Second-trimester maternal serum alpha-fetoprotein levels and the risk of subsequent fetal death

Article Abstract:

Death of the fetus at 20 weeks of pregnancy or later accounts for a large proportion of perinatal deaths in the United States, and the rate of late fetal death may be equal to or greater than that of newborn death in some states. (Perinatal deaths occur between the 28th week of pregnancy and the first month of life.) The early detection of pregnancies at risk for fetal death and the prevention of perinatal death are essential. Increased blood levels of alpha-fetoprotein in the mother during the second trimester, or second three months of pregnancy, may indicate that the fetus has died or is about to die. Alpha-fetoprotein is an antigen (a substance that can provoke an immune response) that is present in the human fetus and in certain diseases in adulthood. The maternal blood level of alpha-fetoprotein is usually measured at 14 to 16 weeks of pregnancy to test for nerve-related defects of the fetus. Elevated levels of alpha-fetoprotein are associated with an increased risk of nerve-related defects in the fetus, more than one fetus, or miscarriage. The relation of increased alpha-fetoprotein and fetal death unrelated to nerve-related defects or more than one fetus was assessed. The study involved 3,113 pregnancies with a single fetus, including 612 that ended in fetal death. The alpha-fetoprotein levels were measured in the second trimester in all cases. The results showed that increased alpha-fetoprotein levels were associated with an increased risk of fetal death, which persisted until the end of pregnancy. The relation between elevated alpha-fetoprotein levels and risk of fetal death was particularly evident in women with abnormally high blood pressure or placental infarction (death of placental tissue due to inadequate blood supply). These results show that elevated alpha-fetoprotein levels in the second trimester of pregnancy are associated with an increased risk of fetal death and that this effect persists for four to five moths after alpha-fetoprotein testing. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Cases, Measurement, Fetus, Alpha fetoproteins

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Hypertension in pregnancy

Article Abstract:

There are four categories of hypertension that can occur during pregnancy; preeclampsia, eclampsia, chronic hypertension and transient hypertension. Preeclampsia usually occurs late in pregnancy, and can threaten the life of both the mother and child. It can rapidly progress to eclampsia, or convulsions. Women with preeclampsia have decreased cardiac output, and may have increased blood vessel resistance. Preeclampsia may be prevented by calcium supplements and low-dose aspirin. Women with preeclampsia may need to be hospitalized, and treated with drugs to manage hypertension and prevent eclampsia. Catheterization of women with preeclampsia to monitor blood pressure and infuse substances to increase blood volume is controversial. A local anesthetic during labor and cesarean section may be safer than a general anesthetic for women with preeclampsia. Pregnant women with chronic hypertension may have a higher risk of complications than those with normal blood pressure, but 85% have normal pregnancies.

Care and treatment, Eclampsia, Preeclampsia, Hypertension in pregnancy, Gestational hypertension

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