Extremely high maternal serum alpha-fetoprotein levels at second-trimester screening

Article Abstract:

Alpha-fetoprotein is a fetal antigen, a protein produced by the fetus that provokes an immune response. The blood levels of alpha-fetoprotein in the mother, referred to as maternal serum alpha-fetoprotein (MSAFP), are measured between 14 and 16 weeks of pregnancy to monitor for fetal defects. Elevated levels of MSAFP have been associated with various fetal abnormalities and adverse outcomes of pregnancy. The outcome of 44 pregnancies was assessed in which MSAFP was eight or more times the normal value. Ultrasonography, a method in which sound waves are used to visualize the fetus, detected fetal defects that accounted for elevated MSAFP in 82 percent of the cases. Complications included fetal defects in 45 percent of cases; death of the fetus in 25 percent; a defect of the placenta (the tissue that nourishes the fetus) in 16 percent; and incorrect estimation of fetal age in 5 percent. The rise in MSAFP could not be explained in 18 percent of the cases, although subsequent follow-up frequently revealed pregnancy-related complications or placental abnormalities. MSAFP of eight or more times the normal value predicted defects of the neural tube, from which the brain and spinal cord develop, in 22.7 percent of cases. There were 16 live births out of the 44 pregnancies. Most incomplete pregnancies involved a major fetal defect and were terminated before 20 weeks of pregnancy. Complications of surviving infants included a birth-related abnormalities in 31 percent; intrauterine growth retardation (IUGR), or delayed growth of the fetus, along with a defect in 19 percent; IUGR in 12.5 percent; and prematurity in 25 percent. Eighty-eight percent of live births were complicated by obstetric problems. These findings show that most pregnancies with a MSAFP level eight or more times the normal value are complicated by fetal defects or death before 20 weeks of pregnancy. In addition, live births from such pregnancies tend to be complicated by obstetric problems and should be carefully monitored. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Diagnosis, Risk factors, Birth defects, Prenatal diagnosis, Fetal death, Alpha fetoproteins

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Accuracy of ultrasonic weight prediction in the fetus with preterm premature rupture of membranes

Article Abstract:

Accurate determination of fetal weight using ultrasound (estimated fetal weight, EFW) is important for monitoring pregnancy, but premature rupture of the membranes (PROM) surrounding the fetus may result in incorrect measurement of its weight. To determine whether this is the case, a comparison of the ultrasound EFW with actual birth weight was performed for premature fetuses with (86 fetuses) and without (112) PROM. Fetuses at 36 weeks' gestation who had had an ultrasonic determination of weight within five days of delivery were included. Results showed that ultrasound was equally accurate in predicting birth weight for fetuses with and without PROM. The average overall EFW error was approximately nine percent. No significant difference in birth weight was found for infants whose membranes had been intact (1,560 grams) and those whose membranes had ruptured prematurely (1,495 grams). Thus, weight estimations made with careful ultrasound technique appear equally accurate for fetuses with and without PROM. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Fetus, Premature rupture of membranes, Premature rupture of the membrane, Birth weight, Prenatal ultrasonography, Ultrasonics in obstetrics

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