Wald N J, Cuckle H S, Boreham J, Brett R, Stirrat G M, Bennett M J, Turnbull A C, Solymar M, Jones N, Bobrow M, Evans C J
Br J Obstet Gynaecol. 1979 Feb;86(2):91-100. doi: 10.1111/j.1471-0528.1979.tb10574.x.
Between May 1975 and the end of 1977, 6443 antenatal patients were screened mainly between 16 and 22 weeks of pregnancy for neural tube defects (NTDs) at the John Radcliffe Hospital, Oxford, by maternal serum alpha-fetoprotein (AFP) measurement; a take-up of 72 per cent. Seventeen out of 18 (94 per cent) patients with open NTD pregnancies (9 out of 9 with anencephaly and 8 out of 9 with open spina bifida) had positive screening tests, and all except one were offered and accepted a termination of pregnancy. Two hundred and forty-five (3.8 per cent) patients with unaffected pregnancies also had positive screening tests, although only 1.4 per cent had an amniocentesis. Following ultrasonography, about 50 per cent of patients with unaffected pregnancies with positive screening tests were not offered an amniocentesis because they had a multiple pregnancy or their gestational age had been underestimated. The odds of having a fetus with an NTD among the women who had an amniocentesis was about 1 to 6 (1 to 11 for open spina bifida alone). Two apparently normal pregnancies were terminated. A survey of the acceptability of the screening programme among a consecutive sample of 73 patients who knew that they had a positive screening test revealed that all except one had no objection to screening in general, and 68 (93 per cent) wanted to be tested again in a future pregnancy. The approximate direct cost of the programme was 2 pounds to 3 pounds per patient screened, or about 1000 pounds per NTD detected (about 2200 pounds per open spina bifida detected).
1975年5月至1977年底，牛津约翰拉德克利夫医院对6443名产前患者进行了筛查，主要在妊娠16至22周期间通过检测母血清甲胎蛋白（AFP）筛查神经管缺陷（NTDs）；筛查参与率为72%。18例开放性NTD妊娠患者中有17例（94%）筛查试验呈阳性（无脑儿9例中的9例，开放性脊柱裂9例中的8例），除1例之外，所有患者均被建议并接受了终止妊娠。245例（3.8%）妊娠未受影响的患者筛查试验也呈阳性，不过只有1.4%的患者接受了羊膜穿刺术。超声检查后，约50%妊娠未受影响但筛查试验呈阳性的患者未被建议进行羊膜穿刺术，原因是她们怀有多胎妊娠或孕周被低估。接受羊膜穿刺术的女性怀有NTD胎儿的几率约为1比6（仅开放性脊柱裂为1比11）。有两例看似正常的妊娠被终止。对73例知道自己筛查试验呈阳性的连续样本患者进行的一项关于筛查项目可接受性的调查显示，除1例之外，所有人总体上都不反对筛查，68例（93%）希望在未来妊娠时再次接受检测。该项目的直接成本约为每位接受筛查的患者2至3英镑，或每检测出一例NTD约1000英镑（每检测出一例开放性脊柱裂约2200英镑）。
