Triple test

The triple test, also called triple screen, the Kettering test or the Bart's test, is an
investigation performed during pregnancy in the second trimester to classify a patient as either
high-risk or low-risk for chromosomal abnormalities (and neural tube defects).
The term "multiple-marker screening test" is sometimes used instead.[1][2] This term can
encompass the "double test" and "quadruple test" (described below).
The Triple test measures serum levels of AFP, estriol, and beta-hCG, with a 70% sensitivity
and 5% false-positive rate. It is complemented in some regions of the United States, as the
Quad test (adding inhibin A to the panel, resulting in an 81% sensitivity and 5% false-positive
rate for detecting Down syndrome)[3] and other prenatal diagnosis techniques, although it
remains widely used in Canada[4] and other countries. A positive test means having a high risk
of chromosomal abnormalities (and neural tube defects), and such patients are then referred
for more sensitive and specific procedures to receive a definitive diagnosis, mostly invasive
procedures like amniocentesis. The Triple test can be understood as an early predecessor to a
long line of subsequent technological improvements. In some American states, such as
Missouri, Medicaid reimburses only for the Triple test and not other potentially more accurate
screening tests, whereas California offers Quad tests to all pregnant women.[5]

Conditions screened
The most common abnormality the test can screen is trisomy 21 (Down syndrome). In
addition to Down syndrome, the triple and quadruple tests screen for fetal trisomy 18 also
known as Edward's syndrome, open neural tube defects, and may also detect an increased risk
of Turner syndrome, triploidy, trisomy 16 mosaicism, fetal death, Smith-Lemli-Opitz
syndrome, and steroid sulfatase deficiency.[6]

Values measured
The triple test measures the following three levels in the maternal serum:[7]

alpha-fetoprotein (AFP)
human chorionic gonadotropin (hCG)
unconjugated estriol (UE3)

Interpretation
The levels may indicate increased risk for certain conditions:
AFP UE3 hCG Associated conditions
low low high Down Syndrome
low low low trisomy 18 (Edward's syndrome)
neural tube defects like spina bifida associated with increase levels of
high n/a n/a acetylcholinesterase in aminonic fluid, or omphalocele, or gastroschisis, or
multiple gestation like twins or triplets
An estimated risk is calculated and adjusted for the expectant mother's age;[8] if she's diabetic;
if she's having twins or other multiples, and the gestational age of the fetus. Weight and
ethnicity may also be used in adjustments.[citation needed] Many of these factors affect the levels of
the substances being measured and the interpretation of the results.
The test is for screening, not for diagnosis,[9] and does not have nearly the same predictive
power of amniocentesis or chorionic villus sampling. The screening test carries a much lower
risk to the fetus, however, and in conjunction with the age-related risk of the patient it is
useful to help determine the need for more invasive tests.

Triple Test Result

If only two of the hormones above are tested for, then the test is called a double test. A quad
test tests an additional hormone, inhibin. Furthermore, the triple test may be combined with an
ultrasound measurement of nuchal translucency.[citation needed]
3.0 Normal 3.1 Normal 3.5 Normal 4.0 Normal 4.7 Normal 5.0 Normal 5.1 Abnormal

Quadruple test
A test of levels of dimeric inhibin A (DIA) is sometimes added to the other three tests, under
the name "quadruple test."[10] Other names used include "quad test", "quad screen", or "tetra
screen." Inhibin A (DIA) will be found high in cases of Trisomy 21 and low in cases of
Trisomy 18.