The Impact of an Additional Targeted Ultrasound Scan in Pregnant Women with Elevated Alpha-Fetoprotein

Elevated maternal serum alpha-fetoprotein (AFP) levels have been linked to various fetal anomalies. Therefore, routine anatomy scans are supplemented with targeted ultrasound scans to detect such anomalies. This study was conducted to assess the added value of an additional targeted ultrasound scan to the routine fetal anatomy scans in pregnant women with elevated AFP levels.

A retrospective cohort study was conducted at a tertiary university medical center. Pregnant women with elevated AFP levels in the second trimester, who have previously undergone routine fetal anatomy scans, were included. The study assessed whether targeted scans provided significant additional diagnostic information.

The study included 151 women, with a median maternal age of 30 years. All women underwent an additional targeted scan due to elevated AFP levels. Eighty percent had a normal targeted scan, nine targeted scans (6%) showed findings not associated with AFP, not previously diagnosed, and 1 patient had a new finding associated with elevated AFP (chorioangioma).

This study suggests that additional targeted ultrasound scans in cases of second-trimester elevated AFP may have limited added value in women who have previously normal routine anatomy scans. Therefore, an additional targeted scan for this diagnosis may be considered for selected cases and not routinely advised. However, findings unrelated to elevated AFP were observed, supporting the trend toward an additional third-trimester routine anatomy scan.