Chasen Stephen T, McCullough Laurence B, Chervenak Frank A
Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, USA.
Am J Obstet Gynecol. 2004 Mar;190(3):769-74. doi: 10.1016/j.ajog.2003.09.067.
Our objective was to assess the impact of nuchal translucency screening for aneuploidy on chorionic villus sampling and amniocentesis rates in an older obstetric population.
Our study population included women >/=35 years old who were delivered at our hospital from January 1, 2000 through December 31, 2002. Records were reviewed to determine whether women underwent nuchal translucency, chorionic villus sampling, and amniocentesis. The chi-squared test for trend was used to evaluate changes in nuchal translucency, chorionic villus sampling, and amniocentesis rates over six 6-month intervals. Maternal characteristics were compared with the use of Mann-Whitney U test and Fisher's exact test.
The 4029 women who met the inclusion criteria had a median age at delivery of 37 years (interquartile range, 36-39 years). The rates of nuchal translucency screening increased from 0% to 41.6% over the study interval. Women who underwent nuchal translucency screening when it was available were older than the women who did not (median age, 37 years [interquartile range, 36-40 years] vs median age, 37 years [interquartile range, 36-39 years]; P=.003). A higher proportion of women who were >/=40 years old underwent nuchal translucency screening when it was available than did women who were 35 to 39 years old (24.9% vs 20.4%; P=.01). Women who underwent nuchal translucency screening were less likely to have chorionic villus sampling compared with women who did not undergo screening (1.9% vs 7.1%; P<.001). Rates of chorionic villus sampling declined over time, although amniocentesis rates remained unchanged. The overall rate of invasive testing declined. Different trends were noted in women who were 35 to 39 years old compared with women who were >/=40 years old.
Higher rates of nuchal translucency screening were associated with lower rates of chorionic villus sampling and invasive testing. The addition of first-trimester screening may lead to reduced rates of invasive testing and fewer losses of normal pregnancies.
我们的目的是评估对老年产科人群进行颈部透明带筛查非整倍体对绒毛取样和羊膜穿刺术发生率的影响。
我们的研究人群包括2000年1月1日至2002年12月31日在我院分娩的年龄≥35岁的女性。查阅记录以确定女性是否接受了颈部透明带检查、绒毛取样和羊膜穿刺术。采用趋势卡方检验来评估在六个6个月间隔期间颈部透明带检查、绒毛取样和羊膜穿刺术发生率的变化。使用Mann-Whitney U检验和Fisher精确检验对产妇特征进行比较。
符合纳入标准的4029名女性分娩时的中位年龄为37岁（四分位间距，36 - 39岁）。在研究期间，颈部透明带筛查率从0%增至41.6%。进行了颈部透明带筛查的女性比未进行筛查的女性年龄更大（中位年龄，37岁[四分位间距，36 - 40岁]对中位年龄，37岁[四分位间距，36 - 39岁]；P = 0.003）。年龄≥40岁的女性中进行颈部透明带筛查的比例高于35至39岁的女性（24.9%对20.4%；P = 0.01）。与未接受筛查的女性相比，接受颈部透明带筛查的女性进行绒毛取样的可能性更小（1.9%对7.1%；P < 0.001）。绒毛取样率随时间下降，尽管羊膜穿刺术发生率保持不变。侵入性检测的总体发生率下降。35至39岁的女性与年龄≥40岁的女性呈现出不同的趋势。
较高的颈部透明带筛查率与较低的绒毛取样率和侵入性检测率相关。孕早期筛查的增加可能会降低侵入性检测率，并减少正常妊娠的丢失。
