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Data from an alpha-fetoprotein pilot screening program in Maine.

J E Haddow, E M Kloza, D E Smith

    Obstetrics and Gynecology
    |November 1, 1983
    PubMed
    Summary
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    Elevated maternal serum alpha-fetoprotein (AFP) screening in Maine requires further diagnostic steps. Sonography is superior to repeat AFP testing for detecting fetal defects when AFP levels are 3 or higher multiples of the median.

    Area of Science:

    • Maternal-fetal medicine
    • Prenatal screening
    • Diagnostic imaging

    Background:

    • Maternal serum alpha-fetoprotein (AFP) screening is a key component of prenatal care.
    • Elevated AFP levels can indicate various fetal abnormalities, necessitating further investigation.
    • Determining the optimal follow-up strategy for elevated AFP is crucial for accurate diagnosis and management.

    Purpose of the Study:

    • To evaluate the diagnostic utility of repeat maternal serum AFP testing versus sonography in pregnancies with elevated AFP.
    • To assess the effectiveness of sonography in identifying specific open fetal defects.
    • To determine the association between elevated AFP levels and adverse pregnancy outcomes such as fetal death and low birth weight.

    Main Methods:

    • Retrospective analysis of maternal serum AFP screening data from Maine.

    Related Experiment Videos

  • Comparison of repeat maternal serum AFP testing and sonography as follow-up diagnostic procedures.
  • Review of sonographic findings for singleton and multiple gestations with elevated AFP.

    • Main Results:

    • 4.8% of screened women had AFP levels >= 2 multiples of the median.
    • Sonography was superior to repeat AFP testing for AFP levels >= 3 multiples of the median.
    • Sonography identified all anencephaly, three open ventral wall defects, and one of two open spina bifida cases in singletons.
    • Elevated AFP (>= 3 multiples of the median) in singletons significantly increased the risk of fetal death and low birth weight.

    Conclusions:

    • Sonography is the preferred next diagnostic step for maternal serum AFP elevations of 3 or more multiples of the median.
    • While sonography is effective, certain defects like closed neural tube defects and some in twins may not be detected.
    • Significantly elevated AFP levels are strong indicators of increased risk for adverse pregnancy outcomes.