Role of fetal echocardiography in stepwise sequential screening for chromosomal disorders (combined test associated with modified genetic sonography)

Abstract

Objectives: To evaluate the contribution made by fetal echocardiography in identifying Down’s syndrome (DS) and other chromosomal disorders in a stepwise sequential screening method (first step: combined test (CT), second step: modified genetic sonography (MGS) (major malformation and nuchal fold)), for DS in the general population of pregnant women. Methods: Prospective study. During a 5-year study period (July 2005–June 2010) 17,911 pregnant women underwent CTs with MGS (with fetal cardiac morphological evaluation performed by obstetricians in a tertiary hospital) as a screening method for DS. We evaluated the sensitivity and false positive rate (FPR) (95% confidence interval (CI)) of three screening methods for DS and all chromosomal disorders: CT, CT + MGS, and CT + fetal echocardiography. Results: A total of 17,911 cases were analyzed with 67 chromosome disorders and 45 DS cases being found. For DS, the CT sensitivity was 80% (95% CI; 68.3–91.7) (36/45) and 79.1% (95% CI; 69.4–88.8) (53/67) for all chromosome disorders, with a FPR of 4.2% (95% CI; 3.9–4.5) (752/17,866) and 4.1% (95% CI; 3.8–4.4) (735/17,844), respectively. For CT + MSG and CT + fetal echocardiography, the sensitivity for DS was 93.3% (95% CI; 85.9–0.99) (42/45) and 95.5% (95% CI; 90.5–0.99) (64/67) for all chromosome disorders. The FPR for CT + MSG was 4.8% (95% CI; 4.5–5.1) (860/17,866) and 4.6% (95% CI; 4.3–4.9) (836/17,844), respectively. The FPR of CT + fetal echocardiography was 4.4% (95% CI; 4.1–4.7) (792/17,866) for DS screening and 4.3% (95% CI; 4–4.6) (770/17,844) for chromosome abnormality screening. Conclusions: Fetal echocardiography is highly capable of identifying DS and other chromosomal disorders as a part of genetic sonography in stepwise sequential screening.

Keywords::

• Down syndrome
• fetal echocardiography
• genetic sonography
• prenatal screening

Declaration of Interest: The authors report no conflicts of interest.