Analysis Of Clinical Application Of One-Stop Clinical Risk Assessment Of Down Syndrome And Trisomy 18 In Early Pregnancy In Xiangxi Area

Objective: To explore the screening efficiency of traditional serum biochemical indicators(PAPP-A,free human beta chorionic gonadotropin)and fetal cervical hyaline thickness(NT)in early pregnancy in Xiangxi area for Down syndrome and trisomy 18 And analysis,to understand the clinical application value of Down’s syndrome(DS)and trisomy 18one-stop clinical risk assessment(OSCAR)in early pregnancy to improve its screening efficiency and provide scientific theoretical basis for its clinical screening.Methods: Selected 8980 pregnant women who were screened for DS and trisomy 18 OSCAR in the Outpatient Department of Obstetrics and Gynecology of Xiangxi Prefecture People’s Hospital from January 2014 to December 2019 as the research subjects.The average delivery age was 32 years old,≥35 There were 2140 pregnant women aged 2140,accounting for 23.83% of the total number.All subjects underwent a B-ultrasound examination at 11-13 + 6 weeks to measure the thickness of the fetal cervical hyaline(NT).At the same time,fasting venous blood was drawn to detect free chorionic gonadotropin(free-β-h CG)in the serum of pregnant women.)And pregnancy-related plasma protein-A levels,combined with clinical data,calculate the risk value of fetal DS and trisomy 18.High-risk pregnant women undergo further prenatal diagnosis.Provide consultation on prenatal diagnosis results,inform pregnant women of the chromosomal abnormalities found in the fetus and the possible prognosis of the fetus,and they will decide whether to leave or leave the fetus.Results:(1)Among the 8980 study subjects,through the comprehensive assessment of PAPP-A and free-β-h CG combined with NT in the early pregnancy,393 pregnant women were at high risk of fetal DS,with a high risk rate of 4.4%,and fetal trisomy 18.Of the 83 high-risk pregnant women,the SPR was 0.9%.The high-risk rate of trisomy 21 and the high-risk rate of trisomy 18 of pregnant women ≥35 years of age were compared with the positive rates of screening for ≥20-25 years old group,≥25-30 years old group,and ≥30-35 years old group.In comparison,the P value is less than 0.05,the difference is statistically significant,and with the increase of age,the high risk rate of trisomy 21 and trisomy 18 increases.(2).As the gestational age increases,the serum pregnancy-associated plasma protein A level of pregnant women increases,and the serum Free-β-h CG level decreases as the gestational age increases.(3).8980 pregnant women were followed up by the final pregnancy outcome and 13 cases of trisomy 21 were diagnosed by amniocentesis in the second trimester,the incidence was 1/690,and 11 cases were detected by OSCAR of Down’s syndrome in early pregnancy.The rate was 84.6%(11/13),the false positive rate was 4.26%(382/8967),the positive predictive value was 2.8%(11/393),and the negative predictive value was99.98%(8585/8587).8980 pregnant women were followed up by the final pregnancy outcome and prenatally diagnosed by amniocentesis in the second trimester,7 cases of trisomy 18 pregnancy,the incidence rate was 1in 1282,of which the one-stop clinical risk assessment of trisomy 18 in the first trimester Five cases were screened and the detection rate was 71.4%(5/7),the false positive rate was 0.87%(78/8973),the positive predictive value was 6.02%,and the negative predictive value was 99.98%(8895/8897).(4)Pregnant women who have not undergone prenatal diagnosis ask about the outcome of pregnancy and the status of the newborn.1240 pregnant women with amniocentesis did not experience fetal loss or infection during pregnancy.The remaining pregnant women had no pregnancy with Down’s syndrome and 18 tri-sign after delivery.Conclusion: One-stop clinical risk assessment(OSCAR)for Down syndrome and trisomy 18 in early pregnancy is highly effective and feasible in the population of western Hunan.It has a high detection rate for trisomy 21 and trisomy 18.The clinical application value is high.Significance: Based on the results of this study,OSCAR screening for Down syndrome and trisomy 18 in early pregnancy should be promoted.Early prenatal diagnosis of high-risk pregnant women who may have fetal chromosomal abnormalities should be performed by chorionic puncture or amniocentesis to reduce the physical and mental damage caused by mid-term labor induction.