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What is a Quadruple Marker Test?

The Quadruple Marker Test (also called the Quad Screen) is an advanced second trimester prenatal blood test performed between 15 and 20 weeks of pregnancy. It is an enhanced version of the Triple Marker test, adding a fourth marker — Inhibin-A — to significantly improve the detection rate for Down Syndrome. By measuring four biochemical substances in the mother's blood and combining them with maternal age, gestational age and body weight, the Quad Screen generates a comprehensive risk profile for chromosomal abnormalities and neural tube defects in the developing baby.

⚠ Important — bring these to your appointment:

• Your latest ultrasound (USG) report confirming gestational age and fetal measurements
• Your gynaecologist's prescription or referral
• Your exact date of birth and current body weight
• Your LMP (Last Menstrual Period) date
• Information on whether you are diabetic (diabetes affects marker levels)

No fasting is required. Ideally done at 16–18 weeks within the 15–20 week window.

The Four Markers Explained

The Quad Screen measures four placental and fetal biochemical markers:

• AFP (Alpha-Fetoprotein) — produced by the baby's liver. High AFP indicates risk of open neural tube defects (Spina Bifida, Anencephaly). Low AFP suggests risk of Down Syndrome or Edwards Syndrome.
• HCG (Human Chorionic Gonadotropin) — produced by the placenta. High HCG is associated with Down Syndrome. Low HCG suggests Edwards Syndrome (Trisomy 18).
• uE3 (Unconjugated Estriol) — produced jointly by the placenta and fetal adrenal glands. Low uE3 indicates risk of Down Syndrome and Edwards Syndrome.
• Inhibin-A — the key addition in the Quad Screen. A protein produced by the placenta that is significantly elevated (above 2.0 MoM) in Down Syndrome pregnancies. Adding Inhibin-A raises the Down Syndrome detection rate from approximately 70–75% (Triple Marker) to approximately 80–85%.

Why Inhibin-A Makes the Quad Screen More Powerful

The impact of adding Inhibin-A to the Triple Marker:

• In Down Syndrome pregnancies, Inhibin-A is typically elevated to about 2.0 MoM — in the opposite direction to AFP and uE3 which are low.
• This additional data point significantly improves the statistical discrimination between Down Syndrome and normal pregnancies, raising the detection rate by approximately 5–10 percentage points.
• The false positive rate (high-risk result in a normal pregnancy) is reduced compared to the Triple Marker alone.
• Elevated Inhibin-A alongside elevated HCG with low AFP and uE3 creates the strongest biochemical signature for Down Syndrome in the second trimester.
• Inhibin-A also has independent clinical value — elevated levels are associated with increased risk of pre-eclampsia and placental dysfunction.

Quadruple Marker Pattern by Condition

Condition	AFP	HCG	uE3	Inhibin-A
Down Syndrome (Trisomy 21)	Low	High	Low	High
Edwards Syndrome (Trisomy 18)	Low	Low	Low	Normal/Low
Open Neural Tube Defect	Very High	Normal	Normal	Normal
Normal Pregnancy	Normal	Normal	Normal	Normal

All values are expressed as MoM (Multiples of the Median). The risk calculation software combines all four MoM values with maternal age, weight, gestational age and ethnicity to generate a final risk ratio for each condition.

Quad Screen vs Triple Marker vs Dual Marker vs NIPT

Test	Timing	Markers	Down Syndrome Detection	Neural Tube Defect
Dual Marker + NT	11–14 weeks	Free Beta-HCG, PAPP-A + NT scan	~85–90%	No
Triple Marker	15–20 weeks	AFP, HCG, uE3	~70–75%	Yes (AFP)
Quad Marker	15–20 weeks	AFP, HCG, uE3, Inhibin-A	~80–85%	Yes (AFP)
NIPT	10+ weeks	Cell-free fetal DNA	>99%	No (NTD not screened)
Amniocentesis	15–20 weeks	Fetal karyotype	100% (diagnostic)	100% (diagnostic)

When is the Quadruple Marker Recommended?

The Quad Screen is recommended for:

• Women who missed the first trimester Dual Marker window (11–14 weeks)
• Women who want the most accurate second trimester biochemical screen available
• Women of Advanced Maternal Age (35 and above)
• Women with a high-risk Triple Marker result needing a more comprehensive screen
• Women with a family history of Down Syndrome, neural tube defects or other chromosomal conditions
• Women with IVF pregnancies or a history of chromosomally abnormal pregnancies
• When NIPT is not affordable and maximum second trimester screen accuracy is desired

Quadruple Marker Test Price in Kolkata

Quadruple Marker (Quad Screen) Test Price: ₹3,350
No fasting required  |  USG report & prescription mandatory  |  15–20 weeks gestational window (ideal: 16–18 weeks)  |  Results in 24–48 hours

Tests in the Prenatal Screening Pathway

• Dual Marker + NT (11–14 weeks) — first trimester combined screen; most accurate first line option
• Quadruple Marker (15–20 weeks) — this test; best available second trimester biochemical screen
• Level 2 Anomaly Scan (18–20 weeks) — detailed structural fetal survey; ordered alongside Quad Marker
• NIPT (10+ weeks) — most accurate non-invasive option; can be ordered instead of or alongside Quad Marker
• Amniocentesis (15–20 weeks) — definitive diagnostic test when Quad Marker is high-risk
• Fetal Echocardiography — heart scan when Down Syndrome risk is elevated (cardiac defects are common in Trisomy 21)

Home Collection for Quadruple Marker Test in Kolkata

Apollo Diagnostics provides home blood sample collection for the Quadruple Marker test across Nagerbazar, Dum Dum, South Dum Dum and surrounding North and Central Kolkata areas. Please ensure your USG report confirming gestational age and your gynaecologist's prescription are ready at the time of home collection — both are mandatory for accurate risk calculation.

• Home collection available: 7:00 AM – 2:30 PM Daily
• No fasting required
• USG report and prescription mandatory at time of collection
• Must be within 15–20 weeks gestation (ideal 16–18 weeks)
• Results in 24–48 hours
• Free home collection on orders above ₹2,000

📞 Book Quadruple Marker Test via WhatsApp — +91 8660434628

Quick Links

→ Apollo Diagnostics Nagerbazar → Full List of Individual Tests → Book Home Collection → Full Body Checkup Packages

Frequently Asked Questions

Q1. What is the Quadruple Marker test used for?

The Quadruple Marker (Quad Screen) measures AFP, HCG, uE3 and Inhibin-A in maternal blood between 15–20 weeks of pregnancy. It calculates the statistical risk of Down Syndrome (Trisomy 21), Edwards Syndrome (Trisomy 18) and open neural tube defects. Adding Inhibin-A improves Down Syndrome detection to approximately 80–85% compared to about 70–75% with the Triple Marker alone.

Q2. What does Inhibin-A add to the Quad Screen?

Inhibin-A is produced by the placenta and is significantly elevated (above 2.0 MoM) in Down Syndrome pregnancies. This additional marker helps the risk calculation software better distinguish Down Syndrome pregnancies from normal ones — raising the detection rate by approximately 5–10 percentage points and reducing false positive rates compared to the Triple Marker alone. Elevated Inhibin-A also independently predicts increased risk of pre-eclampsia.

Q3. When should the Quadruple Marker test be done?

The Quad Screen must be done between 15 and 20 weeks of gestation. The ideal timing is 16–18 weeks for the most accurate AFP and Inhibin-A values. After 20 weeks marker levels shift significantly and risk calculation becomes unreliable. If this window is also missed, Level 2 anomaly scan and NIPT are the remaining options.

Q4. What is the Quadruple Marker test price at Apollo Diagnostics Kolkata?

The Quadruple Marker (Quad Screen) test price at Apollo Diagnostics is ₹3,350. No fasting required. Results available in 24–48 hours. Home collection is available free on orders above ₹2,000.

Q5. What does a high-risk Quadruple Marker result mean?

A high-risk result means the calculated probability of a chromosomal abnormality or neural tube defect is above the threshold — typically 1:250 for Trisomy 21 and 1:100 for Trisomy 18. It is not a diagnosis. Your next step is to discuss the result urgently with your gynaecologist who will advise NIPT (non-invasive, above 99% accuracy) or amniocentesis (diagnostic, 100% accuracy) for chromosomal conditions, and Level 2 anomaly scan for neural tube defects.

Q6. Should I choose Quad Marker or NIPT?

Both serve different purposes. The Quad Marker screens for chromosomal risks (with 80–85% detection for Down Syndrome) and additionally screens for neural tube defects via AFP — at a significantly lower cost. NIPT screens for chromosomal abnormalities with above 99% accuracy but does not screen for neural tube defects and is considerably more expensive. For women who want maximum accuracy for chromosomal conditions, NIPT is the preferred choice. For comprehensive second trimester screening including neural tube defects at lower cost, the Quad Marker is the best available option. Both can be ordered together.

Q7. Does diabetes affect the Quadruple Marker results?

Yes. Insulin-dependent diabetes mellitus (Type 1 diabetes) lowers AFP and uE3 levels in maternal serum — which can affect the risk calculation. It is important to inform your doctor and the laboratory if you have diabetes when requesting the Quad Screen. The risk calculation software has a correction factor for diabetic patients that your gynaecologist or the laboratory will apply to your results.

Q8. Is home collection available for Quadruple Marker test in Kolkata?

Yes. Apollo Diagnostics provides home blood collection for Quadruple Marker tests across Nagerbazar, Dum Dum, South Dum Dum, Amarpalli, Motijheel, Jawpur, Chatakol, Satgachi, Baguiati, Lake Town, Bangur, Kaikhali, Sealdah, Entally, Phoolbagan, Tangra and surrounding areas. Please have your USG report and prescription ready. Book by calling or WhatsApping +91 8660434628.

Q9. How long does it take to get Quadruple Marker test results?

Quadruple Marker test results are typically available within 24–48 hours of sample collection. Digital reports are delivered to your WhatsApp or email for immediate sharing with your gynaecologist.

Q10. Which centre processes my Quadruple Marker sample in Kolkata?

All samples collected across North and Central Kolkata are processed at Apollo Diagnostics Nagerbazar — Nandarani Apartment, 8A Narasingha Avenue, Nagerbazar, Dum Dum, Kolkata 700074. Our lab is NABL-certified and ISO-certified.