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Approach to women with a previous child with mental retardation
Published in Minakshi Rohilla, Recurrent Pregnancy Loss and Adverse Natal Outcomes, 2020
Ashima Arora, Minakshi Rohilla
The conventional or traditional screening tests include measurement of multiple serum markers or analytes that are then converted to a multiple of the median (MoM) value by adjusting for gestational age, maternal age, maternal weight, race, ethnicity, diabetes, number of fetuses with chorionicity, and type of pregnancy (in vitro fertilization). This allows for comparison of the results from different laboratories and populations (Tables 14.4 and 14.5) [14]. This analyte-based screening result is based on composite likelihood ratios and therefore provides specific risks for aneuploidies as ratios that represent the positive predictive value (Figure 14.2).
Neural tube defects: Etiology, prevention, and prenatal diagnosis
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Atsuo Kondo, Shinji Katsuragi, Osamu Kamihira
In the 1970s, it became apparent that a fetus with an open NTD has increased levels of maternal serum alpha-fetoprotein (MSAFP). Since then, the combination of MSAFP and imaging examinations such as ultrasound (US) and magnetic resonance imaging (MRI) has become the major diagnostic modality for detecting NTDs.59 In many countries, screening of MSAFP for NTDs is routinely performed during pregnancy at 16–18 weeks of gestation. In the low-risk pregnancies, MSAFP measurement can detect 80%–90% of fetuses with NTDs. The result of MSAFP measurement is expressed as the multiple of the median (MoM), and cases with over 2.5 times MoM are regarded at a risk of this anomaly. Positive findings of either MSAFP plus US or MSAFP plus MRI can be followed by amniocentesis, detailed US, or both.
Omics and perinatal medicinePreeclampsia
Published in Moshe Hod, Vincenzo Berghella, Mary E. D'Alton, Gian Carlo Di Renzo, Eduard Gratacós, Vassilios Fanos, New Technologies and Perinatal Medicine, 2019
Piya Chaemsaithong, Liona C. Poon
Extensive studies in the last decade have established that the best performance for early prediction of PE can be achieved by a combination of maternal characteristics, medical and obstetric history, together with the measurements of the mean arterial pressure (MAP), uterine artery pulsatility index (PI), and maternal serum placental growth factor (PlGF) at 11–13 weeks of gestation (first trimester combined test) (47,48). This first trimester combined test utilizes a novel survival-time model based on Bayes' theorem to combine the prior information from maternal characteristics and medical and obstetric history with the biomarker multiple of the median (MoM) to estimate patient-specific risk for development of PE (47,48). This approach, within the framework of competing risks, is based on a continuous model for the gestation at delivery with PE, treating births from causes other than PE as censored observations (49,50). Using a risk cut-off of 1 in 100 for preterm PE, at a screen-positive rate of 10%, DRs for early-onset, preterm and term PE were 90%, 75%, and 45%, respectively (47,48). The screening performance of the first trimester combined test has been prospectively evaluated in several populations including Italian (51), Australian (52), American (53), Brazilian (54), and mixed European (55–59) populations. Almost all validation studies have reported comparable predictive performance corresponding to the original studies (52,54–59), except in the Italian and American populations (51,53). Currently an Asia-wide prospective validation study of the first trimester combined test is being undertaken (ClinicalTrials.gov Identifier: NCT03554681).
The role of fetal fibronectin and plasminogen activator inhibitor 1 biomarkers in antenatal prediction of placenta accreta spectrum
Published in Journal of Obstetrics and Gynaecology, 2022
Firat Okmen, Huseyin Ekici, Erdoğan Koca, Veysel Sucu, Merih Ogur, Raziye Narin
Apart from the biomarkers used in the first and second trimesters for the prediction of PAS, various biomarkers such as Placental protein 13 (Şahin et al. 2021), Pro-brain natriuretic peptide, Troponin I, creatine kinase (CK) and its cardiac form (CK-MB) (Ersoy et al. 2016) were used for this purpose in the third trimester. The level of these biomarkers may change during pregnancy with various factors (advanced gestational week, maternal weight, maternal diabetes). Biomarkers used in the first and second trimesters are generally used with multiple of the median (MoM) values. Biomarkers used in the third trimester may have such limitations when compared to the biomarkers used in the first and second trimesters, as MoM values are not used. In addition, biomarkers such as CK and CK-MB used for PAS prediction in the third trimester may be affected by labour and delivery (Leiserowitz et al.1992; Abramovet al. 1996).
Value of PAPP-A combined with BMI in predicting the prognosis of gestational diabetes mellitus: an observational study
Published in Journal of Obstetrics and Gynaecology, 2022
Zhifen Yang, Shengpu Wang, Rui Zheng, Weina Ren, Xiaoli Zhang, Chunyang Wang, Huixin Zhang
Serum level of PAPP-A multiple of the median (MoM) gradually increased over the first, second and third trimesters in control group. Compared with that in control group, serum level of PAPP-A was significantly lower in GDM group (Figure 1(A)). Placental level of PAPP-A in both groups was detected by RT-qPCR. It is shown that placental level of PAPP-A was significantly higher in control group than in GDM group (Figure 1(B)). The association between lower circulating PAPP-A with higher glucose values is consistent with a mechanism which can contribute to development of GDM.
Correlation between elevated maternal serum alpha-fetoprotein and ischemic placental disease: a retrospective cohort study
Published in Clinical and Experimental Hypertension, 2023
Xiaoqing Dai, Huimin Zhang, Bin Wu, Wenwen Ning, Yijie Chen, Yiming Chen
We calibrated the multiple of the median (MoM) of the blood index, such as AFP or free β-hCG, and then instead of the maternal original concentration. The AFP MoM was based on characteristic parameters, such as gestational age and maternal weight. The following is the algorithm and definition of MoM, MoM = [Measured AFP (U/mL)]/[median AFP for gestational age (U/mL) × adjustments] (22).