First-trimester prenatal diagnosis in quintuplets: A practical approach using step-by-step embryo reduction

A multiple pregnancy of high rank may occur in a couple at risk for a Mendelian disorder. Prenatal diagnosis is hampered by the difficulty of (1) obtaining chorionic villi from each zygote arid (2) unequivocally relating each sample to the corresponding embryo. The calculation of the genetic risk according to the number of zygotes led us to propose a diagnostic strategy based on embryo reduction, a technique initially designed to improve the perinatal outcome of multiple pregnancies with normal embryos. We report a case in which this approach allowed rational use of first-trimester chorionic villus sampling in a quintuplet pregnancy at risk for non-ketotic hyperglycinaemia, resulting in the selective birth of unaffected twins.     

石英羟基水-分子水的分馏系数与常规混合水δD分析的关系

采集了 4个不同地区花岗岩石英、热液脉石英 ,分析其中包裹体分子水与结构羟基水的含量、包裹体分子水的δDinclusion、结构羟基水的δDOH,计算了结构羟基水 包裹体分子水之间的D/H分馏系数αOH inclusion。考查了混合水 (结构羟基水 +包裹体分子水 )δDwhole water与单独包裹体水δDinclusion之间的差别 ,分析了这种差别与分馏系数αOH inclusion的关系。结果表明 :花岗岩样品中两种水之间的分馏系数小 ,分馏程度大 ,在常规分析中 ,若采用测定混合水δDwhole water值代表实际流体 (包裹体水 )δDinclusion值时 ,二者间有较大的差异。热液石英脉样品总体来说分馏系数接近于 1,分馏程度小 ,常规分析中引起的二者之间差异小。常规的分析方法用于分馏程度小的热液脉石英是可行的 ,但进行花岗岩石英水的氢同位素分析时有必要区分出包裹体水与羟基水。     

Amniotic fluid alpha-fetoprotein levels and prenatal diagnosis of autosomal trisomies

Pregnancies with fetal trisomy 21 have been associated with low amniotic fluid alpha-fetoprotein levels (AFAFP). This observation led to the suggestion that low AFAFP levels be used as a criterion for completion of a chromosomal analysis in patients who are not otherwise at increased risk for a fetal chromosome abnormality and in whom karyotyping might not have been completed for economic reasons. In order to assess the usefulness of such criteria, we reviewed the AFAFP levels of 90 cases of fetal trisomy 21, 23 cases of trisomy 18, and 10 cases of trisomy 13. These were compared with 2400 control samples with normal chromosome constitution. AFAFP levels were generally lower in pregnancies with trisomy 21, showing a median value of 0·72 MoM. However, 40 per cent of the trisomy 21 samples had AFAFP values greater than 0·8 MoM and 20 per cent were over 1·0 MoM. These data imply that over 50 per cent of Down syndrome cases might have been missed using a cut-off level of 0·70 MoM for completion of chromosome analysis. Using a higher cut-off level will leave only a small percentage of samples unkaryotyped. The distribution of AFP levels in trisomy 13 and 18 is no different from controls; we therefore believe that fetal karyotyping should be completed in every amniotic fluid sample obtained.