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Ultraschall Med. 2019 Apr;40(2):176-193. doi: 10.1055/a-0631-8898. Epub 2018 Jul 12.

DEGUM, ÖGUM, SGUM and FMF Germany Recommendations for the Implementation of First-Trimester Screening, Detailed Ultrasound, Cell-Free DNA Screening and Diagnostic Procedures.

[Article in English, German; Abstract available in German from the publisher]

Author information

1, Prenatal Medicine and Genetics, Düsseldorf, Germany.
Clinic of Obstetrics, University Hospital Zurich, Switzerland.
Department of Obstetrics and Perinatal Medicine, Medical University Bonn, Germany.
Department of Obstetrics and Prenatal Medicine HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany.
Prenatal Medicine, Erfurt, Germany.
Department of Obstetrics and Prenatal Medicine, Medical University Tübingen, Germany.
Obstetrics and Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany.
Department of Obstetrics and Gynecology, Medical University Graz, Austria.
Center for Ultrasound and Prenatal Medicine, Frankfurt, Germany.
Praenamed, Salzburg, Austria.
Ultraschallpraxis Freie Strasse, Basel, Switzerland.
Private, Berlin, Germany.
Prenatal Medicine and Genetics, München, Germany.


in English, German

First-trimester screening between 11 + 0 and 13 + 6 weeks with qualified prenatal counseling, detailed ultrasound, biochemical markers and maternal factors has become the basis for decisions about further examinations. It detects numerous structural and genetic anomalies. The inclusion of uterine artery Doppler and PlGF screens for preeclampsia and fetal growth restriction. Low-dose aspirin significantly reduces the prevalence of severe preterm eclampsia. Cut-off values define groups of high, intermediate and low probability. Prenatal counseling uses detection and false-positive rates to work out the individual need profile and the corresponding decision: no further diagnosis/screening - cell-free DNA screening - diagnostic procedure and genetic analysis. In pre-test counseling it must be recognized that the prevalence of trisomy 21, 18 or 13 is low in younger women, as in submicroscopic anomalies in every maternal age. Even with high specificities, the positive predictive values of screening tests for rare anomalies are low. In the general population trisomies and sex chromosome aneuploidies account for approximately 70 % of anomalies recognizable by conventional genetic analysis. Screen positive results of cfDNA tests have to be proven by diagnostic procedure and genetic diagnosis. In cases of inconclusive results a higher rate of genetic anomalies is detected. Procedure-related fetal loss rates after chorionic biopsy and amniocentesis performed by experts are lower than 1 to 2 in 1000. Counseling should include the possible detection of submicroscopic anomalies by comparative genomic hybridization (array-CGH). At present, existing studies about screening for microdeletions and duplications do not provide reliable data to calculate sensitivities, false-positive rates and positive predictive values.

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