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Interpretive Handbook

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Test 57801 :
Maternal Serum Screening, Integrated, Specimen #1

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

This test combines a first- and second-trimester specimen to screen low-risk pregnancies for Down syndrome (DS), open neural tube defects (ONTD) and trisomy 18 (T18).

Collection of two blood samples is required for this test. A first trimester ultrasound to measure the fetal nuchal translucency (NT) is optional (see special instructions).

Patient demographics and analyte/ultrasound measurements are used to calculate multiple of the median (MoM) values for each of the laboratory analytes and the NT. The pattern of the MoM values is used to calculate post-test risks of ONTD, DS and T18.

Markers used for assessment of risk include first-trimester PAPP-A with or without NT and second-trimester AFP, hCG, unconjugated estriol (uE3) and dimeric Inhibin A.

A DS risk of 1 in 110 or worse is reported as abnormal. This risk cutoff predicts a detection rate of 87 percent at a screen positive rate of 1.0%.

A T18 risk of 1 in 100 or worse is reported as abnormal. This risk cutoff predicts a detection rate of 90 percent at a screen positive rate of <0.5%.

ARUP uses a singleton AFP MoM cut off of >or= 2.5. If the interpretation is "high AFP," there is an increased risk of an ONTD in the pregnancy. This cutoff value predicts a detection rate of 80% at a screen positive rate of 1.5%. High AFP also occurs in unrecognized twin pregnancies and with underestimated gestational age.

Pregnancies at an increased risk for ONTD with an AFP MoM <2.5, but a risk of 1 in 250 or worse, are also reported as abnormal. This is usually due to a family history of ONTD, the use of certain seizure medications by the patient during pregnancy, or the presence of maternal insulin-dependent diabetes, any of which increases a patients risk for ONTD.

An increased risk of congenital steroid sulfatase deficiency or Smith-Lemli-Opitz syndrome (uE3 <or= 0.14 MoM) and poor fetal outcome (hCG >or= 3.5 MoM) is reported as "see note".

Useful For Suggests clinical disorders or settings where the test may be helpful

Helpful to identify pregnancies at increased risk of having a child with Down syndrome (DS), open neural tube defects (ONTD) and trisomy 18 (T18). This test is not diagnostic.

Interpretation Provides information to assist in interpretation of the test results

The first specimen of an integrated Maternal Serum Screening is used to measure PAPP-A. A second sample must be submitted for a final interpretive report.  Acceptable date ranges to draw the second samples will be provided in the Integrated-1 report.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

A screen interpreted as “normal" misses approximately 15% of Down Syndrome, 20% of open neural tube defects and 10% of trisomy 18 cases.

Abnormal results require follow-up with targeted ultrasound, genetic counseling and consideration of fetal diagnostic testing.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

An interpretive report will be provided.

 

Part 2 must be completed in order to receive an interpretable result.

 

If the second specimen is not received for sequential screening, the results are uninterpretable and no maternal risk will be provided.

 

Test Performed by:       ARUP Laboratories

                                    500 Chipeta Way

                                    Salt Lake City, UT 84108


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