Nuchal Scan - Accuracy

Accuracy

Between 65 and 85% of trisomic fetuses will have a large nuchal thickness. Further, other, non-trisomic abnormalities may also demonstrate an enlarged nuchal transparency. This leaves the measurement of nuchal transparency as a potentially useful 1st trimester screening tool. Abnormal findings allow for early careful evaluation of chromosomes and possible structural defects on a targeted basis.

At 12 weeks of gestational age, an "average" nuchal thickness of 2.18mm has been observed, however, up to 13% of chromosomally normal fetuses present with a nuchal lucency of greater than 2.5mm, and thus for even greater accuracy of predicting risks, the outcome of the nuchal scan may be combined with the results of simultaneous maternal blood tests. In pregnancies affected by Down's syndrome there is a tendency for the levels of human chorionic gonadotropin (hCG) to be increased and pregnancy-associated plasma protein A (PAPP-A) to be decreased.

The advantage of nuchal scanning over the previous use of just biochemical blood profiling, is mainly the reduction in false positive rates.

Nuchal scanning alone detects 62% of all Down's Syndrome with a false positive rate of 5.0%, the combination with blood testing gives corresponding values of 73% and 4.7%.

In another study values of 79.6% and 2.7% for the combined screening were then improved with the addition of second trimester ultrasound scanning to 89.7% and 4.2% respectively. A further study reported detection of 88% for trisomy 21 (Down syndrome) and 75% for trisomy 18 (Edwards syndrome), with a 3.3% false-positive rate. Finally, using the additional ultrasound feature of an absent nasal bone can further increase detection rates for Down syndrome to more than 95%.

When screening is positive, Chorionic villus sampling (CVS) or amniocentesis testing is required to confirm the presence of a genetic abnormality. However this procedure carries a small risk of miscarriage so prior screening with low false positive rates are needed to minimize the chance of miscarrying.

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