Testes urinários para rastrear a síndrome de Down
Appendices
Appendix 1. Search strategy
Database: Ovid MEDLINE
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
1 exp Prenatal Diagnosis/
2 nuchal translucency.mp.
3 exp Pregnancy‐Associated Plasma Protein‐A/
4 pregnancy associated plasma protein a.mp.
5 papp‐a.mp.
6 exp Chorionic Gonadotropin, beta Subunit, Human/
7 (b‐hcg or bhcg).mp.
8 human chorionic gonadotropin.mp.
9 exp alpha‐Fetoproteins/
10 alphafetoprotein$.mp.
11 alpha‐fetoprotein$.mp.
12 afp.mp.
13 (unconjugated estriol or unconjugated oestriol).mp.
14 ue3.mp.
15 exp INHIBINS/
16 inhibin a.mp.
17 ultrasound.mp.
18 amniocentesis/
19 chorion$ vill$ sampling.mp.
20 Chorionic Villi‐Sampling/
21 nasal bone.mp.
22 tricuspid regurgitation.mp.
23 ductus venosus.mp
24 marker$.mp.
25 screen$.mp.
26 detect$.mp.
27 accura$.mp.
28 predict$.mp.
29 ROC.mp.
30 ROC curve/
31 AUC.mp.
32 Area under curve/
33 exp false negative reactions/ or exp false positive reactions/
34 (false positive$ or false negative$).mp.
35 likelihood ratio$.mp.
36 sensitiv$.mp.
37 specific$.mp.
38 diagnos$.ti,ab.
39 "reproducibility of results".mp.
40 reference value$.mp.
41 reference standard$.mp.
42 exp Down Syndrome/
43 downs syndrome.mp.
44 down syndrome.mp.
45 trisomy 21.mp.
46 Aneuploidy/
47 aneuploidy.mp.
48 Mosaicism/
49 mosaicism.mp.
50 or/1‐41
51 or/42‐49
52 50 and 51
53 (antenatal$ or prenatal$ or trimester$ or pregnan$ or fetus or foetus or fetal or foetal).mp.
54 52 and 53
55 animal/ not (humans/ and animal/)
56 54 not 55
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EMBASE via Dialog Datastar
1. PRENATAL‐DIAGNOSIS#.DE.
2. FETUS‐ECHOGRAPHY#.DE.
3. PREGNANCY‐ASSOCIATED‐PLASMA‐PROTEIN‐A#.DE.
4. CHORIONIC‐GONADOTROPIN‐BETA‐SUBUNIT#.DE.
5. HCG.AB.
6. PAPP.AB.
7. ALPHA‐FETOPROTEIN#.DE.
8. AFP.AB.
9. ALPHA ADJ FETOPROTEIN$
10. ALPHAFETOPROTEIN$
11. BETA ADJ HUMAN ADJ CHORIONIC ADJ GONADOTROPIN
12. PREGNANCY ADJ ASSOCIATED ADJ PLASMA ADJ PROTEIN
13. (UNCONJUGATED ADJ ESTRIOL OR UNCONJUGATED ADJ OESTRIOL).TI.
14. (UNCONJUGATED ADJ ESTRIOL OR UNCONJUGATED ADJ OESTRIOL).AB.
15. UE3
16. INHIBIN‐A#.DE.
17. INHIBIN ADJ A
18. ULTRASOUND
19. AMNIOCENTESIS
20. CHORION‐VILLUS‐SAMPLING.DE.
21. NASAL ADJ BONE
22. TRICUSPID ADJ REGURGITATION
23. DUCTUS ADJ VENOSUS
24. MARKER OR MARKERS
25. SCREEN OR SCREENING
26. DETECT OR DETECTING OR DETECTION
27. FALSE ADJ POSITIVE$
28. FALSE ADJ NEGATIVE$
29. SENSITIVITY OR SENSITIVE OR SENSITIVITIES
30. SPECIFICITY OR SPECIFICITIES
31. (DIAGNOSE OR DIAGNOSIS OR DIAGNOSTIC OR DIAGNOSTICS OR DIAGNOSES
OR DIAGNOSED).TI.
32. (DIAGNOSE OR DIAGNOSIS OR DIAGNOSTIC OR DIAGNOSTICS OR DIAGNOSES
OR DIAGNOSED).AB.
33. ROC.AB.
34. AUC.AB.
35. AREA‐UNDER‐THE‐CURVE.DE.
36. ROC‐CURVE.DE.
37. ACCURA$
38. PREDICT$
39. REPRODUCIBILITY.DE.
40. REFERENCE ADJ VALUE$
41. REFERENCE‐VALUE.DE.
42. REFERENCE ADJ STANDARD$
43. DOWN‐SYNDROME#.DE.
44. DOWN ADJ SYNDROME OR DOWNS ADJ SYNDROME
45. TRISOMY ADJ '21'
46. MOSAICISM
47. ANEUPLOIDY
48. ANTENATAL$ OR PRENATAL$ OR PREGNANCY OR PREGNANT OR TRIMESTER$ OR MATERNAL OR FETUS OR FOETUS OR FOETAL OR FETAL
49. 1 OR 2 OR 3 OR 4 OR 5 OR 6 OR 7 OR 8 OR 9 OR 10 OR 11 OR 12 OR 13 OR 14 OR 15 OR 16 OR 17 OR 18 OR 19 OR 20 OR 21 Or 22 OR 23 OR 24 OR 25 OR 26 OR 27 OR 28 OR 29 OR 30 OR 31 OR 32 OR 33 OR 34 OR 35 OR 36 OR 37 OR 38 OR 39 OR 40 OR 41 OR 42
50. 43 OR 44 OR 45 OR 46 OR 47
51. 48 AND 49 AND 50
52. HUMAN=YES
53. 51 AND 52
ADJ = adjacent AB = abstract
TI = title $ = truncation symbol DE = descriptor (similar to MeSH)
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CINAHL via OVID
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
1 exp Prenatal Diagnosis/
2 nuchal translucency.mp.
3 pregnancy associated plasma protein.mp.
4 papp$.ti,ab.
5 exp Gonadotropins, chorionic/
6 (b‐hcg or bhcg).mp.
7 human chorionic gonadotropin.mp.
8 exp alpha‐Fetoproteins/
9 alphafetoprotein$.mp.
10 alpha‐fetoprotein$.mp.
11 afp.mp.
12 (unconjugated estriol or unconjugated oestriol).mp.
13 ue3.mp.
14 inhibin$.mp.
15 ultrasound.mp.
16 amniocentesis/
17 chorion$ vill$ sampling.mp.
18 Chorionic Villi‐Sampling/
19 nasal bone.mp.
20 tricuspid regurgitation.mp.
21 ductus venosus.mp.
22 marker$.mp.
23 screen$.mp.
24 detect$.mp.
25 accura$.mp.
26 predict$.mp.
27 ROC.mp.
28 ROC curve/
29 AUC.mp.
30 "area under curve".mp.
31 exp false negative reactions/ or exp false positive reactions/
32 (false positive$ or false negative$).mp.
33 likelihood ratio$.mp.
34 sensitiv$.mp.
35 specific$.mp.
36 diagnos$.ti,ab.
37 "reproducibility of results".mp.
38 reference value$.mp.
39 reference standard$.mp.
40 exp Down Syndrome/
41 downs syndrome.mp.
42 down syndrome.mp.
43 trisomy 21.mp.
44 aneuploidy.mp.
45 mosaicism.mp.
46 (antenatal$ or prenatal$ or trimester$ or pregnan$ or fetus or foetus or fetal or foetal).mp.
47 or/1‐39
48 or/40‐45
49 47 and 48 and 46
*******************************************************
Search terms and instructions for Biosis
The following search terms were entered separately in standard search box (select ‘Titles/subject/abstract’ from the drop‐down box on the right of the search box).
-
“reference standard*”
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“reference value*”
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“reproducibility of results”
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diagnos*
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sensitiv*
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specific*
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“likelihood ratio*”
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“false negative*
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“false positive”
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“area under curve”
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ROC
-
AUC
-
predict*
-
detect*
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marker*
-
screen*
-
accura*
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“ductus venosus”
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“nasal bone”
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“tricuspid regurgitation”
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“chorion* vill* sampling”
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amniocentesis
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ultrasound
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inhibin*
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“unconjugaed oestriol”
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“unconjugated estriol”
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afp
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“alpha fetoprotein*”
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alphafetoprotein*
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“ bhcg”
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“human chorionic gonadotrophin”
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“papp a”
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“pregnancy associated plasma protein”
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“nuchal translucency”
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foetal
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fetal
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foetus
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foetal
-
prenatal*
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antenatal*
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pregnan*
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maternal*
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“trisomy 21”
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mosaicism
-
“down* syndrome”
The search then used the history function to combine terms:
1‐34 – combine using OR
35 – 42 – combine using OR
43 – 45 – combine using OR
The three sets were combined using AND
The combined search strategy had the form
(((((((al: "trisomy 21") or (al: (mosaicism))) or (al: "down* syndrome"))) and (((((((((((((((((((((((((((((((((((al: "reference standard*") or (al: "reference value*")) or (al: "reproducibility of results")) or (al: (diagnos*))) or (al: (specific*))) or (al: (sensitiv*))) or (al: "likelihood ratio*")) or (al: "false negative*")) or (al: "false positive*")) or (al: "area under curve")) or (al: (auc))) or (al: (roc))) or (al: (predict*))) or (al: (accura*))) or (al: (detect*))) or (al: (screen*))) or (al: (marker*))) or (al: "ductus venosus")) or (al: "tricuspid regurgitation")) or (al: "nasal bone")) or (al: "chorion* vill* sampling")) or (al: (amniocentesis))) or (al: (ultrasound))) or (al: (inhibin*))) or (al: "unconjugated oestriol")) or (al: "unconjugated estriol")) or (al: (afp))) or (al: "alpha feto protein*")) or (al: "alpha fetoprotein*")) or (al: "b hcg")) or (al: "human chorionic gonadotropin")) or (al: "papp a")) or (al: "pregnancy associated plasma protein")) or (al: "nuchal translucency")))) and (((((((((al: (foetal)) or (al: (fetal))) or (al: (foetus))) or (al: (fetus))) or (al: (pregnan*))) or (al: (trimester*))) or (al: (prenatal*))) or (al: (antenatal*))))))
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Detection rates (% sensitivity) at a 5% false positive rate for the five most evaluated or best performing test strategies. The estimates are shown with 95% confidence intervals. The test strategies are ordered on the plot according to decreasing detection rate. The number of studies, cases and women included for each test strategy are shown on the horizontal axis.
Betacore, 1st trimester urine test, 5% FPR.
Betacore, 2nd trimester urine test, 5% FPR.
Betacore, 2nd trimester urine test, cutpoint mixed.
Gonadotropin, 2nd trimester urine test, risk 1:100.
Gonadotropin, 2nd trimester urine test, risk 1:384.
Gonadotropin, 2nd trimester urine test, 95% percentile.
ITA, 1st trimester urine test, 5% FPR.
ITA, 2nd trimester urine test, 3.74MoM.
ITA, 2nd trimester urine test, 5% FPR.
Total hCG, 1st trimester urine test, 5% FPR.
Total hCG, 2nd trimester urine test, 5% FPR.
Free ßhCG, 1st trimester urine test, 5% FPR.
Free ßhCG, 2nd trimester urine test, 5% FPR.
Oestriol, 2nd trimester urine test, 5% FPR.
Betacore to oestriol ratio, 2nd trimester urine test, 5% FPR.
Betacore and oestriol, 2nd trimester 5% FPR.
AFP and ITA, 2nd trimester urine test, 3% FPR.
AFP and ITA, 2nd trimester urine test, 5% FPR.
AFP and ITA, 2nd trimester urine test,10% FPR.
AFP and ITA, 2nd trimester urine test, 15% FPR.
AFP, uE3 and ITA, 2nd trimester urine test, 3% FPR.
AFP, uE3 and ITA, 2nd trimester urine test, 5% FPR.
AFP, uE3 and ITA, 2nd trimester urine test, 10% FPR.
AFP, uE3 and ITA, 2nd trimester urine test, 15% FPR.
Age, betacore, 2nd trimester urine test, 1% FPR.
Age, betacore, 2nd trimester urine test, 3% FPR.
Age, betacore, 2nd trimester urine test, 5% FPR.
Age, betacore, 2nd trimester urine test, 10% FPR.
Age, betacore, 2nd trimester urine test, 15% FPR.
Age, betacore, 2nd trimester urine test, 20% FPR.
Age, ITA, 2nd trimester urine test, 5% FPR.
Age, oestriol, 2nd trimester urine test, 5% FPR.
Age, free ßhCG, 2nd trimester urine test, 5% FPR.
Age, betacore to oestriol ratio, 2nd trimester urine test, 1% FPR.
Age, betacore to oestriol ratio, 2nd trimester urine test, 3% FPR.
Age, betacore to oestriol ratio, 2nd trimester urine test, 5% FPR.
Age, free ßhCG to oestriol ratio, 2nd trimester urine test, 5% FPR.
Age, oestriol and free ßhCG, 2nd trimester, 5% FPR.
Age, betacore to free ßhCG ratio, 2nd trimester, 5% FPR.
Age, betacore and oestriol, 2nd trimester 1% FPR.
Age, betacore and oestriol, 2nd trimester, 3% FPR.
Age, betacore and oestriol, 2nd trimester, 5% FPR.
Age, AFP and betacore to oestriol ratio, 2nd trimester, risk 1:10.
Age, AFP and betacore to oestriol ratio, 2nd trimester, risk 1:20.
Age, AFP and betacore to oestriol ratio, 2nd trimester, risk 1:30.
Age, AFP and betacore to oestriol ratio, 2nd trimester, risk 1:58.
Age, AFP and betacore to oestriol ratio, 2nd trimester, risk 1:270.
Age, AFP and betacore to oestriol ratio, 2nd trimester, risk 1:526.
| Review Question | What is the accuracy of urine based markers for screening for Down's syndrome? | ||||
| Population | Pregnant women at less than 24 weeks' gestation confirmed by ultrasound, who had not undergone previous testing for Down’s syndrome. Most studies were undertaken in women identified to be high risk based on maternal age | ||||
| Settings | All settings | ||||
| Numbers of studies, pregnancies and Down's syndrome cases | 19 studies (reported in 29 publications) involving 18,013 pregnancies of which 527 were Down's syndrome pregnancies. | ||||
| Index tests | Risk scores computed using maternal age and first and second trimester urine markers for AFP; ITA; ß‐core fragment; free ßhCG; total hCG; oestriol (also termed as uE3); gonadotropin peptide. | ||||
| Reference standards | Chromosomal verification (amniocentesis and CVS undertaken during pregnancy, and postnatal karyotyping) and postnatal macroscopic inspection. | ||||
| Study limitations | Seven studies only used selective chromosomal verification during pregnancy, and were at risk of under‐ascertainment of Down's syndrome cases due loss of the pregnancy to miscarriage between the serum test and the reference standard. | ||||
| Test | Studies | Women (Cases) | Sensitivity* (95% CI) | Specificity* (95% CI) | Threshold |
| Test without maternal age | |||||
| Single tests | |||||
| First trimester free ßhCG | 1 | 516 (86) | 5 (1 to 11) | 95 (92 to 97) | 5% FPR |
| First trimester ß‐core fragment | 1 | 516 (86) | 10 (5 to 19) | 95 (92 to 97) | 5% FPR |
| First trimester ITA | 2 | 579 (94) | 15 (2 to 62) | 95 | 5% FPR |
| First trimester total hCG | 1 | 516 (86) | 17 (10 to 27) | 95 (92 to 97) | 5% FPR |
| Second trimester oestriol | 2 | 1472 (47) | 23 (8 to 49) | 95 | 5% FPR |
| Second trimester total hCG | 1 | 390 (65) | 31 (20 to 43) | 95 (92 to 97) | 5% FPR |
| Second trimester free ßhCG | 3 | 1517 (107) | 32 (12 to 63) | 95 | 5% FPR |
| Second trimester ß‐core fragment | 6 | 9613 (193) | 41 (20 to 66) | 95 | 5% FPR |
| Second trimester ITA | 3 | 2748 (131) | 43 (35 to 51) | 95 | 5% FPR |
| Second trimester ß‐core fragment to oestriol ratio | 2 | 1649 (35) | 74 (58 to 86) | 95 | 5% FPR |
| Second trimester gonadotropin test | 1 | 105 (14) | 93 (66 to 100) | 95 (88 to 98) | 1:384 risk |
| Double tests | |||||
| Second trimester AFP and ITA | 1 | 524 (24) | 79 (58 to 93) | 95 (93 to 97) | 5% FPR |
| Second trimester ß‐core fragment and oestriol | 1 | 315 (24) | 83 (63 to 95) | 95 (92 to 97) | 5% FPR |
| Triple tests | |||||
| Second trimester AFP, uE3 and ITA | 1 | 524 (24) | 79 (58 to 93) | 95 (93 to 97) | 5% FPR |
| Test with maternal age | |||||
| Single tests | |||||
| Second trimester oestriol | 1 | 474 (69) | 49 (37 to 62) | 95 (92 to 97) | 5% FPR |
| Second trimester ß‐core fragment | 5 | 3419 (155) | 56 (45 to 66) | 95 | 5% FPR |
| Second trimester free ßhCG | 2 | 879 (98) | 57 (47 to 67) | 95 | 5% FPR |
| Second trimester free ßhCG to oestriol ratio | 1 | 474 (69) | 64 (51 to 75) | 95 (92 to 97) | 5% FPR |
| Second trimester ß‐core fragment to free ßhCG | 1 | 474 (69) | 67 (54 to 78) | 95 (92 to 97) | 5% FPR |
| Second trimester ITA | 1 | 1016 (23) | 70 (47 to 87) | 95 (93 to 96) | 5% FPR |
| Second trimester ß‐core fragment to oestriol ratio | 3 | 2088 (105) | 71 (51 to 86) | 95 | 5% FPR |
| Double tests | |||||
| Second trimester oestriol and free ßhCG | 1 | 474 (69) | 68 (56 to 79) | 95 (92 to 97) | 5% FPR |
| Second trimester ß‐core fragment and oestriol | 2 | 1631 (92) | 73 (57 to 85) | 95 | 5% FPR |
| Second trimester AFP and ß‐core fragment to oestriol ratio | 1 | 356 (10) | 90 (55 to 100) | 95 (93 to 97) | 1:58 risk |
| *Tests evaluated by at least one study are presented in the table. Where two studies reported the same threshold, estimates of summary sensitivity and summary specificity were obtained by using univariate fixed effects logistic regression models to pool sensitivities and specificities separately. if the threshold used was a 5% FPR, then only the sensitivities were pooled. AFP: alpha‐fetoprotein; ßhCG: beta human chorionic gonadotrophin;CI: confidence interval; CVS: chorionic villus sampling; FPR: false positive rate; hCG: beta human chorionic gonadotrophin;ITA: invasive trophoblast antigen; uE3: unconjugated oestriol | |||||
| Ratio of DORs (95% CI); P values (studies) | Second trimester AFP and ß‐core fragment to oestriol ratio, risk 1:58 | Second trimester ß‐core fragment and oestriol, 5% FPR | Second trimester ITA, 5% FPR | Second trimester ß‐core fragment to oestriol ratio, 5% FPR |
| Second trimester ß‐core fragment and oestriol, 5% FPR | – | |||
| Second trimester ITA, 5% FPR | – | – | ||
| Second trimester ß‐core fragment to oestriol ratio, 5% FPR | – | 1.5 (0.7 to 3.0); P = 0.27 (K = 2) | ||
| Second trimester ß‐core fragment, 5% FPR | – | 2.2 (1.1 to 4.5); P = 0.02 (K = 2) | – | 1.5 (0.8 to 2.8); P = 0.21 (K = 3) |
| Direct comparisons were made using only data from studies that compared each pair of tests in the same population. Ratio of diagnostic odds ratios (DOR)s were computed by division of the DOR for the test in the column by the DOR for the test in the row. If the ratio of DORs is greater than one, then the diagnostic accuracy of the test in the column is higher than that of the test in the row; if the ratio is less than one, the diagnostic accuracy of the test in the row is higher than that of the test in the column. AFP: alpha‐fetoprotein; CI: confidence interval; DORs: diagnostic odds ratio; FPR: false positive rate; ITA: invasive trophoblast antigen | ||||
| Ratio of DOR (95% CI); P value | Second trimester AFP and ß‐core fragment to oestriol ratio, risk 1:58 | Second trimester ß‐core fragment and oestriol, 5% FPR | Second trimester ITA, 5% FPR | Second trimester ß‐core fragment to oestriol ratio, 5% FPR | ||
| Studies | 1 | 2 | 1 | 3 | ||
| Studies | DOR (95% CI) | 186 (22, 1560) | 50 (30 to 84) | 43 (17 to 110) | 38 (24 to 59) | |
| Second trimester ß‐core fragment and oestriol, 5% FPR | 2 | 50 (30 to 84) | 3.7 (0.4 to 33.0); P = 0.24 | |||
| Second trimester ITA, 5% FPR | 1 | 43 (17 to 110) | 4.3 (0.4 to 44.0); P = 0.22 | 1.2 (0.4 to 3.4); P = 0.78 | ||
| Second trimester ß‐core fragment to oestriol ratio, 5% FPR | 3 | 38 (24 to 59) | 4.9 (0.6 to 43.4); P = 0.15 | 1.3 (0.7 to 2.6); P = 0.41 | 1.1 (0.4 to 3.2); P = 0.80 | |
| Second trimester ß‐core fragment, 5% FPR | 5 | 25 (18 to 36) | 7.3 (0.8 to 63.1); P = 0.07 | 2.0 (1.1 to 3.7); P = 0.03 | 1.7 (0.6 to 4.6); P = 0.30 | 1.5 (0.8 to 2.6); P = 0.18 |
| Indirect comparisons were made using all available data. Ratio of diagnostic odds ratios (DOR)s were computed by division of the DOR for the test in the column by the DOR for the test in the row. If the ratio of DORs is greater than one, then the diagnostic accuracy of the test in the column is higher than that of the test in the row; if the ratio is less than one, the diagnostic accuracy of the test in the row is higher than that of the test in the column. AFP: alpha‐fetoprotein; CI: confidence interval; DORs: diagnostic odds ratio; FPR: false positive rate; ITA: invasive trophoblast antigen | ||||||
| Test | No. of studies | No. of participants |
| 1 Betacore, 1st trimester urine test, 5% FPR Show forest plot | 1 | 516 |
| 2 Betacore, 2nd trimester urine test, 5% FPR Show forest plot | 6 | 9613 |
| 3 Betacore, 2nd trimester urine test, cutpoint mixed Show forest plot | 7 | 10124 |
| 4 Gonadotropin, 2nd trimester urine test, risk 1:100 Show forest plot | 1 | 105 |
| 5 Gonadotropin, 2nd trimester urine test, risk 1:384 Show forest plot | 1 | 105 |
| 6 Gonadotropin, 2nd trimester urine test, 95% percentile Show forest plot | 1 | 105 |
| 7 ITA, 1st trimester urine test, 5% FPR Show forest plot | 2 | 579 |
| 8 ITA, 2nd trimester urine test, 3.74MoM Show forest plot | 1 | 2051 |
| 9 ITA, 2nd trimester urine test, 5% FPR Show forest plot | 3 | 2748 |
| 10 Total hCG, 1st trimester urine test, 5% FPR Show forest plot | 1 | 516 |
| 11 Total hCG, 2nd trimester urine test, 5% FPR Show forest plot | 1 | 390 |
| 12 Free ßhCG, 1st trimester urine test, 5% FPR Show forest plot | 1 | 516 |
| 13 Free ßhCG, 2nd trimester urine test, 5% FPR Show forest plot | 3 | 1517 |
| 14 Oestriol, 2nd trimester urine test, 5% FPR Show forest plot | 2 | 1472 |
| 15 Betacore to oestriol ratio, 2nd trimester urine test, 5% FPR Show forest plot | 2 | 1649 |
| 16 Betacore and oestriol, 2nd trimester 5% FPR Show forest plot | 1 | 315 |
| 17 AFP and ITA, 2nd trimester urine test, 3% FPR Show forest plot | 1 | 524 |
| 18 AFP and ITA, 2nd trimester urine test, 5% FPR Show forest plot | 1 | 524 |
| 19 AFP and ITA, 2nd trimester urine test,10% FPR Show forest plot | 1 | 524 |
| 20 AFP and ITA, 2nd trimester urine test, 15% FPR Show forest plot | 1 | 524 |
| 21 AFP, uE3 and ITA, 2nd trimester urine test, 3% FPR Show forest plot | 1 | 524 |
| 22 AFP, uE3 and ITA, 2nd trimester urine test, 5% FPR Show forest plot | 1 | 524 |
| 23 AFP, uE3 and ITA, 2nd trimester urine test, 10% FPR Show forest plot | 1 | 524 |
| 24 AFP, uE3 and ITA, 2nd trimester urine test, 15% FPR Show forest plot | 1 | 524 |
| 25 Age, betacore, 2nd trimester urine test, 1% FPR Show forest plot | 2 | 2083 |
| 26 Age, betacore, 2nd trimester urine test, 3% FPR Show forest plot | 2 | 2083 |
| 27 Age, betacore, 2nd trimester urine test, 5% FPR Show forest plot | 5 | 3419 |
| 28 Age, betacore, 2nd trimester urine test, 10% FPR Show forest plot | 1 | 926 |
| 29 Age, betacore, 2nd trimester urine test, 15% FPR Show forest plot | 1 | 953 |
| 30 Age, betacore, 2nd trimester urine test, 20% FPR Show forest plot | 1 | 926 |
| 31 Age, ITA, 2nd trimester urine test, 5% FPR Show forest plot | 1 | 1016 |
| 32 Age, oestriol, 2nd trimester urine test, 5% FPR Show forest plot | 1 | 474 |
| 33 Age, free ßhCG, 2nd trimester urine test, 5% FPR Show forest plot | 2 | 879 |
| 34 Age, betacore to oestriol ratio, 2nd trimester urine test, 1% FPR Show forest plot | 1 | 1157 |
| 35 Age, betacore to oestriol ratio, 2nd trimester urine test, 3% FPR Show forest plot | 1 | 1157 |
| 36 Age, betacore to oestriol ratio, 2nd trimester urine test, 5% FPR Show forest plot | 3 | 2088 |
| 37 Age, free ßhCG to oestriol ratio, 2nd trimester urine test, 5% FPR Show forest plot | 1 | 474 |
| 38 Age, oestriol and free ßhCG, 2nd trimester, 5% FPR Show forest plot | 1 | 474 |
| 39 Age, betacore to free ßhCG ratio, 2nd trimester, 5% FPR Show forest plot | 1 | 474 |
| 40 Age, betacore and oestriol, 2nd trimester 1% FPR Show forest plot | 1 | 1157 |
| 41 Age, betacore and oestriol, 2nd trimester, 3% FPR Show forest plot | 1 | 1157 |
| 42 Age, betacore and oestriol, 2nd trimester, 5% FPR Show forest plot | 2 | 1631 |
| 43 Age, AFP and betacore to oestriol ratio, 2nd trimester, risk 1:10 Show forest plot | 1 | 356 |
| 44 Age, AFP and betacore to oestriol ratio, 2nd trimester, risk 1:20 Show forest plot | 1 | 356 |
| 45 Age, AFP and betacore to oestriol ratio, 2nd trimester, risk 1:30 Show forest plot | 1 | 356 |
| 46 Age, AFP and betacore to oestriol ratio, 2nd trimester, risk 1:58 Show forest plot | 1 | 356 |
| 47 Age, AFP and betacore to oestriol ratio, 2nd trimester, risk 1:270 Show forest plot | 1 | 356 |
| 48 Age, AFP and betacore to oestriol ratio, 2nd trimester, risk 1:526 Show forest plot | 1 | 356 |
