Tables for estimation of individual risks of fetal neural tube and ventral wall defects, incorporating prior probability, maternal serum α-fetoprotein levels, and ultrasonographic examination results
American Journal of Obstetrics and GynecologyPublished 1 January 1991
Jim Thornton, Richard Lilford, Robert G. Newcombe
Citations13
SJR quartileQ1
SJR score2.77
SNIP2.75
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Estimation of the risk of open spina bifida in patients who have elevated maternal serum alpha-fetoprotein levels but normal results on detailed anatomy ultrasonographic scan shows that the decision to offer amniocentesis after a negative scan should be individualized.
Abstract
Tables are provided for estimation of the risk of open spina bifida in patients who have elevated maternal serum alpha-fetoprotein levels but normal results on detailed anatomy ultrasonographic scan. Risks are provided for various prior population risks, for various levels of elevated maternal serum alpha-fetoprotein, and for various assumptions about the sensitivity of ultrasonographic examination. The formula used is based on sequential multiplication of odds with the use of Bayes' theorem, but an arbitrary reduction (to the power of 0.5) in the degree to which ultrasonographic information modifies the odds has been made to allow for the nonindependence of ultrasonography and maternal serum alpha-fetoprotein tests. The wide range of resulting risks shows that the decision to offer amniocentesis after a negative scan should be individualized.
Keywords
Medicine
BJOG An International Journal of Obstetrics & GynaecologyEstimating a woman's risk of having a pregnancy associated with Down's syndrome using her age and serum alpha‐fetoprotein level
607 Citations1987Howard Cuckle, Nicholas Wald +1 more
In general, screening for Down's syndrome using both maternal age and serum AFP is more efficient than either alone.
PubMedUltrasound screening for spina bifida: cranial and cerebellar signs in a high-risk population.
95 Citations1987James B. Campbell, Gilbert Wm +2 more
It is demonstrated that certain cranial and cerebellar markers, in particular the lemon sign and the banana sign or absent cerebellum, are consistent features of open spina bifida and are likely to improve the diagnostic accuracy of ultrasonography in the evaluation of pregnancies at high risk for this fetal abnormality.
American Journal of Obstetrics and GynecologyEstimates of birth prevalence rates of spina bifida in the United States from computer-generated maps
79 Citations1983Frank Greenberg, Levy M. James +1 more
Until more exact data are available, these maps represent the best current available data on racial and geographic birth prevalence rates in the United States and are useful for program planning and as an aid in interpreting maternal serum alpha-fetoprotein levels to detect neural tube defects.
American Journal of Obstetrics and GynecologyPredictive value sensitivity, and specificity of ultrasonic targeted imaging for fetal anomalies in gravid women at high risk for birth defects
74 Citations1985Rudy E. Sabbagha, Zubie Sheikh +5 more
A detailed breakdown of the accuracy of ultrasonic targeted imaging in relation to each anatomic category is presented; these data are useful in counseling gravid women with anomalous fetuses.
The LancetDIAGNOSTIC EFFECTIVENESS OF ULTRASOUND IN DETECTION OF NEURAL TUBE DEFECT
58 Citations1983C J Roberts, B. M. Hibbard +4 more
It is unlikely that the effectiveness levels for detection of OSB of 80% observed in this study could be sustained if diagnostic ultrasound were to be offered to all pregnant women, and consideration will need to be given to the question of whether an improved OSB detection rate will be worth the additional cost incurred.
American Journal of Obstetrics and GynecologyClinical interpretation of maternal serum α-fetoprotein concentrations
43 Citations1984M J Adams, Gayle C. Windham +5 more
This adjustment methodology provides a straightforward means for clinical laboratories to report results of assays of maternal serum alpha-fetoprotein in terms of predicted risks, to facilitate understanding by the physician and patient of the clinical meaning of the results of maternal Serum alpha- Fetoprotein testing.
Journal of Ultrasound in MedicineA sonographic sign which predicts which fetuses with hydrocephalus have an associated neural tube defect.
38 Citations1987Christine Penso, Raymond W. Redline +1 more
Angulation or pointing of the fetal frontal bone when hydrocephalus is present, particularly in the second trimester, seems to be a reliable predictor of an associated neural tube defect and mandates a careful search for this defect.
PubMedDiagnostic ultrasound: early detection of fetal neural tube defects.
35 Citations1980Hugh P. Robinson, V D Hood +3 more
In patients with elevated levels of maternal serum AFP, a careful ultrasound examination, in addition to identifying the majority of cases associated with an abnormal fetus, provided a good explanation for the elevation in over half of the remainder.
Journal of diagnostic medical sonographyA Normal Ultrasound Does Not Obviate the Need for Amniocentesis in Patients With Elevated Serum Alpha-Fetoprotein
28 Citations1989A Drugan, Ivan E. Zador +4 more
The rate of fetal malformations identified in this high-risk population and the rate of ultrasound misdiagnosis imply that amniocentesis should still be considered an essential part of the diagnostic workup in these situations.
BMJCan we afford screening for neural tube defects? The South Wales experience.
27 Citations1985B. M. Hibbard, C J Roberts +3 more
Clinical and financial gains and losses accruing from five different options for screening for open neural tube defects were estimated, based principally on the results of detailed monitoring of inputs and outcomes and of process costs in the South Wales Anencephaly and Spina Bifida Study.
American Journal of Obstetrics and GynecologyShould maternal α-fetoprotein estimation be carried out in centers where ultrasound screening is routine?
14 Citations1988S. Tyrrell, Denise Howel +3 more
The number of additional cases of spina bifida that could be detected by offering maternal serum alpha-fetoprotein screening in addition to a routine ultrasound examination is analyzed.
PubMedAlpha-fetoprotein screening for open spina bifida: effect of routine biparietal diameter measurement to estimate gestational age.
10 Citations1984Wald Nj, Cuckle Hs +1 more
Estimates of the detection rate for open spina bifida, the false positive rate, and the odds of being affected given a positive A.F.P. result are provided to help clinicians concerned with providing risk estimates for individual patients.