We have carried out a large retrospective study of α‐fetoprotein (AFP), free‐β human chorionic gonadotrophin (hCG) and pregnancy‐associated plasma protein (PAPP‐A) in the first trimester of pregnancy. Unlike other studies all women had routine ultrasound dating, carried out during a nuchal translucency measurement project. A total of 13 477 serum samples were tested for AFP and 11 659 for free β‐hCG. A subset of 1564 samples from unaffected pregnancies were also tested for PAPP‐A on a case–control basis. All three markers were also determined in 31 samples from pregnancies with Down syndrome. Equations were derived to express results in multiples of the median using both gestational age and crown–rump length and to adjust for maternal weight. Statistical modelling with Gaussian distribution parameters obtained in the study were used to predict the detection rate for a 5 per cent false‐positive rate. The predicted rates were: 73.7 per cent for all three markers; 69.1 per cent for PAPP‐A and free β‐hCG; 47.4 per cent for PAPP‐A and AFP; 57.6 per cent for free β‐hCG and AFP. As these rates are similar to those in the second trimester, health planners may now want to consider a change in policy from second‐trimester to first‐trimester screening with biochemical markers. Copyright © 1999 John Wiley & Sons, Ltd.

Duodenal stenosis associated with oesophageal atresia was diagnosed by ultrasound at 12 weeks' gestation. The diagnosis was made by recognition of a double bubble sign which was more pronounced when a vaginal transducer was used. Post-abortion autopsy confirmed the diagnosis. Oesophageal and duodenal obstruction in this case had no effect on the amount of amniotic fluid or the alpha-fetoprotein concentration since swallowing and subsequent utilization of amniotic fluid do not occur before 12 weeks of gestation.