PRISCA Prenatal Risk Calculation

Contents
Intended Use...........................................................................................................................................2
Summary and Explanation ......................................................................................................................2
Warnings and Precautions ......................................................................................................................2
Materials Supplied...................................................................................................................................2
Required But Not Supplied......................................................................................................................3
Instructions for Use .................................................................................................................................3
PRISCA Start Page.................................................................................................................................3
Input Fields on the PRISCA Start Page ..............................................................................................3
Buttons on the Start Page ...................................................................................................................5
Main Menu Item - Special .....................................................................................................................10
Password...............................................................................................................................................10
Superuser ..........................................................................................................................................10
User ...................................................................................................................................................11
Weight Regression................................................................................................................................11
Statistics ................................................................................................................................................12
New Statistics ....................................................................................................................................13
IMMULITE Download ............................................................................................................................14
Possible Discrepancies: ....................................................................................................................15
Excel Export ..........................................................................................................................................18
Tab Sheet "Settings" .........................................................................................................................19
Tab Sheet "Columns" ........................................................................................................................20
Settings .................................................................................................................................................20
Reports ..............................................................................................................................................21
Configuration .....................................................................................................................................21
Protocols ...............................................................................................................................................24
Referring Doctors ..................................................................................................................................26
Medians.................................................................................................................................................29
References ............................................................................................................................................33
Technical Assistance ............................................................................................................................34

PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 1

Intended Use
PRISCA 4.0 is a software application providing statistical risk assessment for Down's syndrome
(trisomy 21) and Edwards syndrome (trisomy 18) in the first and second trimesters of pregnancy and
for neural tube defects (NTD) in the second trimester. A pregnant woman's risk, as calculated by the
software, is not confirmatory for these chromosomal abnormalities; rather, it is intended for in vitro
diagnostic use as additional support for her decision whether or not to undergo a diagnostic
procedure.
Catalog Number: (PRISCA) PRISCA Prenatal Risk Calculation Software 4.0

Summary and Explanation

Down's syndrome (trisomy 21) is the most common chromosomal abnormality in newborns, with an
incidence of approximately 1:800. The only prenatal test diagnostic for chromosomal abnormalities is
cytogenetic examination (karyotyping) of fetal cells using invasive procedures such as amniocentesis
or chorion villus sampling (CVS).
Bases for the selection of pregnant women to undergo diagnostic procedures of this kind include:
advanced maternal age, the subject's medical history, or a statistical risk assessment derived from
maternal age plus some combination of biochemical screening test results and ultrasound
information. Specific algorithms for statistical risk assessment use some combination of biochemical
markers and maternal age, the exact gestational age and nuchal translucency (in the first trimester) to
estimate the risk.
Risk assessment by PRISCA 4.0 software relies upon maternal age, the exact gestational age,
relevant medical history, and the measurement of multiple biochemical markers used for maternal
screening. Median values throughout weeks 10 up to 13 (first trimester) and from weeks 14 up to 21
(second trimester) need to be well documented for each of the markers.
PRISCA 4.0 compares the subject's serum result with the median for that gestational age to express
the result as a multiple of the median (MoM), for any of the following biochemical tests: PAPP-A and
free β−HCG, during the first trimester; AFP, HCG (or free β−HCG) and unconjugated estriol, during
the second trimester. Optionally, a MoM can also be calculated for nuchal translucency — an
echographic measurement performed in the first trimester — and combined with the biochemical
markers.
PRISCA 4.0 is able to provide MoMs corrected for variable factors such as gestational age, maternal
weight, ethnicity, smoking, twin pregnancy, diabetes and IVF procedures. Once the corrected MoM
value is obtained, the likelihood ratio is calculated for each of these values, and the combination of all
likelihood ratios with maternal age related risk (a priori risk) yields the final risk assessment.
PRISCA 4.0 is a user-friendly program operating under Windows, either on a stand-alone basis or in
a network. It features a statistical module to allow updating of medians and the creation of a quality
control program for monitoring any of the relevant maternal screening components — for example:
MoMs, detection rates, false-positive rates, population parameters, and so on.

Warnings and Precautions

For in vitro diagnostic use.

Materials Supplied
PRISCA Software CD-ROMs 1 and 2 (ZD123CD1, ZD123CD2)
Two CD-ROMs containing installation and software files and instructions for use.

Licence Disc (ZD123LD)

One 3.5 inch floppy disc for the user to record the license number.

2 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)

Required But Not Supplied
For use with the following Assays: AFP (LKAP, L2KAP, L5KAP), Unconjugated Estriol (LKEF, L2KEF,
L5KEF), HCG (LKCG, L2KCG, L5KCG), Free Beta-HCG (LKFB, L2KFB, L5KFB),
PAPP-A (LKPC, L2KPC, L5KPC).
A computer which meets the following minimum system requirements:
Microsoft® Windows™ OS 9x / 2000 / NT / XP
200 MHz CPU
Minimum 16 MB RAM (32 recommended)
256 color video display
800 × 600 screen resolution
4X CD-ROM drive
30 MB Minimum Free Space on the hard drive
Requirements to make a remote connection with pcAnywhere:
2 Serial Ports (COM1 / COM2)
1 Network Board
1 Modem
1 Phone Connection
1 Remote Software "pcAnywhere"

Instructions for Use

PRISCA Start Page

All entries relevant for calculating risk are specified on the PRISCA start page. The appearance of the
start page depends on the protocol selected. The illustration above represents the start page for the
traditional triple-test protocol, which calculates the risk using the following biochemical parameters:
AFP, hCG, uE3. If additional input fields are needed, you will have to select the appropriate protocol.
As soon as enough entries are available, the risk calculation is performed.

Input Fields on the PRISCA Start Page

You may use the "Tab"-key of your keyboard to jump from one field to the next.

PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 3

Date of Birth
The mother’s age is calculated as soon as the date of birth has been entered and you have moved on
to the next input field. In the settings menu, you can specify whether the mother’s age should be
calculated according to the time of delivery or to the time of the blood sample.

Gestational Age
The gestational age must refer to the day of the blood sample. You can enter the gestational age
directly, provided that you have not selected a protocol that also allows you to enter nuchal
translucency.
As soon as the gestational age is known, the corresponding medians are displayed.
If you are unable to enter the gestational age directly (dependent on the selected protocol), or if you
would like PRISCA to calculate this age because you are aware of the biparietal diameter (BPD) or
crown-rump length, click on the button marked "More" (see illustration).

If you would like nuchal translucency to be taken into account, then you must allow PRISCA to
calculate the gestational age using the crown-rump length given.

Determination Method
If you have entered the gestational age directly, you can select the method on which it is based.
Gestational age is regarded as confirmed when it is based on an ultrasound examination, or if the
date of conception is known.

PRISCA sets the determination method automatically when used to calculate gestational age. No
more changes should be made once this has been done.
The above drop-down list is only available for some of the protocols (e.g. the triple test).

Correction Factors
A large number of factors can influence the MoMs. To this end, the MoMs have to be corrected if the
patient is a smoker, a diabetic, or if she has an IVF pregnancy or is expecting twins. Ethnic origins are
also relevant and, of course, the mother's weight.
As far as risk calculation is concerned, only the corrected MoMs that appear in the 4th column at the
bottom of the page are relevant.

4 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)

Risks
PRISCA is able to calculate different risks:
¾ Age risk
¾ Biochemical risk for trisomy 21
¾ Biochemical risk for trisomy 18
¾ A combination from nuchal translucency + biochemical risk for trisomy 21
¾ Neural tube defects risk
Whether or not all risks are calculated depends on what information is available to PRISCA. For
example, in order to calculate the neural tube defect risk, AFP must have been measured. Nuchal
translucency must have been measured in order to calculate combined risk.
You will not be able to calculate the neural tube defect risk during screening in the first trimester, for
example, because AFP can only be measured in the second trimester.
When a risk is below the cut-off value it is deemed usual and is marked green; when a risk is above
the cut-off value it is deemed unusual and is marked red.

Buttons on the Start Page

The buttons on the start page will be described in the next sections.

Browse
This button is used to browse the database.

PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 5

Alternatively, you might want to use the main menu:

New

Insert new record

Delete

Deletes current record

Save

Saves the current record. PRISCA will also save automatically when you use the Browse button.

6 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)

Sort

Opens the patient list:

By clicking on one of the grey column headings, you can sort the database according to the column
selected.

PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 7

Find

Opens the patient list:

Enter a search term into the Search field.

Select the column in which you would like to search.
PRISCA begins searching as soon as the first character is entered into the search field; it goes to the
first matching record in the database.

Report

Begins the printing process. A print preview is displayed:

To print the preview displayed on your monitor, click on the printer symbol. To close the window
without printing, click on the Close button.

8 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)

Batch

Starts the Batch report: This function prints out all the records that you have selected from the patient
list in a previous step.

Selecting Records
Open the list view by clicking on the "List" tab sheet.

Click on the small grey box at the beginning of the line belonging to the records that you would like to
select for printing. Selected lines are highlighted in blue.
You can also mark multiple records by holding the CTRL key on your keyboard while clicking on the
small grey box at the beginning of the line.
To mark records made on a particular day, enter the required date in the date list and click on
"Select".

Close

The Close button terminates PRISCA and saves the current record.

PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 9

Main Menu Item - Special

This menu item contains the following sub-menus:

¾ Password
¾ Weight regression
¾ Statistics
¾ IMMULITE® Download
¾ Excel Export
¾ Settings
¾ Referring Doctors
¾ Medians

Password
Superuser

PRISCA must be started in the "Superuser" access privilege mode to access this page. As you can
see from the illustration above, you can change the default username (Superuser) and the default
password (Superuser).

10 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)

User
In the same way, you can modify the default username for the user-level, and the password for the
user.
These users (default log-in: username=user, password=user) have restricted access to PRISCA and
cannot change settings or make calculations that might influence the risk calculation. We strongly
recommend allowing only one person to login as the "Superuser". This person will carry full
responsibility for any changes made to the default settings.
Save any changes you have made by clicking on the "OK" button.
To change the Superuser settings, click on the Superuser tab sheet.

Weight Regression

The mother’s weight has an influence on the serum values. To this end, the MoMs have to be
corrected. If your database is large enough, you can let PRISCA calculate the algorithms by which
the MoMs are corrected. Given that the mother’s weight has a different influence on each of the
markers, each parameter has its own algorithm.
Select a parameter from the drop-down list (see black arrow). You can enter a date range if you do
not want all the records in your database to be taken into account (perhaps because a lot change has
been made).
You can specify (see blue arrow) which regression curves you would like to have displayed.
You can exclude pregnancies involving twins, IVF treatment and diabetes from the calculation in
order to create a regression curve that is as accurate as possible.
Click on the "Display" button to display the diagram.
Click on the "Print" button to print the diagram.

PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 11

Click on the "Apply new medians" button to apply the new weight regression.

Statistics

Listed are some of the most popular statistics. To load one of these statistics, select a record and
then click on:

LoadNew New statistics are created.

If you have saved the statistics along with a date range, then you will have to
enter new data here: New start date = old end date + 1 day, new end date =
today’s date.
LoadOld The statistics are created according to the way in which they were last saved – no
new calculations are done.
Start date and end date have not changed since the last time they were saved.
New You can create a new set of statistics

12 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)

New Statistics

Enter a descriptive title for the statistics into the name field.
Select a parameter from the drop-down list, according to which the statistics will be calculated. The
parameters illustrated below represent an extract from those available:

Select the type of graph to be created from the list. The following types are available:

You can group the statistics and have them displayed according to month, year etc.
In the Date range field, you can specify whether the statistics should refer to the last x measured
values or whether they should refer to a particular date range.
Select a Calculation method. Although there are a number of options available, not all
parameter/calculation method combinations make sense:

PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 13

It is a good idea to display the positive rate of the biochemical trisomy 21 risk. To do this, select
"biochemical trisomy 21 risk" from the drop-down parameter list and "Positive Rate" as the calculation
method.
You may also want to know the average age of your patients, since if the average age is high, you
can accept higher positive rates. To do this, select "Age at sample date" from the parameter list and
"Mean" or "Median" from the calculation method list.
To investigate whether the results for a particular referring physician are more unusual than on
average, select "Referring Physician" from the parameter list (this parameter cannot be seen in the
illustration) and "Positive Count" from the calculation method list.
Click on the button marked "Run Statistic" to create the graph.
Click on the button marked "Save Statistic" to permanently save the statistics.

IMMULITE Download

Currently, it is only possible to download IMMULITE files if you also use Typolog Software’s
"DESMODA" application. Desmoda is able to receive the data sent from IMMULITE to the LIS. These
files can be read using PRISCA’s IMMULITE Download menu item. (The following illustrations do not
feature records that can be imported into PRISCA, but come from a software application called

14 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)

Follow. For the purpose of illustration, we will be dealing with male patients, but the principle is the
same).
Those files which are capable of being imported are listed (see illustration). Before these records can
actually be imported into PRISCA, you will have to validate them. You might want to validate all of the
records displayed (click on "Validate all records") or you might want to validate each record
individually. By clicking on the "Next" button, all validated records are applied to PRISCA.

Possible Discrepancies:

The list above contains the same patient twice. Select a patient from the list (click in the
corresponding line) and click on Import.

PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 15

In the illustration above, 3 records have been found for which the ID and date of birth are identical but
the names are different. You can do the following:
- Use the name and date of birth for all records, as in the line selected
- Enter a different ID number for the selected record so that it can be distinguished
- Import none of the records

16 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)

The illustration above indicates that a repeat measurement has taken place, since PRISCA already
contains a record with:
- the same ID
- the same first name
- the same last name
- the same date of birth
By clicking in the appropriate box, you can decide whether you want to replace the existing value with
the value to be imported or whether you would like to retain the existing value.

PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 17

Excel Export

Click on the "Prepare" button to fill an empty grid with your records.

Click on "Export" to export the records displayed in the table.

Click on "OK" to exit the menu.
Click on the tab sheet marked "Settings" to alter the default settings for export (name of the export
file, export format etc.).
Click on the tab sheet marked "Columns" to specify which of the table’s columns you would like to
export.

18 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)

Tab Sheet "Settings"

Give your export file a descriptive name.

Choose an export format from the drop-down list. PRISCA 4 supports the following formats:

You can also apply a filter to the database and only export those records that correspond to particular
criteria. To do this, you will have to
- check the field marked Filter.
- select a filter criterion from the drop-down list. The following criteria are available:

- set a date range for the chosen criterion.

If you make any changes to the settings, your database will have to be loaded again. To do this,
select Grid from the tab sheet and click on "Prepare".

PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 19

Tab Sheet "Columns"

Using your mouse, you will find all the database fields that may be exported under the different
tab sheet headings. Check the boxes that you would like to export.
If you make any changes to the settings, your database will have to be loaded again. To do this,
select Grid from the tab sheet and click on "Prepare".

Settings

Only one user with full access privilege (the person logging into PRISCA as Superuser) will have
access to this menu area. Numerous default settings can be changed under "Settings". Each of the
tab sheet pages can be selected by clicking on them.

Reports
This tab sheet page displays the different report layouts.

Configuration
This tab sheet page allows you to change the default settings such as the cut-offs.

Miscellaneous
Here you will find the date format default settings.

Protocols
Here you can specify which input fields for measured biochemical values should appear on the input
page.
Here you can specify which algorithm to use for the risk calculation.

20 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)

Reports

PRISCA can calculate the risk for Down's syndrome using one of four groups:
¾ Triple test: All second-trimester protocols, without nuchal translucency
¾ Triple + NT: Same as above, but with nuchal translucency
¾ Double test: First trimester with the parameters: PAPP-A + free ßhCG, no nuchal
translucency
¾ Double + NT: Same as above, but with nuchal translucency
You can choose which layout to use for each of these groups from the drop-down list.
For the "logo" report types, you can integrate your own logo. To do this, replace the Typolog logo file
(c:\Program Files\Typolog Software\Prisca4\Designs\logo.bmp) with a file of the same name
containing your logo.

Configuration

A tree structure has been used to display all the default settings that may be altered. Click on one of
the plus symbols to open the tree. You can close the tree again by clicking on the minus symbol.
PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 21
Actual Median List Values

Specify which default settings should be displayed in the ethnic origin field on the input page.

Cut-Off Values

You can specify whether a sentence containing a warning should be outputted with the interpretation
of the results when the MoM is particularly high or low. In the example illustrated, this would be the
case for an AFP-MoM of 2.5 and above.

The illustration above is displaying an entry for a cut-off value. This signifies that a result is deemed
unusual when the cut-off value is exceeded. In the example illustrated above, a cut-off (relates to
AFP) of 2.5 MoM has been specified for the neural tube defects risk.

Maximum, Minimum Risks

You can also specify the maximum (see illustration) and minimum risk values to be displayed for
trisomy 18, neural tube defects risk and trisomy 21. In the example illustrated above, a maximum risk
value of 1:70 will be displayed for trisomy 18. For an even greater risk value (i.e. 1:60) the following
would be displayed: >1:70.

22 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)

Export Path

Here you can enter the path of the folder in which you would like to save your export files.

Minimum Records for Median Calculation

Here you can specify the minimum number of records that have to be available for each week of
pregnancy before a median calculation can be carried out. 50 records for each week of pregnancy is
a sensible limit. The lower you set the limit, the more inaccurate the median calculation will be. The
quality of the risk calculation will also diminish accordingly!

Reports

In some cases, parts of the printout are missing. This happens especially with HP printers. In such
cases the bottom margin value of the report, which is not working, needs to be decreased.

PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 23

Date of Risk Calculation

"Date of risk calculation" allows you to specify whether the risks should be displayed at the time of
delivery or time of blood sample.

Protocols

The appearance of the input page will change depending on which protocol is selected. In the
illustration above, the second trimester triple test (AFP-hCG-uE3) has been selected; this protocol will
make the parameters AFP, hCG and uE3 available on the input page.
The illustration below shows additional protocols:

Should you decide to select the last but one protocol from the list, for instance, you will be able to
carry out all screening requirements (first trimester, second trimester, either with or without nuchal

24 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)

translucency) and all input fields will be available on the input page. The illustration below
demonstrates how the input page would look if the last but one protocol was selected:

A triple test has been carried out in the example above. PRISCA uses the gestational age to decide
whether to screen for the first or second trimester. In the example above, the patient is in the 15th
week of pregnancy, which means that second-trimester screening is the only option; PRISCA
automatically displays the medians for the 15th week.

PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 25

Referring Doctors
List View

You can use this menu to enter details of your referring doctors. The illustration below shows the list
view. To view each entry individually, click on the sheet tab marked "Single".

26 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)

Single View

The unique identification field is used to provide an expressive shorthand abbreviation for the
referring doctor. This abbreviation will not appear on printouts.
Address details will appear on printouts.
You can also assign a report layout that is different from the one you usually use for the selected
doctor. This is done by clicking on the "Design" tab sheet.

PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 27

Design

The design tab sheet is almost identical to the one on "Settings / Referring Doctors menu page". The
only difference is that these settings are restricted to the referring doctor currently selected and not to
the entire program (identification "sdfsdf" has been used for the doctor’s abbreviation in the
illustration above).

28 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)

Medians
The median page offers three different views, each of which is described in the sub-headings that
follow.
¾ Overview
¾ Table
¾ Selected Chart

The illustration above shows the results of a median calculation for AFP. You can select the
parameter for which you would like the medians to be calculated from parameter list.
To calculate medians from the data in the underlying database, check the field marked calculate.
To enter or modify the regression coefficients a and b (or c), de-select the field marked calculate.
By excluding certain records from the calculation, the median calculation can be made more
accurate:
¾ Twins
¾ Diabetes
¾ IVF
The display options are used to specify what you would like to see in the diagram.
You can limit the basis on which the data is drawn to a defined date range.

PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 29

When all the settings have been made, click on the "Display" button and you will see an interface
like the one in the illustration above. One of the diagrams has been highlighted. This means that
PRISCA has selected this underlying algorithm as the one that best represents the distribution of the
medians.
You can accept the suggested diagram and select another diagram.
Changes are applied as soon as you click on the "Apply" button. Before you click on "Apply", you
must have clicked on "Display".

Tab Sheet "Overview"

The Overview tab sheet provides an overview of the median calculation results. PRISCA calculates
the medians using different regression algorithms. These regression curves can be seen in the
overview. PRISCA has already highlighted the curve that best represents the measured values.
You can also select one of the other curves, should you regard it as being more suitable.

30 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)

Tab Sheet "Table"

To get a tabular view, click on the tab sheet marked "table". When insufficient data is available to
apply a median calculation, you will receive a warning like the one illustrated above.
PRISCA generates these warnings in line with the limits that have been pre-set in the "Settings"
menu.

PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 31

Tab Sheet "Selected Chart"

The Selected Chart tab sheet generates a single view of the selected diagram chart (see Overview).

32 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)

References
1. Wald, et al. Antenatal screening for Down's syndrome. Health Technol Assess 1998;2(1).
2. Wallace, et al. Calculating correct Down's syndrome risks. Br J Obstet Gynaecol 1999;106:371–2.
3. Palomaki, et al. Cigarette smoking and levels of maternal serum alpha-fetoprotein, unconjugated estriol, and
hcG: impact on down syndrome screening. Obstet Gynecol 1993:81(5 Pt 1).
4. Henriques, et al. Decreased alpha-fetoprotein in amniotic fluid and maternal serum in diabetic pregnancy.
Obstet Gynecol 1993;82(6):960–4.
5. Spencer, et al. Down’s syndrome screening in multiple pregnancies using alpha-fetoprotein and free beta
hCG. Prenatal Diagnosis 1994;14:537–42.
6. de Graaf, et al. Early pregnancy screening for fetal aneuploidy with serum markers and nuchal translucency.
Prenatal Diagnosis 1999;19(5):458–62.
7. Cuckle, et al. Estimating a woman's risk of having a pregnancy associated with Down's syndrome using her
age and serum alpha-fetoprotein level. Br J Obstet Gynaecol 1987;94:387–402.
8. Cuckle, et al. Improved parameters for risk estimation in Down's syndrome screening. Prenatal Diagnosis
1995;15:1057–65.
9. Snijders, et al. Maternal age- and gestation-specific risk for trisomy 21. Ultrasound Obstet Gynecol
1999;13:167–70.
10. Norgaard-Pedersen, et al. Maternal serum markers in screening for Down syndrome. Clin Genet
1990;37:35–43.
11. Wald, et al. Maternal serum screening for Down's syndrome in early pregnancy. BMJ 1988;297:883–7.
12. Wald, et al. Maternal serum unconjugated oestriol and human chorionic gonadotrophin levels in twin
pregnancies: implications for screening for Down's syndrome. Br J Obstet Gynaecol 1991;98:905–908.
13. Coombes, et al. Prenatal screening for trisomy 18 with free beta human chorionic gonadotrophin as a
marker. BMJ 1993;307:1455–8.
14. Neveux, et al. Refinements in managing maternal weight adjustment for interpreting prenatal screening
results. Prenatal Diagnosis 1996;16:1115–9.
15. Palomaki, et al. Risk-based prenatal screening for trisomy 18 using alpha-fetoprotein, unconjugated oestriol
and human chorionic gonadotropin. Prenatal Diagnosis 1995;15:713–23.
16. Wald, et al. Serum screening for Down's syndrome between 8 and 14 weeks of pregnancy. Br J Obstet
Gynaecol 1996;103:407–12.
17. Frishman, et al. Serum-triple-marker screening in in vitro fertilization and naturally conceived pregnancies.
Obstet Gynecol 1997;90(1):98–100.
18. Spencer, et al. The influence of ethnic origin on first trimester. Prenatal Diagnosis 2000;20:491–4.
19. Spencer, et al. The influence of smoking on maternal serum PAPP-A and free beta hCG levels in the first
trimester of pregnancy. Prenatal Diagnosis 1999;19(11):1065–6.

PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21) 33

Technical Assistance
Available outside the United States only. For technical assistance, contact your National Distributor.
The Quality System of Siemens Medical Solutions Diagnostics is certified to ISO 13485:2003.

Siemens Medical Solutions Diagnostics

5210 Pacific Concourse Drive
Los Angeles, CA 90045-6900
USA
Tel (310) 645-8200

2007-03-21
ZD123 – 4

Typolog Software
25436 Tornesch
Germany
+49-4122-960 435

34 PRISCA Prenatal Risk Calculation (ZD123-4, 2007-03-21)