scholarly journals How COVID-19 pandemic is changing the practice of prenatal screening and diagnosis?

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Hakan Golbasi ◽  
Ibrahim Omeroglu ◽  
Burak Bayraktar ◽  
Ceren Golbasi ◽  
Duygu Adıyaman ◽  
...  
Keyword(s):  
Diagnostic Tests ◽  
Prenatal Screening ◽  
Screening Tests ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Outpatient Visits ◽  
Prenatal Diagnostic ◽  
The Impact ◽  
Fetal Screening ◽  
Screening And Diagnosis

Abstract Objectives To evaluate the impact of the COVID-19 pandemic on prenatal screening and diagnostic tests. Methods We conducted a retrospective study with pregnant women attending to the perinatology department of a tertiary referral center. The pre-COVID-19 period between 11 March 2019 and 10 March 2020 and COVID-19 period between 11 March 2020 and 10 March 2021 were evaluated. Both periods were compared in terms of outpatient visits, ultrasound examinations, prenatal screening and diagnostic tests. The correlation of deaths related to COVID-19 pandemic on these parameters was also assessed. Results A total of 38,918 patients were examined and 28,452 ultrasound examinations, 26,672 prenatal screening tests and 1,471 prenatal diagnostic tests were performed over two years. During COVID-19 pandemic, number of outpatient visits decreased by 25.2%, ultrasound examinations decreased by 44.2%, prenatal screening tests decreased by 36.2% and prenatal diagnostic tests decreased by 30.7%. Statistically significant correlation was not observed between deaths related to COVID-19 and outpatient visits (p=0.210), ultrasound examinations (p=0.265), prenatal screening (p=0.781) and diagnostic tests (p=0.158). Among indications of prenatal diagnostic tests, maternal anxiety was significantly higher in COVID-19 period (p=0.023). There was significant decrease in the detection of fetuses with trisomy 21 (p=0.047) and a significant increase in the detection of fetuses with Turner syndrome (p=0.017) during COVID-19 period. Conclusions The COVID-19 pandemic has severely impacted antenatal care. Prenatal fetal screening and diagnosis was adversely affected by the pandemic in terms of detecting genetic and structural anomalies.

scholarly journals Increasing Mean Age of Head and Neck Cancer Patients at a German Tertiary Referral Center

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 832
Author(s):  
Julius M. Vahl ◽  
Marlene C. Wigand ◽  
Michael Denkinger ◽  
Dhayana Dallmeier ◽  
Chiara Steiger ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Catchment Area ◽  
Incidence Rates ◽  
Cancer Center ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
The Impact

Background: The impact of demographic change on the age at diagnosis in German head and neck cancer (HNC) patients is unclear. Here we present an evaluation of aging trends in HNC at a tertiary referral center. Methods: Retrospective cohort study on aging trends at the initial diagnosis of newly diagnosed patients with HNC between 2004 and 2018 at the head and neck cancer center Ulm in relation to demographic data of the catchment area. Results: The study population consisted of 2450 individuals diagnosed with HNC with a mean age of 62.84 (±11.67) years. We observed a significant increase in annual incidence rates and mean age over time. Mean age among HNC patients increased significantly more than among the population in the catchment area. Whereas the incidence rate of patients <50 years did not change, the incidence of HNC patients aged ≥70 years increased the most. The mean patient age in the main tumor sites increased significantly. Surprisingly, HPV-positive patients were not younger than HPV-negative patients, but showed a non-significant trend towards a higher mean age (63.0 vs. 60.7 years). Conclusions: Increasing incidence rates in older patients pose a challenge for health care systems. A nationwide study is needed to assess the dynamics and impact of aging on the incidence of HNC.

scholarly journals 1301. Graphical Analysis of HIV Guidelines Adherence Finds System-Wide Anomalies in Diagnostic Testing

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S469-S470
Author(s):  
Ronald George Hauser ◽  
Ankur Bhargava ◽  
Maggie Chartier ◽  
Marissa Maier
Keyword(s):  
Clinical Practice ◽  
Hiv Testing ◽  
Directed Graph ◽  
Diagnostic Tests ◽  
Case Reports ◽  
Diagnostic Testing ◽  
Screening Tests ◽  
Medical Database ◽  
The Impact ◽  
Resistance Tests

Abstract Background The misuse of HIV diagnostic tests can delay HIV diagnosis, contribute to HIV transmission, incur unnecessary costs, and pose legal risks. Prompted by case reports of misused HIV diagnostic tests, we developed a method to systematically evaluate HIV diagnostic testing that utilized an observational medical database, evaluated performance at different levels (e.g., system, facility, clinician), adjudicated clinical practice patterns as adherent or nonadherent to guidelines, quantified the impact of clinical practice deviations, and identified targets for intervention. Methods We used graph theory to assess patterns of HIV testing in a national healthcare system. We obtained all HIV screening tests, viral loads, and resistance tests performed January 1, 2015–January 31, 2019, excluding HIV-positive and deceased individuals (Figure 1). We modeled the CDC’s HIV diagnostic testing guidelines as a directed graph (Figure 2A). Each node in the graph represented a test, and the edges pointed from one test to the next in chronological order. We then graphed each patient’s HIV testing. This set of patient-level graphs was aggregated into a single graph. Finally, we compared the two graphs, the first representing the CDC’s recommended approach to HIV diagnostic testing and the second representing the observed patterns of HIV testing, to assess for clinical practice deviations. Results The HIV diagnostic testing of 1.643 million patients from 130 facilities provided 8.790 million HIV diagnostic test results for analysis (Figure 1). Significant deviations from recommended practice were found including the use of HIV resistance tests (n = 3,007) and HIV nucleic acid tests (n = 16,567) instead of the recommended HIV screen (Figure 2B). The estimated costs of nonadherent testing totaled $2.427 million in 2018 dollars. Conclusion We developed a method that modeled a complex medical scenario as a directed graph. When applied to HIV diagnostic testing, we identified deviations in clinical practice from guideline recommendations. The model enabled the identification of intervention targets and prompted systemwide policy changes to reduce nonadherent orders and enhance HIV detection (Figure 3). This approach could be applied to diverse medical scenarios. Disclosures All authors: No reported disclosures.

The impact of preimplantation genetic testing for aneuploidy on prenatal screening

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Moti Gulersen ◽  
Alexandra Peyser ◽  
Jiyoung Kim ◽  
Amanda Ferraro ◽  
Randi Goldman ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Prenatal Screening ◽  
Diagnostic Testing ◽  
Second Trimester ◽  
Preimplantation Genetic Testing ◽  
Prenatal Diagnostic ◽  
Second Trimester Screening ◽  
The Impact ◽  
Prenatal Diagnostic Testing ◽  
Euploid Embryo

Abstract Objectives To determine whether preimplantation genetic testing for aneuploidy (PGT-A) is associated with a reduced risk of abnormal conventional prenatal screening results in singleton pregnancies conceived using in vitro fertilization (IVF). Methods This was a retrospective cohort study of singleton IVF pregnancies conceived from a single tertiary care center between January 2014 and September 2019. Exclusion criteria included mosaic embryo transfers, vanishing twin pregnancies, and cycles with missing outcome data. Two cases of prenatally diagnosed aneuploidy that resulted in early voluntary terminations were also excluded. The primary outcome of abnormal first or second-trimester combined screening results was compared between two groups: pregnancy conceived after transfer of a euploid embryo by PGT-A vs. transfer of an untested embryo. Multivariable backwards-stepwise logistic regression with Firth method was used to adjust for potential confounders. Results Of the 419 pregnancies included, 208 (49.6%) were conceived after transfer of a euploid embryo by PGT-A, and 211 (50.4%) were conceived after transfer of an untested embryo. PGT-A was not associated with a lower likelihood of abnormal first-trimester (adjusted OR 1.64, 95% CI 0.82–3.39) or second-trimester screening results (adjusted OR 0.96, 95% CI 0.56–1.64). The incidences of cell-free DNA testing, fetal sonographic abnormalities, genetic counseling, and invasive prenatal diagnostic testing were similar between the two groups. Conclusions Our data suggest that PGT-A is not associated with a change in the likelihood of abnormal prenatal screening results or utilization of invasive prenatal diagnostic testing. Counseling this patient population regarding the importance of prenatal screening and prenatal diagnostic testing, where appropriate, remains essential.

scholarly journals Folic Acid and Birth Defects: A Case Study (Iran)

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Mohammad Bager Hosseini ◽  
Zhila Khamnian ◽  
Saeed Dastgiri ◽  
Bahram Samadi Raad ◽  
Yalda Ravanshad
Keyword(s):  
Folic Acid ◽  
Pregnant Women ◽  
Diagnostic Tests ◽  
Odds Ratio ◽  
Prenatal Screening ◽  
Termination Of Pregnancy ◽  
Medical Diagnostic ◽  
Northwest Region ◽  
The Impact

The aim of this study was to evaluate the impact of folic acid use in pregnancy for the reduction of neural tube defects (NTDs) in the northwest region of Iran. We studied 243 women with pregnancies complicated by some forms of birth defect(s). These patients were identified by medical diagnostic tests as having a fetus with some types of congenital anomalies. The prevalence of NTDs among pregnant women who were referred for therapeutic termination of pregnancy was 24.7 percent. Consumption of folic acid prevented NTDs by 79 percent (Odds Ratio = 0.21, CI 95%: 0.12–0.40) and 94 percent (Odds Ratio = 0.06, CI 95%: 0.03–0.15) compared to pregnancies complicated by other anomalies and normal pregnancies, respectively. Hydrops fetalis, hydrocephaly, Down syndrome, and limb anomalies did not have any significant association with the folic acid use. Along with the advice for the consumption of folic acid for pregnant women, they should be offered prenatal screening or diagnostic tests to identify fetal abnormalities for possible termination of pregnancy.

scholarly journals Impact of ultrasonography on identifying noninvasive prenatal screening false-negative aneuploidy

2019 ◽  
Author(s):  
Wei Li ◽  
Fanwei Zeng ◽  
Baitong Fan ◽  
Nan Yu ◽  
Jing Wu ◽  
...  
Keyword(s):  
Prenatal Screening ◽  
Large Population ◽  
False Negative ◽  
Population Based ◽  
Screening Tests ◽  
Ventricular Septal Defects ◽  
Noninvasive Prenatal Screening ◽  
Septal Defects ◽  
Us Findings ◽  
The Impact

PurposeTo evaluate the impact of ultrasonography (US) on identifying noninvasive prenatal screening (NIPS) false-negative aneuploidy.MethodsAnalysis of large population-based NIPS false-negative aneuploidy data comprising karyotypes, clinical outcomes, and US results.ResultsFrom December 2010 to July 2018, a total of 3,320,457 pregnancies were screened by NIPS performed in BGI; among them, 69 NIPS false-negative aneuploidy cases with informed consent were confirmed, and US examination data for 48 cases were not available. Of the 21 cases with US results, 19 (90.5%) had various abnormalities on ultrasound, and 2 (9.5%) cases were shown to be normal on ultrasound. Additionally, 6 out of 7 live born fetuses (approximately 85.7%) were found to have abnormalities on ultrasound. Ventricular septal defects constituted the most frequently observed ultrasound abnormality type among the 21 NIPS false-negative aneuploidy cases.ConclusionNIPS has expanded rapidly worldwide and now accounts for a large proportion of prenatal screening tests in China. This study suggests that abnormal US findings should not be neglected, even when NIPS produces a negative result. Combining NIPS with an US examination can further reduce the incidence of livebirths with aneuploidy.

scholarly journals The impact of prenatal screening tests on prenatal diagnosis in Taiwan from 2006 to 2019: a regional cohort study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Ching Hua Hsiao ◽  
Ching Hsuan Chen ◽  
Po Jen Cheng ◽  
Steven W. Shaw ◽  
Woei Chyn Chu ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Prenatal Screening ◽  
Diagnostic Testing ◽  
First Trimester ◽  
Screening Tests ◽  
Screening Methods ◽  
Second Trimester ◽  
Invasive Procedures ◽  
Trimester Screening ◽  
The Impact

Abstract Background The purpose of this study is to evaluate the impact of prenatal screening tests on prenatal diagnosis in Taiwan’s 14 years from 2006 to 2019. Methods The prenatal screening methods evolved from the second-trimester serum screening to combined first-trimester screening (cFTS) and then followed by the non-invasive cell-free DNA prenatal test (NIPT). The data used by the Department of Statistics, the Ministry of Health and Welfare and Department of Household Registration, Ministry of the Interior public website. Results This regional registry-based cohort retrospective study examined a total of 2,775,792 births from January 2006 to December 2019. The proportion of advanced maternal age (AMA) pregnancies increased from 11.63% in 2006 to 30.94% in 2019. Overall, invasive diagnostic testing was used in 87.22% of AMA pregnancies. The prenatal detection rate of trisomy 21 and 18 increased from 74.1% and 83.3% in 2006 to 96.9% and 98.8% in 2019, respectively. Conclusion During the second-trimester and cFTS periods, the percentage of AMA pregnancies increased every year and the number of invasive procedures also accompany with increased percentage of AMA. However, during the period that NIPT were implemented, the percentage of invasive procedures decreased.

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