Serum screening is routinely used to detect potential adverse obstetric outcomes such as open neural tube defects and chromosomal abnormalities including Down syndrome.
Screening normally consists of a first trimester combined test and second trimester quadruple screen test.
Abnormal screen tests can indicate a number of different adverse outcomes, each one requiring different management. This can present a dilemma for the obstetrician when deciding how to proceed, states the review. As a population-based screening test to detect pregnancy complications, the serum markers are still questionable as sensitivity is low, false positive rate is high, and no surveillance protocol has been established or proven effective to alter outcomes. Abnormal serum markers, in combination with Doppler ultrasound for example, may improve detection rates of abnormal pregnancy outcomes.
Educating women about the signs and symptoms of certain complications such as pre-eclampsia, decreased fetal movements, preterm labour and vaginal bleeding may be of value, suggests the review.
Nisha Lakhi, Richmond University Medical Center, Staten Island, New York and co-author of the review said:
“The cost of screening and emotional anxiety caused to patients must be outweighed by the benefits of early detection of complications and the ability to reduce the overall risk.
“Despite the large amount of studies and clinical evidence that demonstrate increased pregnancy complications in women with unexplained abnormal maternal serum analytes, the optimal method to manage them is unclear. We feel that patient education and heightened awareness could prevent certain pregnancy complications.”
TOG’s Editor –in-Chief, Jason Waugh said:
“Serum screening is an important method of detecting future possible complications however it must be noted that the results can sometimes lead to a false positive or indicate a range of adverse outcomes. Patients being more aware of particular complications and things to look out for in pregnancy will help diagnosis.”
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The Obstetrician & Gynaecologist (TOG) is published quarterly and is the Royal College of Obstetricians and Gynaecologists’ (RCOG) medical journal for continuing professional development. TOG is an editorially independent, peer reviewed journal aimed at providing health professions with updated information about scientific, medical and clinical developments in the specialty of obstetrics and gynaecology.
Lakhi N, Govind A, Moretti M, Jones J. Maternal serum analytes as markers of adverse obstetric outcome. The Obstetrician & Gynaecologist 2012;14:267–73.