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Prenatal testing
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=== Second trimester === The [[anomaly scan]] is performed between 18 and 22 weeks of [[Gestational age (obstetrics)|gestational age]]. The [[International Society of Ultrasound in Obstetrics and Gynecology]] (ISUOG) recommends that this ultrasound is performed as a matter of routine [[prenatal care]], to measure the fetus so that growth abnormalities can be recognized quickly later in pregnancy, and to assess for [[congenital malformations]] and [[Multiple birth|multiple pregnancies]] (i.e. twins).<ref>{{cite journal | vauthors = Salomon LJ, Alfirevic Z, Berghella V, Bilardo C, Hernandez-Andrade E, Johnsen SL, Kalache K, Leung KY, Malinger G, Munoz H, Prefumo F, Toi A, Lee W | display-authors = 6 | title = Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan | journal = Ultrasound in Obstetrics & Gynecology | volume = 37 | issue = 1 | pages = 116β26 | date = January 2011 | pmid = 20842655 | doi = 10.1002/uog.8831 | s2cid = 10676445 | doi-access = free}}</ref> The scan can detect [[anencephaly]], open [[spina bifida]], [[cleft lip]], [[diaphragmatic hernia]], [[gastroschisis]], [[omphalocele]], [[congenital heart defect]], [[Renal agenesis|bilateral renal agenesis]], [[osteochondrodysplasia]], [[Edwards syndrome]], and [[Patau syndrome]].<ref>{{Cite web|url=https://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/anomaly-scan-18-19-20-21-weeks-pregnant.aspx|title=Mid-pregnancy anomaly scan β Pregnancy and baby β NHS Choices|last=NHS Choices|website=www.nhs.uk|language=en|access-date=December 4, 2017}}</ref> A second-trimester [[Triple test#Quadruple test|Quad blood test]] may be taken (the [[Triple test]] is widely considered obsolete but in some states, such as Missouri, where [[Medicaid]] only covers the Triple test, that's what the patient typically gets). With ''integrated screening'', both a First Trimester Combined Test and a Triple/Quad test is performed, and a report is only produced after both tests have been analyzed. However patients may not wish to wait between these two sets of tests. With ''sequential screening'', a first report is produced after the first trimester sample has been submitted, and a final report after the second sample. With ''contingent screening'', patients at very high or very low risks will get reports after the first-trimester sample has been submitted. Only patients with ''moderate risk'' (risk score between 1:50 and 1:2000) will be asked to submit a second-trimester sample, after which they will receive a report combining information from both serum samples and the [[nuchal translucency|NT]] measurement. The First Trimester Combined Test and the Triple/Quad test together have a sensitivity of 88β95% with a 5% false-positive rate for Down syndrome, though they can also be analyzed in such a way as to offer a 90% sensitivity with a 2% false-positive rate. Finally, patients who do not receive an NT ultrasound in the 1st trimester may still receive a Serum Integrated test involving measuring PAPP-A serum levels in the 1st trimester and then doing a Quad test in the 2nd trimester. This offers an 85β88% sensitivity and 5% false-positive rate for Down syndrome. Also, a patient may skip the 1st-trimester screening entirely and receive only a 2nd-trimester Quad test, with an 81% sensitivity for Down syndrome and 5% false-positive rate.<ref>[https://web.archive.org/web/20170212001459/http://www.cdph.ca.gov/programs/pns/Documents/Provider%20Handbook%20%202009%20WEB.pdf The California Prenatal Screening Program]. cdph.ca.gov</ref>
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