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May 8, 1996

A 35-Year-Old Pregnant Woman Considering Maternal Serum Screening and Amniocentesis

JAMA. 1996;275(18):1440-1446. doi:10.1001/jama.1996.03530420068039

Dr Daley  : Mrs J, a 35-year-old married attorney and mother of 2 preschool-aged children, is in her first trimester of pregnancy. She is considering maternal serum screening and/or amniocentesis for the detection of neural tube defects and chromosomal abnormalities. She is insured with a managed care organization through her husband's medical insurance.Mrs J is healthy and has had 3 previous pregnancies. Her first pregnancy was uncomplicated during gestation, with a 40-hour labor, ending in a cesarean delivery of a healthy boy at term. Her second pregnancy ended in a spontaneous miscarriage during the first trimester. In the first trimester of her third pregnancy, Mrs J's obstetrician, Dr O, offered her serum screening and/or amniocentesis. She and her husband declined both, feeling that the risks of neural tube defects and chromosomal abnormalities were low and that they would not be willing to terminate a pregnancy in the second trimester if