The Triple Check (or Quad Screen) Decision

August 30, 2008

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The Triple Check (or Quad Screen) Decision

by Marjorie Greenfield, M.D.
reviewed and revised by Marjorie Greenfield, M.D.

The purpose of the triple check or quad screen test is to identify those who would benefit from further testing for certain fetal problems. Some practices use three biochemical markers, called the triple check, others have added a fourth marker, and have renamed the testing quad screen. Either test can be used to help detect problems with chromosomes (such as Down Syndrome), and problems where there has been incomplete closure of a body cavity (such as spina-bifida).

There are two general reasons why some people choose not to have testing done:

People who are going to have amniocentesis and ultrasound anyway may not benefit from biochemical testing. Testing helps to identify who should have the amnio and/or ultrasound done. If you are going to have an amniocentesis regardless of the result of the testing, you may not benefit from doing the test. Many (but not all) women who will be 35 years old at delivery fall into this category.

People who are going to have an in-depth ultrasound done anyway and would decline amniocentesis even if it were recommended probably should not have the testing. Again, the test is to see who needs further evaluation, and if the evaluation will be declined, why do the triple check or quad screen? Many (but not all) people who would not terminate a Down Syndrome pregnancy fall into this category.

Making the decision
It is important to think through what you will do with the information you get from your test. If that information will help you make decisions about your pregnancy, then you probably should get the blood test done. If you are not willing to get the further testing that might be recommended, it may be better to forego the triple check or quad screen, rather than spend the rest of your pregnancy worrying about a small increase in risk.

A note for people who are not going to have an ultrasound
These biochemical tests can also give a hint of findings usually seen on ultrasound: inaccurate estimate of the due date, twins, major birth defects that prevent survival (like anencephaly), and some anatomical problems that would make vaginal birth unsafe for the baby. If you are not going to have a second trimester ultrasound, these other factors should be taken into account when making the decision about triple check or quad screen.


RELATED INFORMATION

			Second Trimester Experiences
			The Developing Fetus, Weeks 9-24
			Fetal Assessment
			Genetic Testing in Pregnancy
			Moms-to-Be Testing

Created September 18, 2000
Reviewed and revised July 27, 2004

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