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Triple Marker with Graph (2nd Trimester)

Also referred as

Triple Marker Pregnancy Test (Graph)

Maternal Screening Test

For women

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3 tests

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The Triple Marker with Graph (2nd Trimester) test is a prenatal screening test typically conducted between 14-22 weeks of gestation, ideally between 15-20 weeks (the second trimester) of pregnancy. It analyzes three key biochemical markers in the blood: Alpha-fetoprotein (AFP), Human chorionic gonadotropin (HCG), and Estriol unconjugated (uE3). Combined with ultrasound findings, this evaluation calculates the risk of certain chromosomal abnormalities and neural tube defects in the developing fetus.

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Understanding Triple Marker with Graph (2nd Trimester)

The Triple Marker with Graph (2nd Trimester) test is tailored to give expectant parents insights into the developing baby’s health. It analyzes specific markers in the mother’s blood to assess the risk of chromosomal abnormalities, such as Down Syndrome (Trisomy 21) and Edwards Syndrome (Trisomy 18), wherein extra copies of chromosome 21 and 18 are present and affect the baby's physical and intellectual development. Additionally, it screens for neural tube defects like spina bifida (a spinal cord defect) and anencephaly (a brain defect). These birth defects can result in nerve damage, learning disabilities, paralysis, or stillbirth.

The ‘triple’ in Triple Marker with Graph (2nd Trimester) test refers to the three specific markers measured in the mother’s blood during the screening: AFP, hCG, and uE3. They collectively help estimate the likelihood of certain fetal abnormalities that can affect the baby’s growth and development. The recommendation of the Triple Marker with Graph (2nd Trimester) test is often based on maternal age, medical history, and individual risk factors for chromosomal abnormalities. Pregnant women should consult their doctor to determine the most appropriate screening or diagnostic test based on their specific circumstances.

The results of the biochemical screening are analyzed using an algorithm that takes into account age, race, weight, diabetic status, smoking history, number of fetuses, history of any previous abortion/miscarriage, IVF status, donor's date of birth (DOB), biparietal diameter (BPD) and gestational age. This generates a risk value for the presence of Down syndrome, Edward syndrome, and neural tube defects.

It is important to note that while the Triple Marker with Graph (2nd Trimester) test can screen pregnancies at higher risk for certain conditions, it does not provide a definitive diagnosis. It only tells whether the unborn baby is at risk of developing certain abnormalities and helps doctors and expectant parents make informed decisions about whether further diagnostic testing and genetic counseling are required. Additional confirmatory tests may include newer blood tests like Cell-free DNA (NIPT) to check for chromosomal abnormalities or invasive tests like amniocentesis and chorionic villus sampling (CVS).

No special preparation is required before undergoing the Triple Marker with Graph (2nd Trimester) test. However, an informed consent is needed before undertaking this test. The laboratory personnel will explain the purpose, benefits, and limitations of this test.

Abnormal lab test results represent only the risk and do not mean that the unborn baby has a birth defect or genetic condition. A negative screen means that there is a low risk of Down syndrome, trisomy 18, or an open neural tube defect in the fetus, but it does not guarantee the birth of a healthy baby. The accuracy of risk assessments is based on the demographic information provided at the time of testing. Talk to your doctor about your specific test results.

What does Triple Marker with Graph (2nd Trimester) measure?

Contains 3 tests

The Triple Marker with Graph (2nd Trimester) test measures the levels of three specific markers in the blood of a pregnant woman. These markers are Alpha-Fetoprotein (AFP), Human Chorionic Gonadotropin (hCG), and Estriol unconjugated (uE3).

The analysis of these three markers, along with other factors like maternal age and gestational age, helps assess the risk of Down syndrome, Edwards syndrome, and neural tube defects in the developing baby. The graph in the Triple Marker with Graph (2nd Trimester) test provides a visual representation of the levels of these markers during pregnancy.

It is noteworthy that the Triple Marker with Graph (2nd Trimester) test is a screening test, and any abnormal results may prompt further diagnostic testing for confirmation. Pregnant women should discuss their results and implications with their doctor.

HCG Beta Total Quantitative, Maternal

The HCG Beta Total Quantitative, Maternal test measures the levels of human chorionic gonadotropin (hCG) hormone in the blood. hCG is released in the blood during pregnancy and can be detected as early as 10 to 12 days after conception. The levels of this hormone gradually rise every 2 to 3 days (or 48 to 72 hours) and peak around 8 to 11 weeks after conception. After reaching the peak, the hCG levels decrease and remain steady for the rest of the pregnancy.

Know more about HCG Beta Total Quantitative, Maternal

Alpha Feto Protein, Maternal

An Alpha Feto Protein, Maternal test measures the amount of Alpha Fetoprotein in expectant mothers usually during the second trimester (14th and 22nd weeks). AFP is a protein produced by the fetus, primarily by the fetal liver and yolk sac, and it passes into the mother's blood. The test is typically performed to screen for certain fetal abnormalities, particularly neural tube defects (NTDs) such as spina bifida and anencephaly, as well as chromosomal abnormalities like Down syndrome (trisomy 21), Edwards syndrome (Trisomy 18), etc.

Detecting these abnormalities early in pregnancy allows for appropriate medical management and intervention.

Know more about Alpha Feto Protein, Maternal

Estriol Unconjugated

The Estriol Unconjugated test is used to assess the level of unconjugated estriol (uE3) in the blood, a specific type of estrogen produced during the pregnancy phase. This hormone is mainly synthesized in the placenta and the fetus, with the fetus being responsible for a substantial amount of uE3 production as it grows.

Monitoring the uE3 levels in the maternal serum is useful in evaluating the condition of the fetus. Abnormal unconjugated estriol levels may indicate pregnancy-related complications or concerns, including chromosomal abnormalities, fetal distress, or placental problems. The Estriol Unconjugated is particularly crucial in the second trimester to assess for some conditions, such as Down syndrome, Edward syndrome, or other chromosomal abnormalities, fetal growth and development. Hence the estriol unconjugated test is a significant part of prenatal care as it reveals information that may be valuable for the diagnosis and management of the mother and the baby.

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FAQs related to Triple Marker with Graph (2nd Trimester)

What is the Triple Marker with Graph (2nd Trimester) test, and why is it important?

The Triple Marker with Graph (2nd Trimester) test is a prenatal screening test that evaluates the risk of chromosomal abnormalities and neural tube defects in the developing baby, helping in early detection and appropriate management.

What tests are done in the triple marker test?

The triple marker test assesses three specific biomarkers: AFP (alpha-fetoprotein), HCG (human chorionic gonadotropin), and Estriol unconjugated (a form of estrogen).

When can I go for the triple marker test during my pregnancy?

You can undergo the triple marker test in the second trimester, i.e., ideally between 15 -20 weeks of pregnancy.

How is the triple marker test performed, and is it safe for the baby?

The test involves a simple and safe blood draw from the pregnant woman, posing no risk to the developing baby. It is a non-invasive screening test.

What chromosomal abnormalities are screened by the triple marker test?

The triple marker test primarily screens for Down syndrome (Trisomy 21) and Edwards’ syndrome (Trisomy 18).

How accurate are these tests?

Studies indicate that the detection rate of Down Syndrome with Triple Screen is around 60-70%. It is associated with a false positivity of approximately 5%, meaning that these women may get a screen positive, but the fetus will not be affected with Down syndrome. Initial positive screening test results must be followed with invasive diagnostic testing or noninvasive prenatal testing (NIPT). A normal result reduces the likelihood of trisomy 21 but does not exclude it.

Is the Triple Marker with Graph (2nd Trimester) test only advised for women of age 35 years or more?

No, this test is not specific to women aged 35 years or more. It is recommended for all pregnant women, serving as an important test for detecting fetal abnormalities before birth. However, this test is highly recommended in women with risk factors like age of 35 or older, family history of birth defects, having a previous child with a birth defect, known type 1 diabetic woman, viral infection/ radiation exposure/ harmful drugs during pregnancy.

What does a normal triple marker Screening test mean?

A normal triple marker test result (or a negative result) means the fetus is not at higher risk for a congenital disorder. It just means the risk is low but does not rule out other chromosomal defects like single-gene disorder or other complications. However, a negative screen does not guarantee the birth of a healthy baby. The screening test only screens for Down syndrome, trisomy 18, and open neural tube defects; it is not a diagnostic test. The maternal demographic information provided at the time of testing is used in calculating the patient’s risk of having a fetus with Down syndrome, trisomy 18, or open neural tube defects. Please check the demographic information to ensure the accuracy of the calculated results.

What does an abnormal triple marker Screening test mean?

The triple marker test screens only your risk. It doesn’t tell if the developing baby has a genetic disorder. If your screening test shows an increased risk for a congenital disorder, your doctor will suggest other tests like additional ultrasound or amniocentesis, which help determine if the fetus has a genetic disorder.

What is Down syndrome?

Down syndrome, or Trisomy 21, is a genetic disorder caused by the presence of an extra copy of chromosome 21. It can cause various physical and intellectual challenges.

What is Edwards’ syndrome?

Edwards’ syndrome, or Trisomy 18, is a rare genetic disorder resulting from an extra copy of chromosome 18. It manifests in distinctive physical abnormalities, including a small head, a small jaw, rocker bottom feet (a rounded sole on the bottom of the feet), etc.

What are Neural tube defects?

Neural tube defects (NTDs), including spina bifida and anencephaly, are birth defects of the brain, spinal cord, and spine that occur due to abnormal neural tube development in the fetus. The diagnosis is made on maternal USG during pregnancy or by estimation of maternal serum alpha-fetoprotein (MSAFP) levels early in the second trimester (15–18 weeks of gestation).

Content created by

Dr. Swati Gupta (Anand)

MD Lab Medicine, MBBS

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Last Updated

21st Oct 2025