Clinical Investigation

The cost comparison between the routine amniocentesis and ultrasonographically adjusted age dependent down syndrome risk to detect increased aneuploidy risk in the advanced maternal age

  • Talat Umut Kutlu Dilek
  • Hüseyin Durukan
  • Filiz Çayan
  • İlay Öztürk
  • Arzu Doruk
  • Saffet Dilek

Turk J Obstet Gynecol 2009;6(1):41-47


To asses cost effectiveness of ultrasound based adjusted age related Down syndrome risk over 35’s.


Retrospective study in a tertiary center. Medical records of total 572 patients were reviewed retrospectively. Age based Down syndrome risk were adjusted according to genetic ultrasound between the 16th and 22th weeks’ of pregnancy. By this way, all patients were divided to three distinct group such as high risk group (Adjusted Down syndrome risk higher than 1/300), moderate risk (between the 1/301-1/800) and low risk (Lower than 1/801) Following this, all subjects underwent genetic amniocentesis. Karyotype results and distrubution of aneuploid cases in the risk groups were assesed. Also total cost of genetic amniocentesis and karyotyping and to detect a Down syndrome case were calculated.


By age based risk assesment 134 patients (23,3 %) were classifed as medium risk and 438 patients (76,7 %) were high risk group. By ultrasound adjusted risk estimation, 257 patients (45 %) were classified low risk, 181 cases (31,7 %) classified medium and 133 (23,3 %) were classified as high risk. By genetic ultrasound, we detected major abnormalities in 12 patient (2,1 %) and minor anomalies in 62 (12,7 %) cases. Pregnancy loss was occured in a pregnancy following the memrane rupture. 11 of 13 cases of Down syndrome were detected in high risk group which classified by ultrasound adjusted age risk. Total cost of genetic ultrasound, amniocentesis and, karyotype analysis in high risk group (ultrasound adjusted) was 33280 YTL and cost of one cases of Down syndrome was 3480 YTL.


Routine amniocentesis to pregnant women over 35 years old was not cost effective. By ultrasound adjusted age risk criteria, total cost could be decreased approximately 60 %.

Keywords: Aneuploidiy, Down syndrome, ultrasound, amniocentesis