Ductus venosus pulsatility index as an antenatal screening marker for Down’s syndrome: use with the Combined and Integrated tests

J Med Screen 2009;16:112-118
doi:10.1258/jms.2009.009043
© 2009 Medical Screening Society

 

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Original Articles


A Borrell, Obstetrician 
,


Prenatal Diagnosis Unit, Institute of Gynecology, Obstetrics and Neonataology, Hospital Clinic Barcelona – Maternitat Campus, University of Barcelona Medical School, Sabino Arana 1, 08036 Barcelona, Spain


V Borobio, Obstetrician
,


Prenatal Diagnosis Unit, Institute of Gynecology, Obstetrics and Neonataology, Hospital Clinic Barcelona – Maternitat Campus, University of Barcelona Medical School, Sabino Arana 1, 08036 Barcelona, Spain


J P Bestwick, Statistician
,


Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK


N J Wald, Professor
,


Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK

Correspondence to: A Borrell, Prenatal Diagnosis Unit, Institute of Gynecology, Obstetrics and Neonataology, Hospital Clinic Barcelona – Maternitat Campus, University of Barcelona Medical School, Sabino Arana 1, 08036 Barcelona, Spain; ABORRELL{at}clinic.ub.es


Objectives To assess the value of ductus venosus blood flow (expressedas pulsatility index, DVPI) in antenatal Down’s syndrome screeningwhen used with the Combined and Integrated tests.

Methods DVPI measurements between 10 and 13 weeks’ gestation in 66 Down’ssyndrome and 7184 unaffected pregnancies were collected fromwomen attending the Hospital Clinic, Barcelona, for antenatalcare from 1999 to 2007 and combined with the Serum Urine andUltrasound Screening Study (SURUSS) data to model screeningperformance, safety and cost-effectiveness of the screeningtests with and without DVPI.

Results The median DVPI multiple of the normal median in Down’s syndromepregnancies was 1.55 (95% CI 1.36–1.73). As a single screeningmarker without using maternal age, DVPI has a 62% detectionrate for a 5% false-positive rate. At a 90% detection rate (firsttrimester measurements at 11 weeks’ gestation) the additionof DVPI reduced the false-positive rate of the Combined testfrom 8.5% to 4.6% and the Integrated test from 2.0% to 1.1%,with a corresponding reduction in fetal losses from diagnosticprocedures. There was no material loss of cost-effectiveness.

Conclusion Addition of DVPI measurements to the Combined and Integratedtests substantially improves the efficacy and safety of antenatalDown’s syndrome screening.


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