Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

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Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
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Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Year : 2021 | Month : August | Volume : 15 | Issue : 8 | Page : CE01 - CE04 Full Version

Prenatal Markers of Foetal Complications

Published: August 1, 2021 | DOI:
Hanan L Al-Omary, Zainab M Alawad

1. Assistant Professor, Department of Physiology, College of Medicine/University of Baghdad, Baghdad, Iraq. 2. Lecturer, Department of Physiology, College of Medicine/University of Baghdad, Baghdad, Iraq.

Correspondence Address :
Dr. Zainab M Alawad,
Lecturer, Department of Physiology, College of Medicine University of Baghdad, Bab Al Muadam, P.O.Box 61023, Mail Code 12114, Baghdad, Iraq.


Prenatal markers are commonly used in practice to screen for some foetal abnormalities. They can be biochemical or ultrasonic markers in addition to the newly used cell free Deoxyribonucleic Acid (DNA) estimation. This review aimed to illustrate the applications of the prenatal screening, and the reliability of these tests in detecting the presence of abnormal chromosomes such as trisomy-21, trisomy-18, and trisomy-13 in addition to neural tube defects. Prenatal markers can also be used in the anticipation of some obstetrical complications depending on levels of these markers in the mother’s circulation. In the developed countries, prenatal screening tests are regularly used during antenatal care period. Neural tube defects, numerical and structural chromosomal abnormalities, in addition to some obstetrical problems are commonly screened for, by using prenatal tests. Maternal education about the importance of performing these tests should be done in order to improve the detection rate of foetal abnormalities and some pregnancy complications.


Detection, Neural tube defects, Screening

Prenatal diagnosis refers to the discovery of foetal abnormalities before birth, while screening is the method of surveying group of people, using a special indicator or several indicators and establishing specific level or cut-off levels, in order to recognise those in the group who are at increased risk for a specific disorder (1). The prenatal screening methods were implemented in practice since 1980, mother’s serum was assessed for presence of numerical or structural foetal chromosomal abnormalities. In 1984, a relationship between decreased levels of serum Alpha Fetoprotein (AFP) in the pregnant mother and Down’s syndrome was found (2). After that, the maternal serum tests (biochemistry) and precise ultrasonographic imaging in the second trimester were developed and permitted the recognition of pregnancies with high risk (1).

Later in the 1990s, the screening during pregnancy has been shifted to first trimester via combining the age of the mother, Nuchal Translucency (NT) in the foetus, free beta Human Chorionic Gonadotropin (β-HCG), and Pregnancy-Associated Plasma Protein-A (PAPP-A) in mother’s serum (2). More recently, the prenatal screening methods have been diverted to genomic screening that measures (free foetal DNA) in the mother’s blood (1). If there are abnormal levels of maternal markers, associated with no foetal chromosomal disorders, this may reflect presence of obstetrical complications (3). (Table/Fig 1) shows the concept of prenatal screening. Prenatal markers can aid in the detection of the disorder, in addition to its prognosis and treatment. Markers can identify the biological condition and they can discover the changes in the components of tissues or fluids of the body more accurately (4).

It is essential to understand the difference between the diagnostic test and the screening test, the diagnostic test confirms the presence of the anomaly in the foetus that is thought to be at risk, whereas the screening test searches for the possibility of the abnormality in the foetus in an obviously normal pregnancy (5).

This review sheds the light on the applications and the importance of prenatal screening in the detection of chromosomal disorders and adverse pregnancy outcomes.


Foetal chromosomal aberrations, such as Down’s syndrome and Edward’s syndrome and unfavourable obstetric complications including preeclampsia, preterm deliveries, gestational diabetes, and foetal growth restriction might not be detected merely by taking full history and by evaluating patients’ risk factors especially in nulliparous females.

Prediction of these outcomes within the first three months of pregnancy (first trimester) may allow sufficient time for early intervention like starting a prophylactic management, and trying to identify the severity of the consequences via the follow-up of complicated cases using prenatal markers. This emphasises the importance of research in this area to find more prenatal tests with good prediction rates (5),(6).

Congenital anomalies represent about 7% of neonatal deaths, and a lot of them have no well-known pathophysiological cause, since specific and robust laboratory tests are not always available (7). Physicians depend on tests such as ultrasound and Magnetic Resonance Imaging (MRI). Biomarker including the prenatal markers, are shown to be powerful screening tools to predict disease and health of human, because they mirror an individual’s state of health (7). There is a common method that categorises pregnant women into high or low risk groups based on the possibility of presence or absence of unfavourable foetal or maternal outcomes (8).

Looking for foetal aneuploidy in the first trimester is considered the most widely employed test in the beginning of pregnancy for the prognostication of a successive pregnancy complications, such as, delivering an infant with abnormal chromosomes. This made it necessary for the new development of screening plans by the aid of several biomarkers in early pregnancy for guessing other pregnancy complications that may affect the foetus later on and cause complications, such as preeclampsia, preterm birth, gestational diabetes, and foetal growth limitation (9).

Indications for Prenatal Maternal Biomarkers in Diagnosing and Screening Tests

It is important to screen for possible foetal anomalies in order to minimise the possibility of unwanted results, to establish a proper way of care throughout pregnancy and to identify high risk groups (10). Women above 35-year-old, presence of a previous child with Down’s syndrome or other chromosomal disorders, translocation carrier state in parents, and history of genetic defects in family are common indications of prenatal screening (11).


Gestational hypertension and preeclampsia can lead to maternal and foetal death and morbidity (e.g., prematurity) all over the world (12). The mechanism of increasing blood pressure in pregnancy is not totally understood but mostly it is associated with endothelial dysfunction because of the imbalanced angiogenic controller factors and oxidative stress biomarkers (13).

Preeclampsia is the most common serious problem in pregnancy, with incidence of 2-8% throughout the world (14). The application of several biomarkers in expecting these results has been studied, involving Doppler- indices of uterine artery (15),(16); indicators of the function of placenta, like Pregnancy associated Plasma Protein A (PAPP-A) and plasma-protein 13 (17); inhibin A and activin A, placental growth factor and Vascular Endothelial Growth Factor (VEGF) (18), and the inhibitors of them, soluble FMS-like tyrosine kinase-1 and soluble endoglin (19).

Many promising biomarkers have been suggested, either each one alone or several ones together, although many studies prefer combination of them for satisfactory sensitivity and specificity, to be of clinical importance that may help in predicting women who will possibly have preeclampsia. Biomarkers serum levels in mother’s circulation either increase or decrease during pregnancy in preeclampsia (10),(20).

Many studies have reported that the combination of average blood pressure measurement, doppler of uterine artery, placental growth factor, and PAPP-A, discovered about 80.8% to 93% of preeclampsia cases with a false positive rate of 5-10% (20),(21),(22). Other promising biomarkers like antiangiogenic factors such as sFlt-1, sEng and pro-angiogenic factors like VEGF have been used and studied (10). The discovery of neutrophil-gelatinase associated lipocalin and its relation to the endothelial damage during preeclampsia made the researches work hard to demonstrate its importance and its cut-off values (23),(24). Recently, maternal serum cell free foetal DNA (cfDNA) has become the new gold standard test for screening for aneuploidy, and preeclampsia with a sensitivity and specificity reaching upto 100% (25).


Screening in the beginning of pregnancy (first-trimester) for trisomies twenty one, eighteen and thirteen by adding the age of the pregnant mother, foetal Nuchal Translucency (NT) thickness, foetal heart rate and serum β-hCG, in addition to PAPP-A can discover upto 90% of patients with trisomy 21 and upto 95% of those with trisomies 18 and 13, at a false rate of positivity of nearly 5% (26).

cfDNA in the blood of pregnant mother can discover upto 99% of trisomy 21 conditions, and upto 98% of trisomy 18 conditions and 92% of trisomy 13 conditions with false positive results ranges between (0.1 and 0.3%) (27),(28),(29),(30),(31). It’s involvement in the routine tests depends on the outcomes of combined testing in the 11-13 weeks of pregnancy rather than being an essential first place method (32). In some places in the world there is an additional prenatal screening for single gene disorders like Cystic Fibrosis (CF) and Fragile X- Syndrome (FXS) (33). (Table/Fig 2) shows the suggested strategy for applying the combined test and the cfDNA test according to the results of each one (33).


Accurate laboratory tests are not available for most of the congenital anomalies, so physicians depend on ultrasound imaging and MRI. Biomarkers from maternal plasma are considered very promising (34). By measuring certain molecules in maternal blood, one can predict the type of deformity and can manage the after birth treatment or estimate the prognosis of the abnormality. For instance, to diagnose the dysfunction of the left ventricular systolic action, tests depending on urinary N-terminal pro-brain natriuretic peptide test is accompanied by a plasma N-terminal pro-brain natriuretic peptide test that can aid in detecting left ventricular systolic dysfunction in congenital heart diseases (35).

Biomarkers are analysed to discover certain abnormalities, and help in management of patients postoperatively like cardiac cases with congenital heart diseases. Actually the importance of screening tests is diminished sometimes by the fact that many of the congenital defects are present in newly born babies from pregnant mothers with no or low risk factors (36).


1- Alpha-Fetoprotein (AFP)

This is a type of protein made by the baby in the uterus and is measured in pregnant mother’s serum starting from the sixth week of pregnancy, reaching maximum level in week (thirty four) of gestation.

High values of it are found in: pregnancies of twins, problems in the skin, failure of some organs, congenital nephropathy, cystic hygroma, hepatic necrosis, defects in the neural tube, and defects in the abdominal wall. Diminished levels of it are recorded in cases of disorders in the chromosomes, problems of the placenta, hydrops foetalis, trophoblastic disorders, and pregnant women with diabetes (37).

2- Human Chorionic Gonadotropin (HCG)

This hormone is formed throughout the period of pregnancy, and is released by cells that form the placenta, after fertilisation and attachment to the walls of the uterus. It can first be measured in blood, approximately (eleven days) after the start of pregnancy and almost 12-14 days after conception in test that is done on urine. It approaches its maximum value in the first (8-11) weeks of pregnancy (38).

A low concentration can refer to a mistake in the calculation of pregnancy establishment or the possibility of miscarriage or blighted ovum, and it may refer to the presence of ectopic pregnancy. An increased HCG concentration in pregnancy means, wrong calculation of pregnancy, or molar pregnancy (39).

3- Unconjugated Estriol (uE3)

It is one of group of three natural oestrogens, which are estriol, estradiol and estrone. In women who are not pregnant, the main oestrogen hormone is estradiol that is formed by the ovaries. While throughout pregnancy, estriol is secreted by the placenta and foetus and turns up the most abundant one. Maternal serum uE3 levels is measured as an indicator of the health of the foetal-placental complex and in evaluating gestational problems (26).

4- Inhibin-A

Inhibins are glycoprotein hormones. Inhibin has a negative feedback function on FSH secretion from the pituitary. Inhibin-A is the major type of inhibins in pregnant mother’s blood starting from the fourth week of pregnancy. The exact biological action of inhibin-A in pregnancy is that it could be an excellent indicator of the function of placenta more than β-hCG since it has less half-life. It can be used in anticipating miscarriage, Down’s syndrome, preeclampsia, and foetal growth restriction in the first and/or the second three months of pregnancy (second- trimester) (32).

5- Pregnancy Associated Plasma Protein-A (PAPP-A)

This protein is produced by the foetus and the placenta throughout pregnancy. It has some functions, like preventing the foetus from recognition by the mother’s immune-mechanism, matrix- mineralisation and angiogenesis. It is also applied as a diagnostic test in the first and second trimesters of pregnancy for aneuploidies, like Down’s syndrome (33).

6-Cell Free DNA (cfDNA)

cfDNA can be defined as DNA fragments which are found outside the cell nucleus. They are formed mainly by apoptotic or necrotic process; they also exist in fluids of the body, that’s why they can be used as bioindicators of disease or abnormal conditions. Circulating cfDNA, double-stranded molecule, has a less molecular weight than genomic DNA, in the type of short pieces, ranging between seventy and two hundred base pairs in length.

Cell free DNA clinical applications include sex determination, identification of single gene disorders, detection of paternally inherited allele, isoimmunisation, screening for aneuploidies, anticipation of presence of pregnancy complications such as preeclampsia, preterm birth and small for date (1).


Maternal serum biomarkers, in association with other modalities like ultrasound can improve detection rates of complicated pregnancy or abnormal outcomes. Increased education and the introduction of such measures should be implied as appropriate, also labeling women as high risk should be taken carefully into consideration. Prenatal screening is now an important and well applied part of regular care and observation during pregnancy period in developed countries. Disorders being commonly screened for involve neural tube defects in the foetus, numerical and structural chromosomal abnormalities in addition to some maternal complications.


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DOI and Others


Date of Submission: May 10, 2021
Date of Peer Review: Jun 14, 2021
Date of Acceptance: Jul 03, 2021
Date of Publishing: Aug 01, 2021

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: May 11, 2021
• Manual Googling: Jun 30, 2021
• iThenticate Software: Jul 31, 2021 (7%)

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