Antenatal screening for Down syndrome in New Zealand: Time for a national screening policy?

Unfavorable pregnancy outcomes caused by Chlamydia trachomatis or Neisseria gonorrhoeae infection are well known. The first step in addressing antenatal C. trachomatis and N. gonorrhoeae infection is a national policy to screen all pregnant women for C. trachomatis and N. gonorrhoeae, regardless of symptoms. The aim of this study was to inform policy makers on the presence of antenatal screening recommendations for C. trachomatis and N. gonorrhoeae infection. We conducted a three-part study from June 2015 to February 2016. We analyzed English and French language information online on Ministry of Health websites regarding C. trachomatis and N. gonorrhoeae antenatal screening. We referenced both primary official country and regional policy documents. We contacted the Ministry of Health directly if the information on the national antenatal screening was outdated or unavailable. In parallel, we sent a survey to the regional representative from the World Health Organization to help collect country-level data. Fourteen countries have current policies for antenatal screening of C. trachomatis and/or N. gonorrhoeae infection: Australia, the Bahamas, Bulgaria, Canada, Estonia, Japan, Germany, Latvia, New Zealand, Democratic People’s Republic of Korea, Romania, Sweden, the United Kingdom, and the United States. Australia, New Zealand, and Latvia and the United States restricted antenatal screening to women ≤25 years old and those of higher risk. Several countries responded that they had policies to treat pregnant women with symptoms. This is the currently recommended WHO guideline but is not the same as universal screening. North Korea had policies in place which were not implemented due to lack of personnel and/or supplies. National level policies to support routine screening for C. trachomatis and N. gonorrhoeae infection to prevent adverse pregnancy and newborn outcomes are uncommon.

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An Intelligent Prenatal Screening System for the Prediction of Trisomy-21 Using Triple Test Variables: The Hacettepe System

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.798 ◽

2018 ◽

pp. 1

Author(s):

Doruk Cevdi Katlan ◽

Atakan Tanacan ◽

Gokcen Orgul ◽

Kemal Leblebicioglu ◽

Mehmet Sinan Beksac

Keyword(s):

Down Syndrome ◽

High Risk ◽

Trisomy 21 ◽

Prenatal Screening ◽

Learning Algorithm ◽

Antenatal Screening ◽

Screening System ◽

Triple Test ◽

Beta Human Chorionic Gonadotropin ◽

Input Variables

Objective: To introduce an intelligent prenatal screening system, using triple test variables.Study Design: In this study, we have used a backpropagation learning algorithm (a supervised artificial neural network) to develop an intelligent antenatal screening system (heretofore referred as Hacettepe System). Triple test variables were used as input variables, while “Down syndrome” and “non-Down syndrome” fetuses were the output of the algorithm. Unconjugated estriol (E3), beta-human chorionic gonadotropin, and α-feto protein with gestational week and maternal age (triple test) were used as input variables in the training and testing. Multiples of median values of the E3, α-feto protein, and beta-human chorionic gonadotropin were used in this study. The testing group of Hacettepe system consisted of 97 patients who were found to be high-risk (>1/250) during the routine antenatal screening (triple test) and underwent amniocentesis for fetal karyotyping. Results: Amniocentesis was performed in 97 pregnancies with “high-risk” triple test results (>1/250). Fetal karyotyping revealed trisomy 21 in about 9.3% (9/97) of the pregnancies. Our algorithm (Hacettepe System) detected 77.8% (7/9) of Down syndrome cases. Moreover, all of the normal fetal karyotypes were assigned as normal in the Hacettepe System.Conclusion: We have developed an intelligent system using the backpropagation learning algorithm (using triple test variables) to predict trisomy 21.

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