12 week test for down syndrome

First trimester screening - Mayo Clinic

Overview

Nuchal translucency measurement

First trimester screening includes an ultrasound exam to measure the size of the clear space in the tissue at the back of a baby's neck (nuchal translucency). In Down syndrome, the nuchal translucency measurement is abnormally large — as shown on the left in the ultrasound image of an 11-week fetus. For comparison, the ultrasound image on the right shows an 11-week fetus with a normal nuchal translucency measurement.

First trimester screening is a prenatal test that offers early information about a baby's risk of certain chromosomal conditions, specifically, Down syndrome (trisomy 21) and extra sequences of chromosome 18 (trisomy 18).

First trimester screening, also called the first trimester combined test, has two steps:

A blood test to measure levels of two pregnancy-specific substances in the mother's blood — pregnancy-associated plasma protein-A (PAPP-A) and human chorionic gonadotropin (HCG)
An ultrasound exam to measure the size of the clear space in the tissue at the back of the baby's neck (nuchal translucency)

Typically, first trimester screening is done between weeks 11 and 14 of pregnancy.

Using your age and the results of the blood test and the ultrasound, your health care provider can gauge your risk of carrying a baby with Down syndrome or trisomy 18.

If results show that your risk level is moderate or high, you might choose to follow first trimester screening with another test that's more definitive.

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Why it's done

First trimester screening is done to evaluate your risk of carrying a baby with Down syndrome. The test also provides information about the risk of trisomy 18.

Down syndrome causes lifelong impairments in mental and social development, as well as various physical concerns. Trisomy 18 causes more severe delays and is often fatal by age 1.

First trimester screening doesn't evaluate the risk of neural tube defects, such as spina bifida.

Because first trimester screening can be done earlier than most other prenatal screening tests, you'll have the results early in your pregnancy. This will give you more time to make decisions about further diagnostic tests, the course of the pregnancy, medical treatment and management during and after delivery. If your baby has a higher risk of Down syndrome, you'll also have more time to prepare for the possibility of caring for a child who has special needs.

Other screening tests can be done later in pregnancy. An example is the quad screen, a blood test that's typically done between weeks 15 and 20 of pregnancy. The quad screen can evaluate your risk of carrying a baby with Down syndrome or trisomy 18, as well as neural tube defects, such as spina bifida. Some health care providers choose to combine the results of first trimester screening with the quad screen. This is called integrated screening. This can improve the detection rate of Down syndrome.

First trimester screening is optional. Test results indicate only whether you have an increased risk of carrying a baby with Down syndrome or trisomy 18, not whether your baby actually has one of these conditions.

Before the screening, think about what the results will mean to you. Consider whether the screening will be worth any anxiety it might cause, or whether you'll manage your pregnancy differently depending on the results. You might also consider what level of risk would be enough for you to choose a more invasive follow-up test.

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Risks

First trimester screening is a routine prenatal screening test. The screening poses no risk of miscarriage or other pregnancy complications.

How you prepare

You don't need to do anything special to prepare for first trimester screening. You can eat and drink normally before both the blood test and the ultrasound exam.

What you can expect

First trimester screening includes a blood draw and an ultrasound exam.

During the blood test, a member of your health care team takes a sample of blood by inserting a needle into a vein in your arm. The blood sample is sent to a lab for analysis. You can return to your usual activities immediately.

For the ultrasound exam, you'll lie on your back on an exam table. Your health care provider or an ultrasound technician will place a transducer — a small plastic device that sends and receives sound waves — over your abdomen. The reflected sound waves will be digitally converted into images on a monitor. Your health care provider or the technician will use these images to measure the size of the clear space in the tissue at the back of your baby's neck.

The ultrasound doesn't hurt, and you can return to your usual activities immediately.

Results

Your health care provider will use your age and the results of the blood test and ultrasound exam to gauge your risk of carrying a baby with Down syndrome or trisomy 18. Other factors — such as a prior Down syndrome pregnancy — also might affect your risk.

First trimester screening results are given as positive or negative and also as a probability, such as a 1 in 250 risk of carrying a baby with Down syndrome.

First trimester screening correctly identifies about 85 percent of women who are carrying a baby with Down syndrome. About 5 percent of women have a false-positive result, meaning that the test result is positive but the baby doesn't actually have Down syndrome.

When you consider your test results, remember that first trimester screening indicates only your overall risk of carrying a baby with Down syndrome or trisomy 18. A low-risk result doesn't guarantee that your baby won't have one of these conditions. Likewise, a high-risk result doesn't guarantee that your baby will be born with one of these conditions.

If you have a positive test result, your health care provider and a genetics professional will discuss your options, including additional testing. For example:

Prenatal cell-free DNA (cfDNA) screening. This is a sophisticated blood test that examines fetal DNA in the maternal bloodstream to determine whether your baby is at risk of Down syndrome, extra sequences of chromosome 13 (trisomy 13) or extra sequences of chromosome 18 (trisomy 18). Some forms of cfDNA screening also screen for other chromosome problems and provide information about fetal sex. A normal result might eliminate the need for a more invasive prenatal diagnostic test.
Chorionic villus sampling (CVS). CVS can be used to diagnose chromosomal conditions, such as Down syndrome. During CVS, which is usually done during the first trimester, a sample of tissue from the placenta is removed for testing. CVS poses a small risk of miscarriage.
Amniocentesis. Amniocentesis can be used to diagnose both chromosomal conditions, such as Down syndrome, and neural tube defects, such as spina bifida. During amniocentesis, which is usually done during the second trimester, a sample of amniotic fluid is removed from the uterus for testing. Like CVS, amniocentesis poses a small risk of miscarriage.

Your health care provider or a genetic counselor will help you understand your test results and what the results mean for your pregnancy.

By Mayo Clinic Staff

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Screening for Down's syndrome, Edwards' syndrome and Patau's syndrome

You will be offered a screening test for Down's syndrome, Edwards' syndrome and Patau's syndrome between 10 and 14 weeks of pregnancy. This is to assess your chances of having a baby with one of these conditions.

Down's syndrome is also called trisomy 21 or T21. Edwards' syndrome is also called trisomy 18 or T18, and Patau's syndrome is also called trisomy 13 or T13.

If a screening test shows that you have a higher chance of having a baby with Down's syndrome, Edwards' syndrome or Patau's syndrome, you'll be offered further tests to find out for certain if your baby has the condition.

What are Down's syndrome, Edwards' syndrome and Patau's syndrome?

Down's syndrome

Down's syndrome causes some level of learning disability.

People with Down's syndrome may be more likely to have other health conditions, such as heart conditions, and problems with the digestive system, hearing and vision. Sometimes these can be serious, but many can be treated.

Edwards' syndrome and Patau's syndrome

Sadly, most babies with Edwards' syndrome or Patau's syndrome will die before or shortly after birth. Some babies may survive to adulthood, but this is rare.

All babies born with Edwards' syndrome or Patau's syndrome will have a wide range of problems, which can be very serious. These may include major complications affecting their brain.

Read more about Edwards' syndrome and Patau's syndrome.

What does screening for Down's syndrome, Edwards' syndrome and Patau's syndrome involve?

Combined test

A screening test for Down's syndrome, Edwards' syndrome and Patau's syndrome is available between weeks 10 and 14 of pregnancy. It's called the combined test because it combines an ultrasound scan with a blood test. The blood test can be carried out at the same time as the 12-week scan.

If you choose to have the test, you will have a blood sample taken. At the scan, the fluid at the back of the baby's neck is measured to determine the "nuchal translucency". Your age and the information from these 2 tests are used to work out the chance of the baby having Down's syndrome, Edwards' syndrome or Patau's syndrome.

Obtaining a nuchal translucency measurement depends on the position of the baby and is not always possible. If this is the case, you will be offered a different blood screening test, called the quadruple test, when you're 14 to 20 weeks pregnant.

Quadruple blood screening test

If it was not possible to obtain a nuchal translucency measurement, or you're more than 14 weeks into your pregnancy, you'll be offered a test called the quadruple blood screening test between 14 and 20 weeks of pregnancy. This only screens for Down's syndrome and is not as accurate as the combined test.

20-week screening scan

For Edwards' syndrome and Patau's syndrome, if you are too far into your pregnancy to have the combined test, you'll be offered a 20-week screening scan. This looks for physical conditions, including Edwards' syndrome and Patau's syndrome.

Can this screening test harm me or my baby?

The screening test cannot harm you or the baby, but it's important to consider carefully whether to have this test.

It cannot tell you for certain whether the baby does or does not have Down's syndrome, Edward's syndrome or Patau's syndrome, but it can provide information that may lead to further important decisions. For example, you may be offered diagnostic tests that can tell you for certain whether the baby has these conditions, but these tests have a risk of miscarriage.

Do I need to have screening for Down's syndrome, Edwards' syndrome and Patau's syndrome?

You do not need to have this screening test – it's your choice. Some people want to find out the chance of their baby having these conditions while others do not.

You can choose to have screening for:

all 3 conditions
Down's syndrome only
Edwards' syndrome and Patau's syndrome only
none of the conditions

What if I decide not to have this test?

If you choose not to have the screening test for Down's syndrome, Edwards' syndrome or Patau's syndrome, you can still choose to have other tests, such as a 12-week scan.

If you choose not to have the screening test for these conditions, it's important to understand that if you have a scan at any point during your pregnancy, it could pick up physical conditions.

The person scanning you will always tell you if any conditions are found.

Getting your results

The screening test will not tell you whether your baby does or does not have Down's, Edwards' or Patau's syndromes – it will tell you if you have a higher or lower chance of having a baby with one of these conditions.

If you have screening for all 3 conditions, you will receive 2 results: 1 for your chance of having a baby with Down's syndrome, and 1 for your joint chance of having a baby with Edwards' syndrome or Patau's syndrome.

If your screening test returns a lower-chance result, you should be told within 2 weeks. If it shows a higher chance, you should be told within 3 working days of the result being available.

This may take a little longer if your test is sent to another hospital. It may be worth asking the midwife what happens in your area and when you can expect to get your results.

You will be offered an appointment to discuss the test results and the options you have.

The charity Antenatal Results and Choices (ARC) offers lots of information about screening results and your options if you get a higher-chance result.

Possible results

Lower-chance result

If the screening test shows that the chance of having a baby with Down's syndrome, Edwards' syndrome and Patau's syndrome is lower than 1 in 150, this is a lower-chance result. More than 95 out of 100 screening test results will be lower chance.

A lower-chance result does not mean there's no chance at all of the baby having Down's syndrome, Edwards' syndrome or Patau's syndrome.

Higher-chance result

If the screening test shows that the chance of the baby having Down's syndrome, Edwards' syndrome or Patau's syndrome is higher than 1 in 150 – that is, anywhere between 1 in 2 and 1 in 150 – this is called a higher-chance result.

Fewer than 1 in 20 results will be higher chance. This means that out of 100 pregnancies screened for Down's syndrome, Edwards' syndrome and Patau's syndrome, fewer than 5 will have a higher-chance result.

A higher-chance result does not mean the baby definitely has Down's syndrome, Edwards' syndrome or Patau's syndrome.

Will I need further tests?

If you have a lower-chance result, you will not be offered a further test.

If you have a higher-chance result, you can decide to:

not have any further testing
have a second screening test called non-invasive prenatal testing (NIPT) – this is a blood test, which can give you a more accurate screening result and help you to decide whether to have a diagnostic test or not
have a diagnostic test, such as amniocentesis or chorionic villus sampling (CVS) straight away – this will tell you for certain whether or not your baby has Down's syndrome, Edwards' syndrome or Patau's syndrome, but in rare cases can cause a miscarriage

You can decide to have NIPT for:

all 3 conditions
Down's syndrome only
Edwards' syndrome and Patau's syndrome only

You can also decide to have a diagnostic test after NIPT.

NIPT is completely safe and will not harm your baby.

Discuss with your healthcare professional which tests are right for you.

Whatever results you get from any of the screening or diagnostic tests, you will get care and support to help you to decide what to do next.

If you find out your unborn baby has Down's syndrome, Edwards' syndrome or Patau's syndrome

If you find out your baby has Down's syndrome, Edwards' syndrome or Patau's syndrome a specialist doctor (obstetrician) or midwife will talk to you about your options .

You can read more about what happens if antenatal screening tests find something.

You may decide to continue with the pregnancy and prepare for your child with the condition.

Or you may decide that you do not want to continue with the pregnancy and have a termination.

If you are faced with this choice, you will get support from health professionals to help you make your decision.

For more information see GOV.UK: Screening tests for you and your baby

The charity Antenatal Results and Choices (ARC) runs a helpline from Monday to Friday, 10am to 5.30pm on 020 7713 7486.

The Down's Syndrome Association also has useful information on screening.

The charity SOFT UK offers information and support through diagnosis, bereavement, pregnancy decisions and caring for all UK families affected by Edwards' syndrome (T18) or Patau's syndrome (T13).

Screening tests for Down syndrome in the first 24 weeks of pregnancy

Relevance
Down's syndrome (also known as Down's disease or Trisomy 21) is an incurable genetic disorder that causes significant physical and mental health problems and disability. However, Down syndrome affects people in completely different ways. Some have significant symptoms, while others have minor health problems and are able to lead relatively normal lives. There is no way to predict how badly a child might be affected.

Expectant parents during pregnancy are given the opportunity to have a screening test for Down syndrome in their baby to help them make a decision. If a mother is carrying a child with Down syndrome, then a decision should be made whether to terminate the pregnancy or keep it. The information gives parents the opportunity to plan life with a child with Down syndrome.

The most accurate screening tests for Down syndrome include amniotic fluid (amniocentesis) or placental tissue (chorionic villus biopsy (CVS)) to identify abnormal chromosomes associated with Down syndrome. Both of these tests involve inserting a needle into the mother's abdomen, which is known to increase the risk of miscarriage. Thus, screening tests are not suitable for all pregnant women. Therefore, more often take blood and urine tests of the mother, and also conduct an ultrasound examination of the child. These screening tests are not perfect because they can miss cases of Down syndrome and are also at high risk of being positive when the child does not have Down syndrome. Thus, if a high risk is identified using these screening tests, further amniocentesis or CVS is required to confirm the diagnosis of Down syndrome.

What we did
We analyzed combinations of serum screening tests in the first (up to 14 weeks) and second (up to 24 weeks) trimesters of pregnancy with or without ultrasound screening in the first trimester. Our goal was to identify the most accurate tests for predicting the risk of Down syndrome during pregnancy. One ultrasound index (neckfold thickness) and seven different serological indexes (PAPP-A, total hCG, free beta-hCG, unbound estriol, alpha-fetoprotein, inhibin A, ADAM 12) were studied, which can be used separately, in ratios or in combination with each other, obtained before 24 weeks of gestation, thereby obtaining 32 screening tests for the detection of Down's syndrome. We found 22 studies involving 228615 pregnant women (including 1067 fetuses with Down syndrome).

What we found
During Down Syndrome screening, which included tests during the first and second trimesters that combined to determine overall risk, we found that a test that included neckfold measurement and PAPP- A in the first trimester, as well as the determination of total hCG, unbound estriol, alpha-fetoprotein and inhibin A in the second trimester, turned out to be the most sensitive, as it allowed to determine 9out of 10 pregnancies associated with Down syndrome. Five percent of pregnant women who were determined to be at high risk on this combination of tests would not have a child with Down syndrome. There have been relatively few studies evaluating these tests, so we cannot draw firm conclusions or recommendations about which test is best.

Other important information to consider
Ultrasounds by themselves have no adverse effects on women, and blood tests can cause discomfort, bruising, and, in rare cases, infection. However, some women who have a high-risk Down syndrome baby on screening and who have had an amniocentesis or CVS are at risk of miscarriage of a non-Down syndrome baby. Parents will need to weigh this risk when deciding whether to perform amniocentesis or CVS after a "high risk" screening test is identified.

Translation notes:

Translation: Abuzyarova Daria Leonidovna. Editing: Prosyukova Ksenia Olegovna, Yudina Ekaterina Viktorovna. Project coordination for translation into Russian: Cochrane Russia - Cochrane Russia (branch of the Northern Cochrane Center on the basis of Kazan Federal University). For questions related to this translation, please contact us at: [email protected]; [email protected]

Screening tests for Down syndrome in the first 24 weeks of pregnancy

Relevance
Down syndrome (also known as Down syndrome or Trisomy 21) is an incurable genetic disorder that causes significant physical and mental health problems and disability. However, there is great variation in how Trisomy Down affects people. Some individuals have severe suffering, while others have little problems and are able to lead relatively normal lives. There is no way to predict how badly each child may be affected.

Parents-to-be are given the option of having a Down test during pregnancy to help them make decisions. If a pregnant woman is carrying a child with Down syndrome, then a decision must be made whether to terminate or continue the pregnancy. This information offers parents the opportunity to plan for life with a Down child.

The most accurate tests to detect Down include testing of amniotic fluid (fluid around the fetus, amniocentesis required) or placental tissue (chorionic villus biopsy (CVS)) for abnormal chromosomes associated with Down. Both tests require the insertion of a needle into the mother's abdomen and increase the risk of miscarriage. Thus, the tests are not suitable to be given to all pregnant women. Instead, screening uses tests that measure markers in the mother's blood, urine, or baby's ultrasound. These screening tests are not perfect, they can miss cases of Down and also give a "high risk" result to some women whose children do not have Down. Thus, pregnancies identified as Down's "high risk" pregnancies using these screening tests require further testing by amniocentesis or CVS to confirm a Down's diagnosis.

What we did
The aim of this review was to find out which of the screening tests done during the first 24 weeks of pregnancy are most accurate in predicting the risk of Down pregnancy. We studied 7 different urinary markers that can be used alone, in ratios, or in combination, taken up to 24 weeks of gestation. This cumulatively creates 24 screening tests for Down. We found 19 studies involving 18,013 pregnant women, of which 527 were pregnancies with Down syndrome.

What we found
Evidence does not support the use of urine tests to screen for Down syndrome during the first 24 weeks of pregnancy. The amount of evidence is limited.