Antenatal Testing:
The Quadruple Screen.
Introduction.

We would like to take a moment to more fully explain the purpose of the quadruple screen and its role as an important aspect of prenatal care.

Why is antenatal testing like the quadruple screen important?

The goal of every obstetrician and expectant parent is to have a healthy, memorable pregnancy and delivery experience. However, from time to time, pregnancies may be complicated by fetal problems that can occur during development. Tests such as the quadruple screen are designed to help doctors in the evaluation of pregnancies for possible fetal concerns. If a problem with a pregnancy is detected in advance of a patient’s delivery, an obstetrician can help provide parental counseling about medical care appropriate to the abnormality of the fetus.

What is a quadruple screen?

A quadruple screen is a test performed generally between 15 and 22 weeks gestation that measures four chemicals in a patient’s blood. The four components of the quadruple screen are inhibin-A, beta-hCG, alpha-fetoprotein and estriol. When these tests are evaluated in the context of other factors, such as maternal age, weight, gestational age, ethnicity, and family history of birth defects, the risk for possible pregnancy abnormalities can be calculated.


What do my results mean?

A quadruple screen is a “screening” test meaning that it does not provide a “yes” or “no” answer to whether a patient’s baby is normal. Instead, the quadruple screen helps to identify pregnancies that are categorized as either low-risk or high-risk for possible pregnancy abnormalities. A “negative” result for a patient’s quadruple screen indicates that the patient is low-risk for fetal developmental problems. This is considered reassuring but should not be misconstrued as a promise of a normal baby. Likewise, a “positive” quadruple screen result indicates a higher possible risk for fetal developmental problems but again is not a guarantee that a patient’s baby has a genetic problem or birth defect.

What happens if my test is returned as “positive?”

The quadruple screen tests for the fetal genetic risks of Down Syndrome, a similar genetic condition referred to as Edward’s Syndrome, and early brain and spine developmental problems such as Spina Bifida. However, it can also provide additional information about other abnormalities that can affect the baby’s health and growth that may prove helpful to a patient’s doctor in caring for her pregnancy.


Patients with a positive result on their quadruple screen will be encouraged to undergo additional testing to evaluate their pregnancy further. A referral to a maternal fetal medicine sub-specialist, also referred to as a perinatalogist, is generally recommended where a detailed ultrasound evaluation of the baby can be performed and the patient and the perinatalogist can discuss whether additional testing may be needed, such as an amniocentesis.


If a pregnancy is found to be complicated by a serious birth defect, the parents will be given the opportunity to undergo counseling to help them understand more fully the implications of the medical condition of their baby, its potential for recurrence in future pregnancies, and medical options for care during this pregnancy. If the pregnancy complications are severe, termination may sometimes be considered. If the fetal problems are compatible with life after delivery but pose a serious threat to a newborn’s well-being, arrangements can be made to deliver at a large hospital where an infant can receive the most advanced medical care possible.


Conclusion.

Every parent and physician hopes for a perfect pregnancy and a memorable delivery. The quadruple screen provides physicians with the ability to detect many fetal problems prior to delivery. When problems do occur, knowing what these concerns are in advance of a patient’s delivery can help an obstetrician provide counseling for the parents and make arrangements for the very best in medical care indicated by the developmental problems of the fetus.


Although the American College of Obstetricians and Gynecologists has recommended that pregnant patients be screened for birth defects, the cost of the quadruple screen laboratory test may or may not be covered by different health insurance plans. Patients are encouraged to check with their health plan to see if this is a covered benefit before having the test performed.


We hope this brief explanation of the importance of the quadruple screen test during pregnancy has proven helpful. If you have any additional questions, please feel free to discuss them further with your doctor.