Evaluation of prenatal diagnosis of associated congenital heart diseases by fetal ultrasonographic examination in Europe

Ultrasound scans in the mid trimester of pregnancy are now a routine part of antenatal care in most European countries. With the assistance of Registries of Congenital Anomalies a study was undertaken in Europe. The objective of the study was to evaluate prenatal detection of congenital heart defects (CHD) by routine ultrasonographic examination of the fetus. All congenital malformations suspected prenatally and all congenital malformations, including chromosome anomalies, confirmed at birth were identified from the Congenital Malformation Registers, including 20 registers from the following European countries: Austria, Croatia, Denmark, France, Germany, Italy, Lithuania, Spain, Switzerland, The Netherlands, UK and Ukrainia. These registries follow the same methodology. The study period was 1996–1998, 709 030 births were covered, and 8126 cases with congenital malformations were registered. If more than one cardiac malformation was present the case was coded as complex cardiac malformation. CHD were subdivided into ‘isolated’ when only a cardiac malformation was present and ‘associated’ when at least one other major extra cardiac malformation was present. The associated CHD were subdivided into chromosomal, syndromic non-chromosomal and multiple. The study comprised 761 associated CHD including 282 cases with multiple malformations, 375 cases with chromosomal anomalies and 104 cases with non-chromosomal syndromes. The proportion of prenatal diagnosis of associated CHD varied in relation to the ultrasound screening policies from 17.9% in countries without routine screening (The Netherlands and Denmark) to 46.0% in countries with only one routine fetal scan and 55.6% in countries with two or three routine fetal scans. The prenatal detection rate of chromosomal anomalies was 40.3% (151/375 cases). This rate for recognized syndromes and multiply malformed with CHD was 51.9% (54/104 cases) and 48.6% (137/282 cases), respectively; 150/229 Down syndrome (65.8%) were livebirths. Concerning the syndromic cases, the detection rate of deletion 22q11, situs anomalies and VATER association was 44.4%, 64.7% and 46.6%, respectively. In conclusion, the present study shows large regional variations in the prenatal detection rate of CHD with the highest rates in European regions with three screening scans. Prenatal diagnosis of CHD is significantly higher if associated malformations are present. Cardiac defects affecting the size of the ventricles have the highest detection rate. Mean gestational age at discovery was 20–24 weeks for the majority of associated cardiac defects. Copyright © 2001 John Wiley & Sons, Ltd.     

First trimester screening for Down syndrome and assisted reproduction: no basis for concern

In pregnancies obtained after assisted reproduction the false-positive rate of second trimester Down syndrome (DS) screening is increased by 1.5–3-fold. This may cause an increase in the number of amniocenteses and the fetal loss rate. The present study for the first time examined whether assisted reproductive technologies affect the results of first trimester screening. The markers PAPP-A, free β-hCG and the nuchal translucency (NT) thickness were examined at 12–14 weeks' gestation. Screening markers in 47 in vitro fertilisation (IVF), 63 ovulation induction (OI) and 3026 spontaneously conceived singleton pregnancies were compared. The MoM (multiples of the median) value in the IVF pregnancies was 1.02 (95% CI: 0.85–1.22) for PAPP-A, 1.14 (95% CI: 0.95–1.37) for β-hCG and 0.97 (95% CI: 0.89–1.05) for NT; the MoM value in the OI pregnancies was 0.89 (95% CI: 0.76–1.05) for PAPP-A, 1.08 (95% CI: 0.93–1.25) for β-hCG and 1.02 (95% CI: 0.95–1.11) for NT. The first trimester marker values in assisted reproductive pregnancies and spontaneously conceived pregnancies were not significantly different. Estimated false-positive rates for a risk cut-off of 1:400 varied from 4.7% in IVF pregnancies to 5.1% in OI pregnancies. Therefore the false-positive rate in Down syndrome screening should be independent of the method of conception. Copyright © 2001 John Wiley & Sons, Ltd.     

Prenatal diagnosis for women aged 37 years and over: to have or not to have

Forty percent of pregnant women aged 37 years and over do not have prenatal diagnosis despite being eligible for a free test. The present study aimed to determine how often, and which, untested women were making a choice about this, how many declined an offer and why. A questionnaire was given to untested women, aged 37 years and over, at no less than 24 weeks gestation. A total of 375 (81.5%) women declined, 72 (16%) were not offered a test and 13 presented too late antenatally. There was a three-fold increased likelihood (OR 3.10 95% CI 1.44, 6.65) of no offer for urban non-English speaking background women, compared with the reference group (metropolitan, English speaking). Unpartnered women were also significantly less likely to receive an offer (OR 3.18, 95% CI 1.19, 8.46). Risk to the baby was the main reason for declining. When offered non-invasive prenatal screening, most decliners of prenatal diagnosis accepted, even those who declined because they were opposed to abortion. We estimate that overall 33% of older pregnant women were being offered and declining amniocentesis and/or chorion villus sampling (CVS). Only 6% were not offered a test, but this small proportion is over-represented by minority groups who must be given equal opportunity to make this choice. Copyright © 2001 John Wiley & Sons, Ltd.     

First-trimester assessment of placenta function and the prediction of preeclampsia and intrauterine growth restriction

Preeclampsia and intrauterine growth restriction (IUGR) are major contributors to perinatal mortality and morbidity worldwide. Both are characterized by impaired trophoblastic invasion of the maternal spiral arteries and their conversion from narrow muscular vessels to wide non-muscular channels. Despite improvement in the understanding of the pathophysiology of these conditions, ability to accurately identify pregnant woman who will develop them is limited. This greatly impairs the development and testing of preventive interventions. While different measures of placental dysfunction have been associated with increased risk for adverse pregnancy outcomes, the ability of any single one to accurately predict these outcomes is poor. Developing predictive tests is further challenged by difficulty in the timing of the measurements, as both the structural and biochemical characteristics of the placenta change with increasing gestational age. The ideal screening test would accurately predict the development of adverse pregnancy outcomes early enough to provide a window for preventive interventions. Improvement in ultrasound technology provides potentially useful novel tools for evaluating placental structure, but measuresments need to be standardized in order to be useful. Maternal serum analyte screening is a noninvasive test of placental biochemical function, but present serum marker alone is not sufficiently accurate to suggest its routine use in clinical practice. The use of first trimester biochemical markers in combination with uterine artery Doppler screening is promising as a potential screening tool. Prospective longitudinal studies using standardized methodology are necessary to further evaluate the choice of parameters and strategies of combination to achieve the best predictive models. Copyright © 2010 John Wiley & Sons, Ltd.     

Inaccurate estimation of risk in second trimester serum screening for Down syndrome among women who have already had first trimester screening

Problems can arise in prenatal screening for Down syndrome when tests are performed in the first and second trimester and some women who have a negative first trimester test have a second trimester serum test. The second test result does not usually take account of the previous one being negative. Even if it does, it is often inaccurate. Using published data the extent of the error was examined. The age-specific risk of an affected pregnancy in such women will be lower than if no first trimester test had been performed. The distributions of the screening markers in affected and unaffected pregnancies will be different from those in unscreened women. If the appropriate age-specific risk and marker distributions are not used, error will arise. For example, a 35-year-old woman with nuchal translucency (NT), pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotrophin (hCG) levels at the normal median would have a risk of 1 in 6500. If she then had the Triple Test with alpha-fetoprotein (AFP), unconjugated oestriol, and hCG levels of 0.7, 0.7 and 1.5 multiples of the median (MoM), respectively, her risk, ignoring the previous result, would be overestimated (1 in 95 compared with the correct estimate of 1 in 705). If the previous result was included, but the age-specific risk and second trimester marker distributions were not revised, her risk would be underestimated (1 in 820). If the correct age-specific risk and screening marker distributions were used, risk estimates would be accurate, but two tests would be less efficient than integrating all the screening information into a single test. The practice of offering second trimester serum screening to women who have already been screened is best avoided. Copyright © 2001 John Wiley & Sons, Ltd.     

PAM在污泥脱水中的筛选研究

污泥的处理与处置是城镇生活污水处理系统中的重要组成部分.在机械脱水过程中,采用投加药剂提高污泥脱水效果,根据不同污泥组成,选择不同类型高分子聚丙烯酰胺.本文以某城市生活污水处理厂污泥为处理对象,考察污泥含水率、污泥沉降性能等指标,通过实验室小试,对8种聚丙烯酰胺(WS1-WS8)的溶解性能、粘度性能和脱水效果进行对比试验研究,优选出2种PAM及其配比浓度,以离心脱水一体机为脱水设备,进行上机应用试验,并通过对比泥饼含水率,确定最佳絮凝剂为WS7.     

我国地表水中药物与个人护理品污染现状及其繁殖毒性筛查

根据文献报道,我国地表水中已检出至少144种药物及个人护理用品(pharmaceuticals and personal care products,PPCPs),包括抗生素、激素、其他药物、个人护理品(personal care products,PCPs)4大类,其中检出浓度最高的达到了μg·L~(-1)量级,在长期的污染下有可能对水生生物产生内分泌干扰效应或繁殖毒性,进而影响到整个水生生物种群的繁衍变化。因此,有必要根据我国地表水中PPCPs的污染水平,筛查出具有潜在生态风险的PPCPs。由于目前缺乏针对PPCPs类污染物的筛选体系,以国内外优先控制污染物筛选体系为基础,借鉴基于风险的欧洲兽药分级方法,利用风险指数(risk index,RI),筛选得出目前我国的地表水中有16种具有繁殖毒性的PPCPs的RI1,包括1种抗生素,5种激素类药物,3种其他药物和7种PCPs,其中乙炔雌二醇(ethinylestradiol,EE2)的RI最高(115 730),其次是壬基酚(nonylphenol,NP)(1 796)、邻苯二甲酸二丁酯(dibutyl phthalate,DBP)(255.31),对水生态环境有较高的风险的PPCPs需进一步进行较高层次的风险评价。     

采用膜污染指数评估天然有机物在低压超滤膜中的污染行为

针对超滤膜的过滤特性,采用膜污染指数（FI）来研究天然有机物（NOM）的膜污染行为.实验中,腐殖酸（HA）、牛血清蛋白（BSA）以及海藻酸钠（NaAlg）被用作模型有机物进行超滤膜污染研究.结果表明,NOM-膜滤先后经过快反应和慢反应污染阶段,其中快反应膜污染指数（TFIF）远大于慢反应膜污染指数（TFIS）.说明短时间内NOM容易在低压膜上积累,造成通量迅速下降,引起较为严重的污染.因此,反应最初阶段,低压膜与有机物的作用决定了整个膜污染的趋势.经过水力清洗,通量有一定恢复,膜阻力降低,能够去除部分污染物,但仍有少量有机物附着在膜丝,从而造成不可逆污染.3种有机物造成的不可逆污染比例依次为BSA〉HA〉NaAlg,而通过化学清洗后,其不可逆污染比例依次为：NaAlg〉BSA〉HA,腐殖酸和蛋白容易造成不可逆污染,但碱洗易于除去,多糖造成的不可逆污染相对较轻,但碱洗难以去除.污染物与膜之间的相互作用可能是造成污染的主要原因.总的说来,FI计算方法简单,能够综合描述膜污染情况,具有一定的应用价值.