A component of placental isoferritin, p43, is an immuno-regulatory protein associated with suppression of the immune system. Maternal serum p43 levels increase throughout pregnancy and low serum levels have been associated with various pathological pregnancies, particularly those with a defect of placentation. We measured maternal serum p43 retrospectively in banked samples from 42 Down syndrome, 20 Edwards' syndrome and 281 unaffected pregnancies to assess its screening potential in both the first and second trimesters. The median maternal serum p43 level in Down syndrome was 1.58 times higher than that in the unaffected pregnancies (p=0.01, two-tail). The median level was slightly, but not significantly, reduced in Edwards' syndrome. Statistical modelling, including parameters for alpha-fetoprotein, free beta-human chorionic gonadotrophin, and unconjugated oestriol suggested that it might have a role in Down syndrome screening when combined with two or three of these markers. Larger scale studies are now needed.

OBJECTIVE

To determine how frequently hydatidiform mole will be detected in a maternal serum Down's syndrome screening programme.

METHODS

Affected pregnancies were identified using a national register. Unconjugated oestriol (uE3) and human chorionic gonadotrophin (hCG) were measured in stored serum samples and alphafetoprotein (AFP) levels were available from previous neural tube defect screening at 15-20 weeks gestation.

METHODS

Ten pregnancies with a complete mole (i.e., hydropic placenta without a fetus), nine with stored serum samples and one with an AFP level only.

RESULTS

The median values were 0.08, 0.13 and 1.83 multiples of the normal median for AFP, uE3 and hCG respectively. Six out of nine (67%) tested for all three markers had a high risk of Down's syndrome given maternal age and the marker levels.

CONCLUSIONS

Many molar pregnancies that have not presented clinically before 15 weeks will be detected through Down's syndrome screening.

The authors have presented their experiences on prenatal screening of fetal trisomies in this second part of a prospective study between 1988 and 1990. They gained their conclusions by processing 63,496 pregnancies during three years. The results show that maternal age plays the most important role in the prenatal screening of fetal trisomies in Hungary. They recommend fetal karyotyping for every pregnant woman aged 35 years or more. They emphasized that using of a combined screening method (i.e. maternal age, serum alpha-fetoprotein, human chorionic gonadotropin, oestriol) is only permissible if the hormonal and cytogenetic laboratory background are provided under standard circumstances. Since these are not available for the vast majority of pregnant women in Hungary they concluded that, at least for the time being, the main criteria for prenatal screening of fetal trisomies is the maternal age. By applying this recommendation 25-30 percentage of Down syndrome fetuses can be detected.

OBJECTIVE

To investigate the relationship between fetal trisomy 21 and alpha fetoprotein (AFP), unconjugated oestriol (uE3) and beta human chorionic gonadotropin (beta-hCG) levels in maternal serum, amniotic fluid and fetal serum.

METHODS

AFP, uE3 and beta-hCG levels in maternal serum, amniotic fluid and fetal serum from 17 pregnancies with fetal trisomy 21 and 131 unaffected control pregnancies were measured between 16 to 28 weeks gestation using radioimmunoassay.

RESULTS

In these pregnancies with fetal trisomy 21, the AFP and uE3 levels in maternal serum, amniotic fluid and fetal serum were lower than those in controls; but beta-hCG levels were higher (P < 0.05).

CONCLUSIONS

To measure maternal serum AFP, uE3 and beta-hCG levels will be useful in prenatal detection of trisomy 21.

Owing to differences in maternal serum alpha-fetoprotein, human chorionic gonadotrophin and oestriol levels between native Japanese and Caucasian women screened in this laboratory, a study was conducted to measure amniotic fluid alpha-fetoprotein (AFAFP) levels in native Japanese pregnancies. When the native Japanese AFAFP levels were compared with a United States (non-Black) population, the Japanese medians did not decrease as rapidly over the 14 to 22 weeks of gestation period investigated. At 14 weeks, the difference was negligible, graduating to a difference of 20 per cent by 22 weeks' gestation. Native Japanese pregnancy AFAFP levels should be interpreted based upon population data from that group alone. From these findings, prenatal screening laboratories should be encouraged to collect preliminary data for comparison before screening is initiated for a defined ethnic group.

Between 1981 and 1986, 9,840 women were monitored by antepartum nonstressed cardiotocography (CTG). A satisfactory fetal reserve pattern was detected in 91%, a reduced reserve pattern in 8% and a critical reserve pattern in 1%. The incidences of fetal growth retardation, Apgar score less than 6 at 1 minute, perinatal mortality and Caesarean section all increased significantly (p less than 0.001) as the degree of cardiotocographic fetal reserve worsened. Intrauterine growth retardation and/or low urinary oestriol excretion was associated with a highly significantly increased incidence of abnormal CTG traces (14.2%, p less than 0.001). A satisfactory fetal reserve pattern on cardiotocography was a reliable predictor of fetal well-being, since after exclusion of lethal malformations, the perinatal mortality rate in those patients monitored within 7 days of delivery was 3/1,000.