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Elevated maternal serum AFP and normal ultrasound: what next?
1Intermountain Health Care, Department of Perinatology, Salt Lake City, UT 84143.
Given the discovery of intracranial changes observed in fetuses with open spina bifida, the wisdom of routinely performing amniocentesis on persons with unexplained maternal serum alpha-fetoprotein elevations is now being questioned. The detection rate for spina bifida with a targeted ultrasound examination is greater than 95%. Yet one must also consider the sensitivity of ultrasound in detecting other anomalies, such as ventral wall defects and fetal karyotype anomalies. Although the sensitivity of ultrasound for neural tube defects has improved dramatically in recent years, it cannot detect all chromosome or structural anomalies that may be detected by amniocentesis. Therefore, patients should be made aware of their specific risks following a targeted ultrasound and offered the option of amniocentesis.
Given the discovery of intracranial changes observed in fetuses with open spina bifida, the wisdom of routinely performing amniocentesis on persons with unexplained maternal serum alpha-fetoprotein elevations is now being questioned. The detection rate for spina bifida with a targeted ultrasound examination is greater than 95%. Yet one must also consider the sensitivity of ultrasound in detecting other anomalies, such as ventral wall defects and fetal karyotype anomalies. Although the sensitivity of ultrasound for neural tube defects has improved dramatically in recent years, it cannot detect all chromosome or structural anomalies that may be detected by amniocentesis. Therefore, patients should be made aware of their specific risks following a targeted ultrasound and offered the option of amniocentesis.