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Elevated alpha-fetoprotein and a normal fetal sonogram: association with placental abnormalities
A C Fleischer1, A B Kurtz, R J Wapner
1Department of Radiology (Ultrasound), Vanderbilt University Medical Center, Nashville, TN 37232.
AJR. American Journal of Roentgenology
|April 1, 1988
Summary
Elevated alpha-fetoprotein (AFP) in maternal serum or amniotic fluid, despite a normal-appearing fetus, often indicates placental abnormalities like hemorrhage. These findings suggest placental issues may cause abnormal AFP levels.
Area of Science:
- Maternal-Fetal Medicine
- Prenatal Diagnostics
- Reproductive Biology
Background:
- Elevated maternal serum alpha-fetoprotein (AFP) levels can indicate fetal abnormalities.
- However, normal fetal anatomy on ultrasound with elevated AFP requires further investigation.
- Placental abnormalities are a potential, often overlooked, cause.
Purpose of the Study:
- To investigate the association between elevated AFP levels (serum and amniotic fluid) and sonographically detected placental abnormalities.
- To determine the incidence of placental hemorrhage in pregnancies with elevated AFP and normal fetal anatomy.
- To compare placental hemorrhage rates between cases with elevated AFP and a control group.
Main Methods:
- Retrospective analysis of 25 pregnancies with elevated AFP and normal fetal sonography.
- Detailed "consultative" sonographic examination for fetal anatomy.
- Assessment of amniotic fluid AFP levels in a subset of cases.
- Sonographic evaluation for placental abnormalities, specifically hemorrhage (retroplacental and subchorionic).
- Comparison with a control group of 112 patients with normal AFP levels.
Main Results:
- 16 out of 25 (64%) pregnancies with elevated AFP and normal fetuses showed sonographically detectable placental hemorrhage.
- Control group had a 3.6% incidence of subchorionic hemorrhage.
- Elevated serum and amniotic fluid AFP was associated with placental hemorrhage or hydropic changes.
- Placental hemorrhage occurred in 64% of cases with elevated AFP and normal fetuses, versus 3.6% in controls.
Conclusions:
- Sonographically detectable placental abnormalities are frequently associated with elevated maternal serum and/or amniotic fluid AFP levels, even with normal fetal anatomy.
- Placental hemorrhage (retroplacental or subchorionic) is a significant finding in these cases.
- Fetomaternal admixture from placental hemorrhage or intraamniotic bleeding may explain the elevated AFP levels.