VALUE OF THE COMBINED TEST
IN PRENATAL DIAGNOSTICS Lončar D *Corresponding Author: Dragan Lončar, Gynecology and Obstetrics Clinic, Clinical Center
Kragujevac , Vojislava Kalanovića 1A/3, 34000 Kragujevac, Serbia; Tel.: +381-64-616-8999;
E-mail: drloncar@sezampro.rs page: 53 download article in pdf format
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Abstract
Congenital anomalies are the cause of 20.0-
25.0% of cases of perinatal death, while 3.0% of
children are born with malformations of varying
size. We examined the predictive values and defined
the credibility ratio of the combined test results. Of
317 examined pregnant women, 16 (5.05%) gave a
pathological karyotype after amniocentesis: of these,
nine (2.84%) had chromosomal number aberrations
and seven (2.21%) had chromosomal structure
aberrations. We determined the ultrasonographic
parameters using the standards of the Fetal Medicine
Foundation (location please). We measured free
β-subunit of choriogronadotropin (β-HCG) and
pregnancy associated plasma protein A (PAPP-A)
in venous blood from pregnant women using a
combined commercial assay. Sensitivity of the test
is 94.0%, and specificity is 99.0%. The positive
likelihood ratio [likelihood ratio test (LR+)] is 94.00,
a negative likelihood ratio is [likelihood ratio test
(LR–)] 0.06. The pretest probability that pregnant
women carry a fetus with chromosomal abnormality
is 1:250. Posttest odds after the combined test to
discover this abnormality is 0.3760, and probability
of the same case is 0.2732 if it happens that the test
result is positive. The result of our study confirms
the justification of combined test usage in routine
clinical practice, since the posttest odds rate in the
case of a positive screening increases several times
over (almost 90 times); the probability of detecting a
chromosomal abnormality was about 70 times. The
combined screening test, if used methodologically
correctly, has a high predictive value in detecting
fetal congenital anomalies.
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