First trimester screening using ultrasound and serum markers in Panamanians: Factors associated with adverse pregnancy outcomes

Background: Th ere is no published data on the association between serum biochemical and ultrasonographic markers and adverse pregnancy outcomes. Th erefore, the aim of this study was to determine the factors associated with perinatal outcomes in singleton pregnancies using ultrasound and maternal serum markers during the fi rst trimester in Panamanians. Materials and Methods: Th is was a prospective observational study of 468 fi rst trimester singleton pregnancies conducted over a 7-year period. All women attending a prenatal screening clinic during the study period were informed of the study and the option to participate. Two maternal serum markers, free β-human chorionic gonadotropin (β-hCG) and pregnancy associated plasma protein-A (PAPP-A), and four fetal ultrasound markers, nuchal translucency thickness, nasal bone, fl ow across the tricuspid valve, and fl ow in the ductus venosus (DV), were measured by certifi ed maternal fetal medicine specialists. Adverse outcomes included miscarriage, major structural defects, genetic disorders, and major fetal cardiac defects. Results: A total of 454 (97%) pregnancies were unaff ected. Median maternal age was 31.5 years (range: 18-50). Maternal age was signifi cantly greater in cases of adverse outcome (P = 0.007). Th e number of adverse outcomes associated with an absent or hypoplastic nasal bone, tricuspid valve regurgitation, and abnormal fl ow in the DV were signifi cantly greater relative to unaff ected pregnancies (Ps < 0.001). No diff erences were found in fetal crown-rump length or maternal serum levels of β-hCG or PAPP-A. Conclusion: Abnormal ultrasound markers are associated with adverse outcomes. Women with normal ultrasound and serum markers should be reassured of low risk of adverse pregnancy outcomes.