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Dimeric inhibin A is now used by some commercial laboratories in combination with the 3 traditional analytes.

With a screen-positive rate of 5 % or less, this new 4-analyte combination appears to detect 67 % to 76 % of Down syndrome cases in women younger than 35 years (ACOG, 2001).

Multiple serum markers testing and counseling should also be offered to women age 35 or older who wish to avoid the risks of amniocentesis or CVS but desire information on their risk of having a Down syndrome fetus.

High maternal serum levels of h CG with low levels of MSAFP and/or unconjugated estriol in pregnant women has been associated with an increased risk of carrying a Down syndrome fetus.

Multiple serum marker testing, in conjunction with adequate counseling, should be offered to pregnant women under age 35 who desire information on their risk of having a Down syndrome fetus.

Women found to be at high-risk would be candidates for amniocentesis or chorionic villus sampling (CVS), with karyotyping of the tissue obtained to confirm the diagnosis.

This contradicts the very optimistic results obtained from predictive modeling of performance.

Simplified distributional assumptions showed some evidence of benefit from the use of repeated measures of PAPP-A but not for repeated measures of u E3 or h CG.

The results of the FASTER trial are described in CPB 282 - Noninvasive Down Syndrome Screening.

Serum concentrations of the free beta subunit of h CG are higher than average, and pregnancy-associated protein A concentrations are lower, in the presence of a fetus with Down syndrome.

The combination of free beta-h CG, PAPP-A, and maternal age appears to yield detection and false-positive rates comparable to second-trimester serum screening (63 % and 5.5 %, respectively) (ACOG, 2001).

Measurement of multiple serum markers offers a means of identifying young women who are at high-risk of having a Down syndrome fetus; women found to be at high-risk would be offered confirmatory testing by karyotyping tissue obtained by amniocentesis or CVS.

Multiple marker testing may also allow pregnant women at high-risk (such as pregnant women age 35 and older) an alternative means of determining the likelihood of having a Down syndrome fetus if they wish to avoid the risk of fetal harm and death associated with amniocentesis and CVS.

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Repeated measurements (first and second trimester) of maternal serum levels of h CG, u E3 and PAPP-A together with AFP in the second trimester were carried out.

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