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First trimester anomaly screening in Romania using bestavailable option (FMF method by audited examiners)

Authors: MV Calomfirescu, MB Muresan, M Zvanca, D Nemescu, AM Vayna,A Veduta, A Murariu, R Sendroiu, G Marinescu

Objective:

To asess if the results, from daily practice point of view, offirst trimester screening in Romania by FMF auditedexaminers meets the expected statistics according withFMF methodology.

Methods:

A database query was designed to extract the data using ASTRAIA 1.23.4 tobe compatible with FMF 2.5. The query was sent to all FMF audited examinerspresent on FMF website. In adition the expected and diagnosed chromosomalanomalies were comunicated from first trimester audit module, togheter withsoftware version. Patterns of screened population and results were searched.

RESULTS

Results:

Only 9 FMF audited examiners send data foranalysis. Unfortunately, sofware used isheterogenous from FMF 2.2 to 2.5 and ASTRAIAfrom 1.21 to 1.23.4. For this reason the datacolected was limited and only few parameterswere analised.A number of 7107 pregnancies were examined

starting 01.01.2010. Most examiners started usingFMF methodology later.

Conclusions:

First trimester screening for anomalies is done in Romania using best available option (FMF audited option)in a limited extent / population. Even fewer are engaging in promoting and publishing the results.3 population patterns were identified within exams of daily practice:-general population;-higher risk population;-referral population.Results measured in high risk % and prenatally diagnosed chromosomal anomalies were consistent withthese populations with increased high risk and number of chromosomal anomalies for older population andeven more for referral practice.

Results:

Age averaged from 29 to 31,4 (mean 30) with 16,67% over 35 years, multiplepregnancy was seen in 1,2 upto 6,5%, NT over median varried from 19,7 upto

75,3% and over 95% in 0 upto 13,5% of cases. Bias NT varried from -0,24 to 0,25with high risk ranging from 0,8 upto 8,3. The diagnosed chromosomal anomaliesvarried from 0% upto 382% compared to expected number for correspondingpopulation.Few patterns were identified:-average age 29,5 years, 15,83% over 35 years, bias NT -0,01 mm, high risk from 0,8upto 3,3 with prenatal diagnosed chromosomal anomalies les that 1,2 times inexcess of expected, few examiners with 0;-average age 31,4 years, 22,1% over 35 years, bias NT 0,04, high risk in 4,8%,NT>50% in 52,2%, NT>95% in 5,4% with prenatal diagnosed chromosomalanomalies in 1,85 times excess of expected;-average age 30,3 years, 15,73% over 35 years, bias NT 0,19 mm, high risk in 6,5%,NT>50% in upto 75%, NT>95% in upto 13,5% with prenatal diagnosedchromosomal anomalies in more that 3,5 times excess of expected.

City

Pacients

Number

Average

Age % over 35

Multiple

pregnancyes NT > 50% NT > 95% delta NT % high risc

Nr. Of Down

Sdr-echo

estimation

Down sdr

Prenatal

confirmation

nr alte

estimat

nr alt confirm

prenat

%anom

conf/exp

Used

program

Bucuresti 1 684 30,7 17,3 3,2 38,2 3,3 NK 3,3 1,7 3 1,7 1 1,18 astraia 1,22

Bucuresti 2 2132 29 17,9 NK 53,8 4,1 0,02 1,9 4,9 4 4,9 7 1,12 FMF 2,2

Timisoara 1 1413 30,4 14,6 6,5 75,3 13,5 0,25 5,4 2,8 7 2,8 13 3,57 astraia 1,23

Timisoara 2 353 29,7 10,8 1,4 35,4 2,1 -0,09 1,1 0,7 0 0,7 0 0,00 FMF 2,2

Arad 579 29,4 13 1,7 52,4 8,9 0,03 3,1 1,3 3 1,3 0 1,15 astraia 1,23

Iasi 623 30,3 18,3 4,3 58,9 5,1 0,06 8,3 1,7 5 1,7 8 3,82 astraia 1,23

Bucuresti 3 244 30,4 8,2 1,2 19,7 0,8 -0,24 0,8 0,5 0 0,5 0 0,00 FMF 2,3

Bucuresti 4 97 30,5 14,4 3,8 24,2 0 -0,18 2 0,3 0 0,3 0 0,00 FMF 2,5

Bucuresti 5 982 31,4 22,1 5,3 52,2 5,4 0,04 4,8 2,7 3 2,7 7 1,85 astraia 1,23