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# Integrated screen

I'm 44 and pregnant. My doctor can not seem to explain to me what a positive result on the Integrated screen would mean for me. My age alone puts me in a high risk category for Down's Sydrome- I understand that. Will the Integrated screen automatically yield a high risk result for me because of my age alone? I'm also confused that she says that the highest risk the tests can yield is 1 in 100. This, to me, means a 1% chance of having a baby with one of the birth defects the screen is measuring. However, I keep reading-- and my doctor agrees-- the screen (without amniocentesis) has a 92% accuracy rate in predicting Downs Syndrome (or Trisomy 18 or a neaural tube defect). This is conflicting data to me. If I got a positive on the integrated screen, could I interpret that to mean there is a 92% chance my baby has one of the 3 birth defects? If so, why are the results reported in a ratio such as 1 in 10,000 or 1 in 250, etc.? If it's going to come out positive simply because I'm 44, it's just another worry for me to have with no value. Will you please clarify the numbers for me?
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The 92% "accuracy rate" refers the sensitivity of the Integrated Screening.  It means that in routine screening, 92% of the women who are carrying a baby with Down Syndrome will have a positive Integrated Screen result (most screens in the 2nd trimester are considered positive risk if risk is greater than 1 in 270).  On the flip side, it also means that 8% of the women who are carrying a baby with Down syndrome will have a negative risk assessment.

The ratio used in interpreting risk is the result of a mathematical calculation of data and statistics, comparing your blood markers to the frequency rates of Down Syndrome and the data of thousands of pregnancies.  Because Integrated Screening is not diagnostic, it will always be measured as a "ratio" of risk -- in percentages -- and age is part of that calculation.  Although older women are more likely to have a positive screen, many have results that show negative risk and go on to have normal pregnancies.

Do keep in mind that screening may cause worry for some women and indeed have no value.  What should be driving your decision whether or not to "screen" is to think about if and how the information will impact the management of your pregnancy.  Curiosity is not a good incentive to pursue screening or testing; it's important that you choose only those tests and options that best benefit your personal situation.  I hope this helps.

~eureka
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I am 19 1/2 weeks pregnant and 39 yrs old. I wish I had not taken the quad screen tests. My doctor told me it would more than likely come back positive due to my age and it did and now I am worried, and upset. My risk factor came back 1/10 chance of having my baby having down syndrome. I will not do the amnio because I will not terminate and it is not worth the risk to the baby - even though it would be peace of mind or devistation for me.  I had a level II u/s and genetic counseling. The dr tried to tell me look at the flip side, I have a 90% chance of the baby being normal. Well a 1/10 risk is not good. My age risk alone was 1/88.  Just rememberr all it is, is a risk factor screen not a diagnostic test. Thats what I try to keep remembering.
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