Karl Oliver Kagan

Objective To assess whether the fetal fraction (FF) has an impact on the screen‐positive rate (SPR) in cell‐free DNA (cfDNA) screening for trisomy 21. Methods Retrospective analysis based on samples analyzed using the Harmony ® Prenatal Test (Roche Inc). Due to the size of the data set, we focused on the SPR, which was stratified according to the maternal age, weight, gestational age, and FF distribution. Results The study cohort consisted of 364,881 patients, including 2614 with a high‐risk‐result. Median maternal and gestational ages were 34.6 years and 12.4 weeks. FF was dependent on maternal age, weight, and gestational age. SPR was 0.72% and it was independent of maternal weight but was dependent on maternal age. There was a positive but weak association between the FF and the SPR until the FF reached 20.0% (OR p = 1.021, p < 0.001, Nagelkerkes r 2 = 0.001). This group included 357,800 pregnancies or 98.1% of the study population. In the group of pregnancies with a FF > 20%, the association was stronger (OR 1.099, p < 0.001, Nagelkerkes r 2 = 0.042). Conclusion The SPR in cfDNA screening for trisomy 21 was relatively constant up to a FF of about 20%.

Objective To investigate how often antenatal corticosteroids (ACS) were administered within the optimal time frame in women at risk of preterm birth (PTB) in relation to several diagnoses and risk factors. Method The study was designed as a retrospective cohort trial, in which the data of all births taking place in 2016 in the German federal state of Rhineland‐Palatinate were evaluated. Frequency analyses, subgroup analyses, and logistic regression were performed. Results Birth occurred within the ideal time frame (≥24 h, ≤7 days) in only 15.2% of all pregnant women who were treated with ACS because of an increased risk of PTB ( N = 1544). The ideal time frame after ACS administration was reached in less than 25% of all cases in each subgroup, with little difference between the different diagnoses and risk factors for PTB (range 11.3%–22.2%). Patients with multiple pregnancy had a significantly higher chance for delivery within the ideal time frame. There was an odds ratio greater than 1 for a birth event within the ideal time frame in patients with preterm prelabor rupture of membranes, pre‐eclampsia, oligohydramnios, amniotic infection syndrome, and in patients with multiple diagnoses. In most diagnoses, the average time between ACS administration and birth was significantly shorter compared with patients without the diagnosis or risk factor. Conclusion In women at risk of PTB, the individual risk profile should first be identified before ACS management begins. The likelihood of achieving the ideal time frame additionally depends on the diagnosis.