Down's plan to cut miscarriage

Better risk stratification for Down's syndrome prenatal tests could cut unnecessary investigations and miscarriages, a BMJ study suggests.

Canadian researchers carried out computer simulations of the cost-effectiveness and outcomes for 19 potential screening strategies on 110,948 pregnancies.

A range of screening models are currently in use, and some may be leading to women being inappropriately deemed to be at high-risk.

Fewer miscarriages and unnecessary terminations would occur if women were classed in the first trimester as high-risk when there was a one in nine chance of the fetus having Down's syndrome, the researchers found.

High-risk women would then be offered early diagnosis by chorionic villous sampling. Low-risk women would be reassured and not undergo second trimester testing.

The researchers warn, however, that risk levels are often misunderstood by patients.

'It may be difficult to refuse a diagnostic test at first trimester for an anxious woman with a calculated risk close to the cut-off because some women want an early diagnosis,' they say.

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