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Alain Gagnon - One of the best experts on this subject based on the ideXlab platform.
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No. 262-Prenatal Screening for and Diagnosis of Aneuploidy in Twin Pregnancies.
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 2017Co-Authors: François Audibert, Alain GagnonAbstract:To provide a Canadian consensus document with recommendations on Prenatal Screening for and diagnosis of fetal aneuploidy (e.g., Down syndrome and trisomy 18) in twin pregnancies. The process of Prenatal Screening and diagnosis in twin pregnancies is complex. This document reviews the options available to pregnant women and the challenges specific to Screening and diagnosis in a twin pregnancy. Clinicians will be better informed about the accuracy of different Screening options in twin pregnancies and about techniques of invasive Prenatal diagnosis in twins. PubMed and Cochrane Database were searched for relevant English and French language articles published between 1985 and 2010, using appropriate controlled vocabulary and key words (aneuploidy, Down syndrome, trisomy, Prenatal Screening, genetic health risk, genetic health surveillance, Prenatal diagnosis, twin gestation). Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. Searches were updated on a regular basis and incorporated in the guideline to August 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The previous Society of Obstetricians and Gynaecologists of Canada guidelines regarding Prenatal Screening were also reviewed in developing this clinical practice guideline. The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). There is a need for specific guidelines for Prenatal Screening and diagnosis in twins. These guidelines should assist health care providers in the approach to this aspect of Prenatal care of women with twin pregnancies. RECOMMENDATIONS. Copyright © 2017. Published by Elsevier Inc.
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Prenatal Screening for and Diagnosis of Aneuploidy in Twin Pregnancies
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 2011Co-Authors: François Audibert, Alain GagnonAbstract:Objective: To provide a Canadian consensus document with recommendations on Prenatal Screening for and diagnosis of fetal aneuploidy (e . g . , Down syndrome and trisomy 18) in twin pregnancies . Options: The process of Prenatal Screening and diagnosis in twin pregnancies is complex . This document reviews the options available to pregnant women and the challenges specific to Screening and diagnosis in a twin pregnancy .
Jacob A. Canick - One of the best experts on this subject based on the ideXlab platform.
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Prenatal Screening for trisomy 21: recent advances and guidelines.
Clinical chemistry and laboratory medicine, 2012Co-Authors: Jacob A. CanickAbstract:The performance of Prenatal Screening tests for the identification of trisomy 21 (Down syndrome) has markedly improved since the 1970s and early 1980s when maternal age was the sole mode of Screening the general pregnant population. With the discovery of second trimester serum markers in the 1980s and 1990s and implementation of double, triple, and quad marker testing; the discovery of first trimester serum and ultrasound markers in the 1990s and implementation of the combined test; and the development of the integrated test and sequential Screening strategies over the past decade, the performance of Screening has improved to a detection rate of 90%–95% at a false positive rate of 2%–5%. In this review, I will describe the advances in Prenatal Screening for trisomy 21, present current Screening strategies, and discuss guidelines published by professional societies and regulatory bodies, with a focus on current Prenatal Screening practice in the USA.
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Prenatal Screening for open neural tube defects
Clinics in laboratory medicine, 2003Co-Authors: Jacob A. Canick, Leonard H. Kellner, Allan T. BombardAbstract:The era of Prenatal Screening for serious birth defects began in the 1970s with the discovery that amniotic fluid and maternal serum levels of alpha-fetoprotein (AFP) were increased in pregnancies affected by fetal open neural tube defects. Since then, Prenatal Screening has become a part of routine obstetric care. In this article, the use of AFP in Prenatal Screening for open neural tube defects is discussed in the context of the laboratory and the laboratory's interactions with the practicing obstetrician.
Gerrit Van Der Wal - One of the best experts on this subject based on the ideXlab platform.
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Understanding pregnant women's decision making concerning Prenatal Screening.
Health psychology : official journal of the Division of Health Psychology American Psychological Association, 2008Co-Authors: Matthijs Van Den Berg, Danielle R. M. Timmermans, Dirk L. Knol, Jacques Th. M. Van Eijk, Denhard J. De Smit, John M. G. Van Vugt, Gerrit Van Der WalAbstract:Objective: This study is aimed at enhancing understanding Prenatal Screening decision making through testing a hypothesized decision model based on decision theory and health behavior theory. Design: We obtained questionnaires from 1,666 pregnant women who were offered Prenatal Screening for Down's syndrome. Path analysis (using LISREL) resulted in a final model with reasonable model fit, which was verified by split-sample cross-validation. Main outcome measures: These included perceived probability, perceived severity, attitude toward termination, response efficacy, attitude toward Prenatal Screening, subjective norm, child-related anxiety, and intention to undergo Prenatal Screening. Results: Attitude toward termination of pregnancy, perceived test efficacy, and subjective norm regarding the desirability of having Prenatal Screening determined a woman's attitude toward having a Prenatal test. Anxiety was influenced by perceived risk and perceived severity of having a child with Down's syndrome, and by subjective norm, but this appeared to be a weak predictor of intention to test. Pregnant women with a positive attitude toward Prenatal Screening, and who perceived a subjective norm in favor of undergoing Prenatal Screening, showed a greater intention to have Prenatal Screening done. Conclusion: These findings suggest that more attention should be paid toward the values and social context of pregnant women during the counseling process. © 2008 American Psychological Association.
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Are counsellors' attitudes influencing pregnant women's attitudes and decisions on Prenatal Screening?
Prenatal diagnosis, 2007Co-Authors: Matthijs Van Den Berg, J.h. Kleinveld, Danielle R. M. Timmermans, Dirk L. Knol, Jacques Th. M. Van Eijk, Gerrit Van Der Wal, John M. G. Van VugtAbstract:Objectives It is generally recognised that choices concerning treatment or Screening should be people’s own, autonomous decisions. However, in the context of genetic counselling, many studies found that counsellors deviate from nondirectiveness, or that subjective norm influences behaviour. The present study aimed to investigate whether Prenatal counsellors (midwives, gynaecologists) influence pregnant women’s decisions and their attitudes regarding Prenatal Screening. It was hypothesised that uptake rates and attitudes would be associated with the counsellor’s attitude toward Prenatal Screening. Methods Pregnant women attending their midwifery or gynaecology practice were asked to fill out postal questionnaires before and after they were offered Prenatal Screening for Down syndrome. Their Prenatal counsellors also filled in a questionnaire. These questionnaires assessed attitudes toward Prenatal Screening and background variables. The study sample consisted of 945 pregnant women, being guided by 97 Prenatal counsellors. Results Multilevel regression analyses revealed that neither uptake rates, nor attitude toward Prenatal Screening were significantly predicted by counsellors’ attitudes toward Prenatal Screening.
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Informed decision making in the context of Prenatal Screening.
Patient education and counseling, 2005Co-Authors: Matthijs Van Den Berg, Danielle R. M. Timmermans, John M. G. Van Vugt, Leo P Ten Kate, Gerrit Van Der WalAbstract:This study aimed to construct a measure of informed decision making that includes knowledge, deliberation, and value-consistency, and to assess the level of informed decision making about Prenatal Screening, and differences between test acceptors and test decliners. Women attending one of 44 midwifery and gynaecology practices were asked to fill out postal questionnaires before and after the Prenatal Screening offer. The principal outcome was the level of informed decision making. For this purpose, knowledge about Prenatal Screening, deliberation about the pros and cons of the alternatives, test uptake, and attitude towards having a Prenatal Screening test were measured. Eighty-four percent of the participants were sufficiently knowledgeable about Prenatal Screening, 75% of the decisions were deliberate, and 82% were value-consistent. Fifty-one percent of the participants made an informed decision. Test acceptors made less informed decisions as compared to test decliners. This difference was mainly caused by the lower rate of deliberation in this group. It appears from this study that Prenatal Screening decisions are often not informed decisions. This is inconsistent with the main objective of offering Screening, which is to enable people to make informed decisions. Decision makers should be encouraged during the counselling to deliberate about the various alternatives.
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Informed decision making in the context of Prenatal Screening.
Patient Education and Counseling, 2005Co-Authors: Matthijs Van Den Berg, Danielle R. M. Timmermans, John M. G. Van Vugt, Leo P. Ten Kate, Gerrit Van Der WalAbstract:Objective: This study aimed to construct a measure of informed decision making that includes knowledge, deliberation, and valueconsistency, and to assess the level of informed decision making about Prenatal Screening, and differences between test acceptors and test decliners. Methods: Women attending one of 44 midwifery and gynaecology practices were asked to fill out postal questionnaires before and after the Prenatal Screening offer. The principal outcome was the level of informed decision making. For this purpose, knowledge about Prenatal Screening, deliberation about the pros and cons of the alternatives, test uptake, and attitude towards having a Prenatal Screening test were measured. Results: Eighty-four percent of the participants were sufficiently knowledgeable about Prenatal Screening, 75% of the decisions were deliberate, and 82% were value-consistent. Fifty-one percent of the participants made an informed decision. Test acceptors made less informed decisions as compared to test decliners. This difference was mainly caused by the lower rate of deliberation in this group. Conclusion: It appears from this study that Prenatal Screening decisions are often not informed decisions. This is inconsistent with the main objective of offering Screening, which is to enable people to make informed decisions. Practice implications: Decision makers should be encouraged during the counselling to deliberate about the various alternatives. # 2005 Elsevier Ireland Ltd. All rights reserved.
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Accepting or declining the offer of Prenatal Screening for congenital defects: test uptake and women's reasons.
Prenatal diagnosis, 2005Co-Authors: Matthijs Van Den Berg, Danielle R. M. Timmermans, John M. G. Van Vugt, Johanna H. Kleinveld, E. Garcia, Gerrit Van Der WalAbstract:Objectives Prenatal Screening for Down syndrome has become standard practice in many western countries. In the Netherlands, however, Prenatal Screening tests for congenital defects are not offered routinely. The present study aims to assess test uptake in a large, unselected population of pregnant women, and to give more insight into the decision for or against Prenatal Screening through nuchal translucency measurement or maternal serum Screening. Patients and Methods The study is part of a randomized controlled trial with two groups, each being offered a different Prenatal Screening test, and a control group. Pregnant women received postal questionnaires at three stages of their pregnancy. Results Of the women being offered the nuchal translucency measurement or the second trimester maternal serum test, 53 and 38% respectively accepted the test offer. The main reasons for accepting were ‘gaining knowledge about the health of the foetus/curiosity’ (50%), ‘favourable characteristics of the Screening test’ (18%), and ‘increased risk of having a child with DS’ (15%). The main reasons for declining were ‘unfavourable characteristics of the Screening test’ (42%), ‘not applicable/not necessary’ (35%), ‘anxiety/uncertainty’ (36%), ‘adverse characteristics of the invasive tests’ (32%), and ‘being against abortion’ (15%). Discussion The uptake of Prenatal Screening was relatively low, and different distributions of reasons were reported, compared to other studies. These differences may be due to the specific Dutch situation in which Prenatal Screening is not part of standard Prenatal care. The question arises as to whether informed decision-making would be reduced if Prenatal Screening became routinised. Copyright © 2005 John Wiley & Sons, Ltd.
François Audibert - One of the best experts on this subject based on the ideXlab platform.
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No. 262-Prenatal Screening for and Diagnosis of Aneuploidy in Twin Pregnancies.
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 2017Co-Authors: François Audibert, Alain GagnonAbstract:To provide a Canadian consensus document with recommendations on Prenatal Screening for and diagnosis of fetal aneuploidy (e.g., Down syndrome and trisomy 18) in twin pregnancies. The process of Prenatal Screening and diagnosis in twin pregnancies is complex. This document reviews the options available to pregnant women and the challenges specific to Screening and diagnosis in a twin pregnancy. Clinicians will be better informed about the accuracy of different Screening options in twin pregnancies and about techniques of invasive Prenatal diagnosis in twins. PubMed and Cochrane Database were searched for relevant English and French language articles published between 1985 and 2010, using appropriate controlled vocabulary and key words (aneuploidy, Down syndrome, trisomy, Prenatal Screening, genetic health risk, genetic health surveillance, Prenatal diagnosis, twin gestation). Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. Searches were updated on a regular basis and incorporated in the guideline to August 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The previous Society of Obstetricians and Gynaecologists of Canada guidelines regarding Prenatal Screening were also reviewed in developing this clinical practice guideline. The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). There is a need for specific guidelines for Prenatal Screening and diagnosis in twins. These guidelines should assist health care providers in the approach to this aspect of Prenatal care of women with twin pregnancies. RECOMMENDATIONS. Copyright © 2017. Published by Elsevier Inc.
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Prenatal Screening for and Diagnosis of Aneuploidy in Twin Pregnancies
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 2011Co-Authors: François Audibert, Alain GagnonAbstract:Objective: To provide a Canadian consensus document with recommendations on Prenatal Screening for and diagnosis of fetal aneuploidy (e . g . , Down syndrome and trisomy 18) in twin pregnancies . Options: The process of Prenatal Screening and diagnosis in twin pregnancies is complex . This document reviews the options available to pregnant women and the challenges specific to Screening and diagnosis in a twin pregnancy .
Sandra A. Farrell - One of the best experts on this subject based on the ideXlab platform.
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Maternal age–based Prenatal Screening for chromosomal disorders
Canadian Family Physician, 2013Co-Authors: June C. Carroll, Andrea L. Rideout, Brenda Wilson, Judith Allanson, Sean M. Blaine, Mary Jane Esplen, Sandra A. Farrell, Gail E. Graham, Jennifer Mackenzie, Wendy S. MeschinoAbstract:Objective To explore views of women and health care providers (HCPs) about the changing recommendations regarding maternal age–based Prenatal Screening. Design Mixed-methods design. Setting Ontario. Participants A sample of women who had given birth within the previous 2 years and who had attended a family medicine centre, midwifery practice, or baby and mother wellness program (n = 42); and a random sample of family physicians (n = 1600), and all Ontario obstetricians (n = 694) and midwives (n = 334) who provided Prenatal care. Methods We used focus groups (FGs) to explore women's views. Content analysis was used to uncover themes and delineate meaning. To explore HCPs' views, we conducted a cross-sectional self-completion survey. Main findings All FG participants (42 women in 6 FGs) expressed the importance of individual choice of Prenatal Screening modality, regardless of age. They described their perception that society considers women older than 35 to be at high obstetric risk and raised concerns that change in the maternal age–related Screening policy would require education. The HCP survey response rate was 40%. Results showed 24% of HCPs agreed that women of any age should be eligible for invasive diagnostic testing regardless of Prenatal Screening results; 15% agreed that the age for diagnostic testing should be increased to 40 years, 14% agreed that diagnostic testing should be reserved for women with positive Prenatal Screening results, and 45% agreed that Prenatal Screening should remain unchanged. Conclusion Maternity care organizations have recommended that maternal age–based Prenatal Screening is no longer appropriate. Informed choice is of paramount importance to women and should be part of any change. Health care providers need to be engaged in and educated about any change to Screening guidelines to offer women informed choices.
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standardized procedural practices of the ontario Prenatal Screening program for aneuploidies and open neural tube defects
Clinical Biochemistry, 2012Co-Authors: Nathalie Lepage, Ayeshah Chaudhry, Danijela Konforte, Julie L V Shaw, K Veljkovic, Alan Dennis, Shamim Rashid, Sandra A. FarrellAbstract:Abstract Background/Objectives The Ontario Prenatal Screening Program (OPSP) follows internationally recognized standardized procedures for laboratories and genetics clinics. However, it has been found that some procedures are subject to interpretation, so the current procedures are designed to facilitate a unified approach in the interpretation of literature recommendations. In Ontario, the OPSP offers multiple Screening modalities with integrated Prenatal Screening (including both first and second trimester markers) being the most commonly chosen option. Other Screening modalities include first trimester Screening, second trimester quad Screening, serum integrated Screening, and NT-Quad. Methods The standardization was based on a literature review and on current practices in Ontario. Results/discussion The main finding of the review was a paucity of published data relating to the procedures and the decision-making processes involved in Prenatal Screening. The purpose of this publication is to provide the most up-to-date and pertinent information for clinical laboratory professionals involved with Prenatal Screening for Down syndrome, trisomy 18 and open neural tube defects.
