RESUMEN
OBJECTIVE: To study pregnant women's preference among various screening options for Down syndrome (DS) in routine clinical setting, and its potential association with women's demographic characteristics. METHODS: Women aged 35 years and older carrying singleton pregnancy were offered a variety of screening tests for DS before 14 weeks of gestation. Their preference was confirmed by the test they actually underwent. The association between women's choice of test and a number of demographic characteristics was studied using multinomial regression. RESULTS: Among 1967 eligible women, 619 opted for first-trimester screening test (FTS), 924 for partial integrated test (PIT), and 424 for full integrated test (FIT). Nulliparous women and working mothers were more likely to choose FTS and FIT. Women with history of subfertility were more likely to choose FIT. Women with family history of chromosomal abnormalities were more likely to choose FTS. The choice of screening test could be predicted for 49.9% of women using four demographic characteristics. CONCLUSIONS: Among older women of predominantly Chinese ethnicity, integrated test is a favorite alternative to FTS. Their choice of DS screening test can be predicted by their obstetric and socioeconomic characteristics. Many women show willingness to pay for a test with a lower false-positive rate.
Asunto(s)
Síndrome de Down/diagnóstico , Prioridad del Paciente , Diagnóstico Prenatal/métodos , Adulto , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Tamizaje Masivo/economía , Tamizaje Masivo/métodos , Tamizaje Masivo/psicología , Edad Materna , Persona de Mediana Edad , Prioridad del Paciente/economía , Prioridad del Paciente/estadística & datos numéricos , Embarazo , Primer Trimestre del Embarazo , Diagnóstico Prenatal/economía , Diagnóstico Prenatal/psicología , Medicina Reproductiva , Factores SocioeconómicosRESUMEN
OBJECTIVE: To explore whether the outcomes of second-trimester pregnancy termination for fetal abnormalities are affected by fetal diagnoses. METHODS: This was a retrospective review of cases undergoing second-trimester pregnancy termination for the fetal diagnoses of hemoglobin Barts, trisomy 21, and trisomy 18 during the period from 1999 to 2006. The affected pregnancies were terminated by vaginal misoprostol. The outcome measures were: (1) abortion within 24 hours after misoprostol commencement, (2) histology-confirmed incomplete abortion, and (3) experience of significant side effects during termination (temperature over 39 degrees C or need for metoclopramide for vomiting). RESULTS: One hundred and twenty cases were available for analysis. After adjusting for maternal age, parity, history of cesarean delivery, body mass index, gestation, and fetal hydrops, pregnancy termination for trisomy 21 was associated with a higher risk of incomplete abortion than trisomy 18 and hemoglobin Barts (odds ratio 5.25, 95% confidence interval 1.24-22.19, p = 0.024). The chance of abortion within 24 hours and experience of significant side effects were not found to be associated with fetal diagnosis. CONCLUSIONS: Pregnancy termination for trisomy 21 is associated with a higher risk of incomplete abortion. Fetal diagnosis affects the outcome of pregnancy termination.
Asunto(s)
Aborto Eugénico , Feto/anomalías , Segundo Trimestre del Embarazo , Diagnóstico Prenatal , Abortivos no Esteroideos/administración & dosificación , Aborto Eugénico/métodos , Administración Intravaginal , Adulto , Cromosomas Humanos Par 18 , Síndrome de Down/diagnóstico , Síndrome de Down/patología , Femenino , Feto/patología , Hemoglobinas Anormales/metabolismo , Humanos , Misoprostol/administración & dosificación , Proyectos Piloto , Embarazo , Segundo Trimestre del Embarazo/fisiología , Diagnóstico Prenatal/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Trisomía/diagnóstico , Talasemia alfa/diagnóstico , Talasemia alfa/patologíaRESUMEN
OBJECTIVE: To explore the effect of gestational age on the outcome of second-trimester termination of pregnancies for foetal abnormalities. METHOD: A retrospective study was conducted on 280 pregnancies terminated for foetal abnormalities in the second trimester using vaginal misoprostol. The gestational age at termination was divided into three groups: 13-16 weeks, 17-20 weeks and 21-23 weeks. The likelihood of (1) abortion within 24 h of commencement of misoprostol, (2) incomplete abortion and (3) experiencing significant side effects was compared among these three gestational groups after adjusting for maternal age, parity and body mass index (BMI). RESULTS: Compared to termination after 20 weeks, pregnancy termination for foetal abnormality before 17 weeks of gestation was associated with higher chance of incomplete abortion (OR 2.2, 95% CI 1.07-4.61, p = 0.032) and lower chance of experiencing significant side effects (OR 0.11, 95% CI 0.01-0.91, p = 0.041). CONCLUSION: Women undergoing pregnancy termination for foetal abnormalities in the early second trimester should be informed of possible higher chance of incomplete abortion.