Abstract:
OBJECTIVE:To investigate the differences in costs and outcomes of Down syndrome screening using data from the First and Second Trimester Evaluation of Risk (FASTER) Trial. METHODS:Seven possible screening options for Down syndrome were compared: 1) Triple Screen-maternal serum alpha fetoprotein, estriol, and hCG; 2) Quad-maternal serum alpha fetoprotein, estriol, hCG, and Inhibin A; 3) Combined First-nuchal translucency, pregnancy-associated plasma protein A (PAPP-A), free beta-hCG; 4) Integrated-nuchal translucency, PAPP-A, plus Quad; 5) Serum Integrated-PAPP-A, plus Quad; 6) Stepwise Sequential-Combined First plus Quad with results given after each test; and 7) Contingent Sequential-Combined First and only those with risk between 1:30 and 1:1,500 have Quad screen. The detection rates for each option were used given a 5% false-positive rate except for Contingent Sequential with a 4.3% false-positive rate. Outcomes included societal costs of each screening regimen (screening tests, amniocentesis, management of complications, and cost of care of Down syndrome live births), Down syndrome fetuses identified and born, the associated quality-adjusted life years, and the incremental cost-utility ratio. RESULTS:Based on the screening results derived from the 38,033 women evaluated in the FASTER trial, the Contingent Sequential screen dominated (lower costs with better outcomes) all other screens. For example, the Contingent Sequential cost 32.3 million dollars whereas the other screens ranged from 32.8 to 37.5 million dollars. The Sequential strategy led to the identification of the most Down syndrome fetuses of all of the screens, but at a higher cost per Down syndrome case diagnosed ($719,675 compared with $690,427) as compared with the Contingent Sequential. Because of the lower overall false-positive rate leading to fewer procedure-related miscarriages, the Contingent Sequential resulted in the highest quality-adjusted life years as well. The Contingent Sequential remained the most cost-effective option throughout sensitivity analysis of inputs, including amniocentesis rate after positive screen, rate of therapeutic abortion after Down syndrome diagnosis, and rate of procedure-related miscarriages. CONCLUSION:Analysis of this actual data from the FASTER Trial demonstrates that the Contingent Sequential test is the most cost-effective. This information can help shape future policy regarding Down syndrome screening.
journal_name
Obstet Gynecoljournal_title
Obstetrics and gynecologyauthors
Ball RH,Caughey AB,Malone FD,Nyberg DA,Comstock CH,Saade GR,Berkowitz RL,Gross SJ,Dugoff L,Craigo SD,Timor-Tritsch IE,Carr SR,Wolfe HM,Emig D,D'Alton ME,First and Second Trimester Evaluation of Risk (FASTER) Research Consordoi
10.1097/01.AOG.0000263470.89007.e3subject
Has Abstractpub_date
2007-07-01 00:00:00pages
10-7issue
1eissn
0029-7844issn
1873-233Xpii
110/1/10journal_volume
110pub_type
杂志文章abstract::Fetal oxytocin contribution to the mother during spontaneous labor was investigated using a specific and sensitive radioimmunoassay to measure oxytocin in blood, amniotic fluid, and urine. In 26 subjects with spontaneous labor and vaginal delivery (Group I) and 18 subjects with cesarean section after labor (Group II),...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1978-08-01 00:00:00
abstract::Pain management should be provided whenever medically indicated. The American Society of Anesthesiologists (ASA) and the American College of Obstetricians and Gynecologists (ACOG) believe that women requesting epidural analgesia during labor should not be deprived of this service based on their insurance or inadequate...
journal_title:Obstetrics and gynecology
pub_type: 指南,杂志文章,实务指引
doi:
更新日期:2004-07-01 00:00:00
abstract::Primary dysmenorrhea is defined as pain during the menstrual cycle in the absence of an identifiable cause. It is one of the most common causes of pelvic pain in women. Dysmenorrhea can negatively affect a woman's quality of life and interfere with daily activities. The pathophysiology of primary dysmenorrhea is likel...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/AOG.0000000000004096
更新日期:2020-11-01 00:00:00
abstract::Two hundred ninety-four women with cervical intraepithelial neoplasia were treated once with either cryotherapy or laser vaporization. Treatment results were controlled for grade, size, and distribution of cervical intraepithelial neoplasia. Cervical intraepithelial neoplasia measuring less than 3 cm in diameter witho...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1985-12-01 00:00:00
abstract::Three hundred fifty real-time scans were performed on pregnant women for various indications. Placental localization was satisfactorily obtained in 173 of 174 studies. Estimates of fetal gestation from directly measured biparietal diameter were +/-2 weeks of actual gestation in 153 of 172 (88.9%) measurements. The pre...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00006250-197803000-00006
更新日期:1978-03-01 00:00:00
abstract:OBJECTIVE:To investigate the need for further surgery after laparoscopic excision of endometriosis or hysterectomy. METHODS:In this retrospective study, women who had surgery for endometriosis-associated pain at the Cleveland Clinic were assessed for requirement for subsequent surgery. One hundred twenty patients who ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3181758ec6
更新日期:2008-06-01 00:00:00
abstract:BACKGROUND:In an effort to minimize injuries associated with closed laparoscopic entry, many surgeons use a 10-mm standard open laparoscopy technique. Disadvantages of this open technique are that it requires a larger incision, fascial sutures, and does not always achieve an airtight seal. Although 5-mm laparoscopics w...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000001202
更新日期:2016-03-01 00:00:00
abstract::The early detection of preterm labor and the prevention of preterm birth require special attention to early subtle signs and symptoms of preterm labor. The concept of "Braxton Hicks contractions" may negate these early signs and symptoms by falsely reassuring patients, thus encouraging them not to seek medical care pr...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1990-04-01 00:00:00
abstract:OBJECTIVE:To examine the association between the mode of delivery and the risk of offspring obesity by age 21 years using a large community-based birth cohort study in Australia. METHODS:We followed-up a subsample of 2,625 offspring for whom we had measured physical assessments, including height and weight at 21 years...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000000016
更新日期:2013-12-01 00:00:00
abstract::Non-Hodgkin lymphoma was diagnosed initially in a curettage specimen of a puerperal uterus 3 weeks after normal delivery of a healthy infant. The disease, which probably existed during the last trimester of pregnancy, was classified as clinical stage IVb. Combination chemotherapy resulted in immediate improvement and ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1990-03-01 00:00:00
abstract::Preoperative abdominopelvic computed tomography results and operative findings were compared in 52 patients undergoing second-look laparotomy to confirm tumor status. Seventeen true-negative, 22 false-negative, and 13 true-positive scans were found. The sensitivity was 0.38, specificity was 1.0, and diagnostic accurac...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1985-05-01 00:00:00
abstract::Endometriosis of the sciatic nerve is rare but must be included in the differential diagnosis of sciatic pain. Patients present with typical signs and symptoms of sciatica, which are cyclic in nature. Electromyography and computed tomographic scanning are useful in diagnosis. At laparoscopy or laparotomy, a characteri...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:
更新日期:1988-03-01 00:00:00
abstract::In a paired, controlled, retrospective study, 44 low birth weight breech fetuses delivered vaginally were compared with 44 breech fetuses delivered by cesarean section. Seven deaths occurred in the vaginal delivery group, compared with only 1 in the abdominal delivery group. Asphyxia, trauma, and intracranial hemorrha...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1979-09-01 00:00:00
abstract:BACKGROUND:Primary vaginal stones in children are extremely rare but important because they are often mistaken for bladder calculi on plain film. CASE:A 13-year-old girl was admitted to the hospital with abdominal pain. Physical and serial radiologic examinations found a hard mass anterior to the rectum. By vaginoscop...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:2001-11-01 00:00:00
abstract:OBJECTIVE:To assess the effect of antenatal and postnatal corticosteroids on head circumference growth and weight gain from birth to discharge. METHODS:We conducted a retrospective analysis of nonanomalous newborns admitted to the neonatal intensive care unit from 23 to 34 6/7 weeks of gestation. Independent variables...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(01)01657-x
更新日期:2002-01-01 00:00:00
abstract:OBJECTIVE:To compare ondansetron with metoclopramide in the treatment of hyperemesis gravidarum. METHODS:We enrolled 160 women with hyperemesis gravidarum in a double-blind randomized trial. Participants were randomized to intravenous 4 mg ondansetron or 10 mg metoclopramide every 8 hours for 24 hours. Participants ke...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1097/AOG.0000000000000242
更新日期:2014-06-01 00:00:00
abstract:OBJECTIVE:To compare the effectiveness of orally administered nifedipine and intravenously administered labetalol for acute blood pressure control in hypertensive emergency of pregnancy. METHODS:In this double-blind, randomized, controlled trial, pregnant women with sustained increase in systolic blood pressure of 160...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1097/AOG.0b013e3182a9ea68
更新日期:2013-11-01 00:00:00
abstract:OBJECTIVE:To evaluate a new sonographic method to measure depth and width of proximal urethral dilation during coughing and Valsalva maneuver and to report its use in a group of stress-incontinent and continent women. METHODS:Fifty-eight women were evaluated, 30 with and 28 without stress incontinence proven urodynami...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(98)00420-7
更新日期:1999-03-01 00:00:00
abstract:OBJECTIVE:Epidermal growth factor is a ubiquitous mitogen that also possesses insulin-like properties. Fetal mal-growth is associated with altered epidermal growth factor levels. Maternal diabetes is frequently complicated by macrosomia, but the effect of maternal diabetes on fetal epidermal growth factor levels is not...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000110545.64874.49
更新日期:2004-02-01 00:00:00
abstract:OBJECTIVE:To describe the incidence and type of fetal injury identified in women undergoing cesarean delivery. METHODS:Between January 1, 1999, and December 31, 2000, a prospective cohort study of all cesarean deliveries was conducted at 13 university centers. Information regarding maternal and infant outcomes was abs...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1097/01.AOG.0000237116.72011.f3
更新日期:2006-10-01 00:00:00
abstract::Case-control studies begin at the end. Two groups of patients, those with disease (cases) and those without (controls), are compared to determine the degree of exposure to a presumed risk factor. This research method is commonly used to study rare diseases or diseases that take years to develop. If a higher proportion...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:
更新日期:1994-07-01 00:00:00
abstract::A retrospective study of 343 women who lacked prenatal care was conducted to ascertain the effect of recent cocaine abuse on birth weight and gestational age. All pregnant women admitted in labor to a large urban teaching hospital between January 1 and December 31, 1986 who had not received prenatal care were included...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1988-09-01 00:00:00
abstract::The effectiveness of the carbon dioxide laser was evaluated in the treatment of penile, anorectal, and urethral condylomata acuminata in 40 men. All but six cases of urethral condylomata were prior conventional treatment failures. Postlaser follow-up ranged between one and two years, with an average of 16 months. No p...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1984-05-01 00:00:00
abstract::The authors determined the prevalence of certain major congenital disorders among live-born infants of 6509 mothers in a prepaid health plan for the 30-month period of January 1, 1980 through June 30, 1982 who used a wide variety of drugs during the first trimester of pregnancy. The results were similar to those obtai...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1985-04-01 00:00:00
abstract:OBJECTIVE:To compare persistent ectopic pregnancy after laparoscopic salpingostomy versus salpingostomy at laparotomy for the treatment of intact ampullary ectopic pregnancy. METHODS:We reviewed the medical records of 157 patients who had undergone salpingostomy for intact ampullary ectopic pregnancy at Yale-New Haven...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1993-03-01 00:00:00
abstract::Sacral nerve stimulation delivers nonpainful electrical pulses to the sacral nerves that modulate the reflexes that control the bladder, bowels, and pelvic floor musculature. This relatively simple procedure was generated to improve and restore function in patients with a variety of pelvic floor disorders. Currently t...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/AOG.0000000000002968
更新日期:2018-12-01 00:00:00
abstract::Monitoring the quality of well-established multisite clerkships can be aided by the use of trend analysis and graphic-oriented presentations. Five years of data on student performance, experience, and perceptions are reported for an obstetrics and gynecology clerkship offered at eight geographically dispersed sites. O...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1985-11-01 00:00:00
abstract:BACKGROUND:Infection and endotoxemia have been associated with neurologic injury in the newborn. In addition, recent reports have noted an increased incidence of fetal neurologic injury in the presence of intrauterine infection. CASES:Three pregnancies complicated by acute appendicitis and refractory preterm labor res...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(95)00211-9
更新日期:1995-10-01 00:00:00
abstract::Danazol is widely used in the management of endometriosis and mammary dysplasia. However, its mechanism of action is still obscure because of the few studies done and the controversial results obtained. Antigonadotropic activity has been postulated by some investigators, whereas others have observed no effect on the g...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1979-04-01 00:00:00
abstract::Serum measurements of beta-human chorionic gonadotropin (beta-hCG) for pregnancy tests are now positive at very low levels (25 mIU/mL). Sonography is the diagnostic method of choice for patients with the possibility of intrauterine trophoblastic disease. A case is reported in which ultrasound confused an ovarian neopl...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00006250-198603001-00027
更新日期:1986-03-01 00:00:00