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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Pregnancy Diet Plan

Pregnancy Diet Plan

The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.

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