Double markers in fest trimester First trimester serum screening for abnormal proteins

  

 

Never thought in this way!!!!  Have you ever thought that serum amylates (Double markers-like serum free beta- hCG & PAPP-A) which represent foetal structural wellbeing to some extent comes from placenta and reflects placental wellbeing. I never thought in this way, Did you??

Maternal Blood Proteins in First Trimester Screening:-A number of proteins in the maternal circulation have been found during the time of pregnancy. Many of these proteins( Where from you are coming to maternal circulation ?? )  are made or modified by the placenta.

Differences in levels of some of the proteins have been observed in patients carrying a fetus with Down syndrome and certain other chromosome abnormalities. The discovery of these slight differences in protein levels forms the basis for using them in screening protocols.

These are referred to as biochemical markers. Certain patterns of biochemical markers have been associated with fetal Down syndrome as well as other conditions. The levels of these proteins change during pregnancy, so interpretation requires knowledge of the gestational age.

Also, the effectiveness of these proteins varies with gestational ages. For example, differences in protein levels may be observed during the second trimester but not the first, while other proteins show differences during the first trimester but not the second.

 

Q .1:  Should we routinely insist on “Prenatal screening for Down’s syndrome” in our country??

Ans:  Yes. As of now such tets i.e NT and Serum D markers are being almost routinely offered in the first trimester of pregnancy between 11 and 13.6 weeks. This includes A)  ultrasound measurement of nuchal translucency (NT) and  B) the determination of fetal maternal serum biomarkers like  pregnancy-associated plasma protein-A (PAPP-A) and free beta human chorionic gonadotropin (free beta-hCG).

Q.2: Question of feasibility in India?  One should remember that at India at a given point of time approximately 5% of population is pregnant. I intend to mean that pregnant women represent approximately 5% of the total population. Although one cannot expect that all women will seek antenatal care (100%), a realistic target should be set based on the current rate of coverage.

Q.3: Missing link!!!  Question of demand & supply.

An increase of 5 to 10% of antenatal care coverage per year could be contemplated if the current rate is 50% or less. What will happen to Sonologists working at India if there is 100% coverage for all preg women of India by proper standard ANC which includes NT scan .

I just can’t imagine the immense load of NT scan they have to carry out per day not to speak of supply of PPE for sonologist for each case of NT scan!!!