The aim of this prospective study was to compare triple test screening 
(alpha-fetoprotein, beta-chorionic gonadotrophin and unconjugated oestriol) with 
amniocentesis in the detection of fetuses with Down's syndrome in women of 35 
years of age or more. Between 1992 and 1996, maternal serum markers were 
evaluated in 1406 women who had amniocentesis for prenatal diagnosis of 
chromosomal abnormalities related to a maternal age of 35 or more years. Sixteen 
fetuses with Down's syndrome were identified in the whole group by amniocentesis 
and karyotyping. The group with negative triple test screening consisted of 919 
pregnancies and included two fetuses with trisomy-21 (false negatives). With 
triple test screening in the age group over 35, there was a detection rate of 
87.5% for cut-off points ranging from 1:200 up to 1:350, with corresponding 
false positive rates ranging between 23% and 34%. In our population, if we had 
practiced the policy of offering amniocentesis only to women screening positive 
for the ages of 35 and 36 and to all pregnant women of 37 or more, we would have 
carried out 30% less amniocenteses. In this group of 1406 women, 33 abnormal 
karyotypes were detected with amniocentesis (16 Down's syndrome included) and 
equal number of elective abortions were carried out. Nevertheless, 19 healthy 
fetuses and neonates were lost after amniocentesis. Considering the high 
detection rates that can be achieved with triple test screening, the existing 
procedure related risk of amniocentesis (0.5-1.0%), and the facts that 
conception in women over 35 years of age is usually more difficult and the 
background loss usually higher than in younger women, we believe that in the 
future women over 35 should be offered a choice between non-invasive and 
invasive procedures after being thoroughly informed.