Site Map

Quadruple screen test

Quad screen; Multiple marker screening; AFP plus; Triple screen test; AFP maternal; MSAFP; 4-marker screen; Down syndrome - quadruple; Trisomy 21 - quadruple; Turner syndrome - quadruple; Spina bifida - quadruple; Tetralogy - quadruple; Duodenal atresia - quadruple; Genetic counseling - quadruple; Alpha-fetoprotein quadruple; Human chorionic gonadotropin - quadruple; hCG - quadruple; Unconjugated estriol - quadruple; uE3 - quadruple; Pregnancy - quadruple; Birth defect - quadruple; Quadruple marker test; Quad test; Quadruple marker screen

The quadruple screen test is a blood test done during pregnancy to determine whether the baby is at risk for certain birth defects.

Images

Quadruple screen

How the Test is Performed

This test is most often done between the 15th and 22nd weeks of the pregnancy. It is most accurate between the 16th and 18th weeks.

A blood sample is taken and sent to the lab for testing.

The test measures levels of 4 pregnancy hormones:

If the test does not measure levels of inhibin A, it is called the triple screen test.

To determine the chance of your baby having a birth defect, the test also factors in:

How to Prepare for the Test

No special steps are needed to prepare for the test. You can eat or drink normally before the test.

How the Test will Feel

You may feel slight pain or a sting when the needle is inserted. You may also feel some throbbing at the site after the blood is drawn.

Why the Test is Performed

The test is done to find out if your baby might be at risk for certain birth defects, such as Down syndrome and birth defects of the spinal column and brain (called neural tube defects). This test is a screening test, so it does not diagnose problems.

Certain women are at greater risk of having a baby with these defects, including:

Normal Results

Normal levels of AFP, hCG, uE3, and inhibin A.

Normal value ranges may vary slightly among different laboratories. Talk to your health care provider about the meaning of your specific test results.

What Abnormal Results Mean

An abnormal test result does NOT mean that your baby definitely has a birth defect. Often, the results can be abnormal if your baby is older or younger than your provider had thought.

If you have an abnormal result, you will have another ultrasound to check the age of the developing baby.

More tests and counseling may be recommended if the ultrasound shows a problem. However, some people choose not to have any more tests done, for personal or religious reasons. Possible next steps include:

During pregnancy, increased levels of AFP may be due to a problem with the developing baby, including:

High AFP can also mean that you are carrying more than 1 baby.

Low levels of AFP and estriol and high levels of hCG and inhibin A may be due to a problem such as:

Considerations

The quadruple screen can have false-negative and false-positive results (although it is slightly more accurate than the triple screen). More tests are needed to confirm an abnormal result.

If the test is abnormal, you may need to talk to a genetic counselor.

References

ACOG Practice Bulletin No. 162: Prenatal diagnostic testing for genetic disorders. Obstet Gynecol. 2016;127(5):e108-e122. PMID: 26938573 pubmed.ncbi.nlm.nih.gov/26938573/.

Driscoll DA, Simpson JL. Genetic screening and prenatal genetic diagnosis. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 10.

Wapner RJ, Dugoff L. Prenatal diagnosis of congenital disorders. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 32.

Williams DE, Pridjian G. Obstetrics. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier; 2016:chap 20.

BACK TO TOP

Review Date: 1/10/2022  

Reviewed By: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

ADAM Quality Logo
Health Content Provider
06/01/2025

A.D.A.M., Inc. is accredited by URAC, for Health Content Provider (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics. This site complied with the HONcode standard for trustworthy health information from 1995 to 2022, after which HON (Health On the Net, a not-for-profit organization that promoted transparent and reliable health information online) was discontinued.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2024 A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.