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Elevated maternal serum AFP and normal ultrasound: what next?
1Intermountain Health Care, Department of Perinatology, Salt Lake City, UT 84143.
Seminars in Ultrasound, CT, and MR
|February 1, 1993
Summary
Routine amniocentesis for elevated maternal serum alpha-fetoprotein may be reconsidered. Targeted ultrasound offers high detection rates for spina bifida but cannot identify all fetal anomalies, necessitating patient counseling on amniocentesis options.
Area of Science:
- Maternal-Fetal Medicine
- Prenatal Diagnosis
- Medical Genetics
Background:
- Elevated maternal serum alpha-fetoprotein (MSAFP) levels historically prompted amniocentesis.
- Intracranial changes in fetuses with open spina bifida challenge this standard practice.
Purpose of the Study:
- To evaluate the role of routine amniocentesis in unexplained elevated MSAFP.
- To compare the diagnostic capabilities of targeted ultrasound versus amniocentesis for fetal anomalies.
Main Methods:
- Review of diagnostic performance of targeted ultrasound for open spina bifida.
- Assessment of ultrasound's sensitivity for other fetal anomalies (ventral wall, karyotype).
- Consideration of amniocentesis's ability to detect chromosomal and structural anomalies.
Main Results:
- Targeted ultrasound detects over 95% of open spina bifida cases.
- Ultrasound sensitivity for neural tube defects has significantly improved.
- Ultrasound cannot detect all chromosomal or structural anomalies detectable by amniocentesis.
Conclusions:
- Routine amniocentesis for elevated MSAFP warrants re-evaluation.
- Patients require comprehensive counseling on risks and benefits after targeted ultrasound.
- Amniocentesis remains a valuable option for detecting anomalies not identified by ultrasound.