Test Detail
Interpreting Results

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Written by
Dr. Shreya Gupta
BDS, MDS - Oral and Maxillofacial Pathology
Reviewed by
Dr. Ashish Ranjan
MBBS, MD (Pharmacology)
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Triple Marker with Graph

Triple Marker with Graph
You need to provide
This test is for
Test Preparation
  1. Test is valid between 14-22 weeks of gestation (Ideal 15-20 weeks) Please keep the hard copy of your latest pregnancy ultrasound report(Level 2) and Maternal Screen details(LMP,DOB,Body Weight,Diabetic status,& IVF) ready at the time of your test.


What is Triple Marker with Graph?

A triple marker test is done in pregnant women to detect any abnormalities in the fetus before birth. The triple marker with graph test is also known as the Triple test, multiple marker test, multiple marker screening, and AFP plus test.

This test measures three markers in the blood:

  • Alpha-fetoprotein (AFP)

  • Human chorionic gonadotropin (HCG)

  • Estriol

Why is Triple Marker with Graph done?

  • To diagnose Down syndrome

  • To diagnose neural tube defects

  • To diagnose the failure of closure of the abdomen in the fetus.

  • To diagnose multiple pregnancies

  • To diagnose miscarriage or ectopic pregnancy

What does Triple Marker with Graph Measure?

This test measures three markers which include AFP, HCG, and estriol in the blood. As there are three markers involved, it is known as the Triple Marker test.

AFP is a protein which is produced by the fetus. If the levels of AFP are high, it indicates neural tube defects in the fetus or there can be incomplete closure of the fetus abdomen.

HCG hormone is produced by cells of the placenta. If the levels of HCG are low, it indicates a miscarriage or ectopic pregnancy. Whereas, if the levels of HCG are high this indicates multiple pregnancies.

Estriol is a form of the hormone estrogen which is present in both fetus and placenta. If the levels of estriol are low, it indicates the risk of the baby getting delivered with Down syndrome especially when the levels of AFP are low and HCG are high.

If the levels of all these three markers are abnormal, there can be a presence of neural tube defects like spina bifida (spinal cord fails to develop properly), anencephaly (absence of brain, skull, and scalp), and multiple pregnancies (twins or triplets).

     This test is done between 15-20 weeks of pregnancy. Females who are 35 years or more, have a family history of birth defects, or have diabetes or are using insulin have a higher risk of getting abnormal values of these markers. Exposure to high levels of radiation or having the viral infection during pregnancy can also be considered as possible risk factors associated with these high levels. This test is also helpful to indicate any complications in the fetus after birth.

Interpreting Triple Marker with Graph results


Pregnancy Weeks





32.01 ng/mL

    32200 mIU/mL

        0.55 ng/mL


37.67 ng/mL

    25690 mIU/mL

        0.76 ng/mL


44.33 ng/mL

    20490 mIU/mL

        1.00 ng/mL


52.16 ng/mL

   16340 mIU/mL

        1.25 ng/mL


61.38 ng/mL

    13040 mIU/mL

         1.50 ng/mL


72.33 ng/mL

     10400 mIU/mL

          1.76 ng/mL


Cut off

Detection rate

False positive rate

Neural tube defects

≥ 2.5 MoM (Multiples of median)

70-75 %

2-4 %

Down Syndrome (Trisomy 21)

1: 250

65 %

5 %

Edwards Syndrome (Trisomy 18)


60 %

0.3 %

The base of screening tests is a statistical analysis of patient’s data which includes the demographic (statistical study of populations) and biochemical (laboratory) data.

Confirmation is mandatory by amniocentesis.  

The results are illustrated in the form of a graph in the test report.

Answers to Patient Concerns & Frequently Asked Questions (FAQs) about Triple Marker with Graph

Frequently Asked Questions about Triple Marker with Graph

Q. Can the defects in fetus be caused because of the age of pregnant women?
Yes, a pregnant woman who is 35 years or older has a greater risk of developing defects in the fetus. Apart from that, other factors such as exposure of the woman to high levels of radiation, diabetes or if the woman is taking insulin can affect the development of the fetus. Viral infection at the time of pregnancy can also be a risk factor in the development of the fetus.
Q. Is Triple marker with graph test only advised for women of age 35 years or more?
No, this test not only for women of age 35 years or more. Every pregnant woman is advised to take this test, as it is very important for detecting any abnormality in the fetus before birth. This test is done in between 15 and 20 weeks of pregnancy.
Q. What other tests are required for diagnosis of abnormalities in fetus?
In case the results are abnormal, the doctor may advise amniocentesis in which a thin, hollow needle is used to withdraw amniotic fluid (the fluid that surrounds the fetus) from the uterus. This test is useful to detect any genetic or fetal conditions present in the fetus. If the levels of AFP are high, the doctor will advise ultrasound for a detailed examination of neural tube defects.
Q. How is this test performed?
This test is performed on a blood sample. A syringe with a fine needle is used to withdraw blood from a blood vessel in your arm. The healthcare provider will tie an elastic band around your arm to make the blood vessels swell with blood. This makes it easier to withdraw blood. You may be asked to tightly clench your fist. Once the veins are clearly visible, the area is cleaned with an antiseptic solution and then the needle is inserted into the blood vessel to collect the sample. You will feel a tiny pinprick during the procedure. Blood sample once collected will then be sent to the laboratory.
Q. Is there any risk associated with this test?
There is no risk associated with the test. However, since this test involves a needle prick to withdraw the blood sample, in very rare cases, a patient may experience increased bleeding, hematoma formation (blood collection under the skin), bruising or infection at the site of needle prick.
Q. Is there any preparation required before the test?
Inform the doctor about the medications you may be taking. No other specific preparations are usually required before this test.
Q. What is Trisomy 18?
It is also known as Edwards Syndrome which is caused by the development of an extra chromosome 18. Because of this, the normal pattern of development in the baby gets disturbed even before its birth. The effects caused by Trisomy 18 are very complicated as compared to Down syndrome. The effects are so severe that it can cause stillbirth (death at the time of birth) of the child.
Q. What is Down's syndrome?
It is a genetic disorder in which extra genetic material from chromosome 21 gets transferred to the fetus. This transfer affects the development of the fetus leading to abnormal development both physically and mentally. The affected baby will have a small head and short neck, obliquely positioned eyes looking in an upward direction, large tongue coming out of the mouth, flat face, wide hands with short fingers, and lack of muscle tone.
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