second trimester risk cut-off of 1:250

Screening test

Detection rate (%)

False-positive rate (%)

Triple test

81

6.9

Quadruple test

84

5.7

Combined test

83

5

Integrated test

90

2.8

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Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.

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