Heinig J, Steinhard J, Schmitz R, Nofer J R, Witteler R, Mosel A, Ahrens A, Kiesel L, Klockenbusch W
Department of Obstetrics and Gynaecology, University of Münster, Münster, Germany.
Prenat Diagn. 2007 Apr;27(4):312-6. doi: 10.1002/pd.1662.
To examine the effect of early vaginal bleeding on first-trimester screening markers for Down syndrome.
A retrospective study was conducted on 1755 normal singleton fetuses that underwent first-trimester combined screening for Down syndrome on the basis of ultrasound and maternal serum markers. Fetal delta-nuchal translucency (NT), maternal serum pregnancy-associated plasma protein A (PAPP-A) and free beta-hCG were compared between pregnancies with (n = 252) and without (n = 1503) an episode of vaginal bleeding. Subgroup analysis for the intensity of bleeding (spotting n = 191; light n = 32; heavy n = 29) was performed.
The median +/- SD (log(10)) for delta-NT, multiple of medians (MoM) PAPP-A and MoM free beta-hCG (corrected for maternal weight, smoking and ethnicity) was - 0.17 +/- 0.62, 1.10 +/- 0.28, 1.1 +/- 0.28 and - 0.15 +/- 0.51, 0.98 +/- 0.26, 0.94 +/- 0.3 in pregnancies with and without a history of early vaginal bleeding, which were not significantly different. Exclusion of patients with spotting from the vaginal bleeding group revealed significantly higher maternal serum free beta-hCG MoM values (median +/- SD (log(10))) compared to patients without bleeding, 1.29 +/- 0.27 vs 0.96 +/- 0.3(p = 0.011). Screen-positive (cut off of 1:350) rate after combined first-trimester screening was 28.1% in patients with light vaginal bleeding and 8.4% in patients without bleeding (p = 0.001).
Light vaginal bleeding before first-trimester combined screening for Down syndrome leads to a higher screen-positive rate after combined first trimester screening, without a significant difference in serum levels of the screening markers.
探讨孕早期阴道出血对唐氏综合征孕早期筛查标志物的影响。
对1755例正常单胎胎儿进行回顾性研究，这些胎儿基于超声和母体血清标志物接受了孕早期唐氏综合征联合筛查。比较有（n = 252）和无（n = 1503）阴道出血史的孕妇的胎儿颈项透明层厚度（NT）差值、母体血清妊娠相关血浆蛋白A（PAPP-A）和游离β-人绒毛膜促性腺激素（β-hCG）。对出血强度进行亚组分析（点滴出血n = 191；少量出血n = 32；大量出血n = 29）。
有和无早期阴道出血史的孕妇，其NT差值、PAPP-A中位数倍数（MoM）和游离β-hCG MoM（校正母体体重、吸烟和种族因素）的中位数±标准差（log(10)）分别为-0.17±0.62、1.10±0.28、1.1±0.28和-0.15±0.51、0.98±0.26、0.94±0.3，差异无统计学意义。将阴道出血组中点滴出血的患者排除后发现，与无出血的患者相比，母体血清游离β-hCG MoM值显著更高（中位数±标准差（log(10)）），分别为1.29±0.27和0.96±0.3（p = 0.011）。孕早期联合筛查后，少量阴道出血患者的筛查阳性率（截断值为1:350）为28.1%，无出血患者为8.4%（p = 0.001）。
孕早期联合筛查唐氏综合征前出现少量阴道出血会导致孕早期联合筛查后筛查阳性率更高，而筛查标志物的血清水平无显著差异。
