Tables for estimation of individual risks of fetal neural tube and ventral wall defects, incorporating prior probability, maternal serum alpha-fetoprotein levels, and ultrasonographic examination results

Article Abstract:

In pregnancy, elevated blood levels of maternal alpha-fetoprotein (AFP) can indicate the presence of defects of the fetal neural tube such as spina bifida (in which the spinal cord is pushed through an abnormally open spinal canal, often associated with severe neurological damage), but researchers differ in their criteria for cut-off points above which additional testing is warranted. Moreover, the additional testing often includes amniocentesis (sampling the amniotic fluid, in which the fetus floats), a procedure that carries a small (0.5 to 1 percent) risk of induced miscarriage. Ultrasonography can now provide such precise detail that some researchers rely on it alone to look for defects; most, however, want the additional information that AFP screening can provide. Patients decide whether to undergo amniocentesis or rely on the evidence provided by ultrasound and AFP levels, based on the perceived risks and benefits of both courses of action. To provide information helpful in such situations, risk tables were constructed for open spina bifida and abdominal (ventral) wall defects (failure of the abdominal wall to develop properly). The tables present the risk of these conditions for patients with different AFP levels and a detailed ultrasonographic examination that yielded normal findings (thus, extreme cases of spine bifida were not included, since these are easily detected with ultrasound). The tables include information for populations with different frequencies of spina bifida, as well as differing levels of sensitivity in the previous ultrasound evaluation (80, 90, and 95 percent sensitivity). The results show that amniocentesis cannot be recommended simply on the basis of elevated maternal AFP concentrations, nor avoided simply because ultrasonographic results are normal. Rather, the decision to undergo amniocentesis should be based on the patient's values and her individualized risk probabilities. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Abnormalities, Risk factors, Neural tube, Neural tube defects, Amniocentesis, Spina bifida, Alpha fetoproteins

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The paradox of electronic fetal monitoring: more data may not enable us to predict or prevent infant neurologic morbidity

Article Abstract:

Electronic fetal heart rate (FHR) monitoring can indicate periods of fetal distress but cannot predict nor prevent brain damage. Electronic FHR monitoring was first introduced in the 1960s and is now used in approximately 60% of all deliveries. Labor complications such as uteroplacental insufficiency and umbilical cord compressions have been associated with certain heart rate patterns, but the efficacy of FHR monitoring in preventing neurological disorders like cerebral palsy has not been demonstrated. In an analysis of FHR patterns from 55 brain-damaged infants, 31 had abnormal FHR patterns at the onset of monitoring, 28 had an abnormality at some point in monitoring and nine had no FHR abnormalities during the monitoring. However, there were no specific FHR patterns that indicated risk of brain damage and no time period was identified before or after which intervention may have prevented brain damage.

Fetal heart rate monitoring, Electronic fetal monitoring, Brain damage

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Maternal serum screening for fetal trisomy 18: benefits of patient-specific risk protocol

Article Abstract:

A triple screen used in conjunction with maternal age can identify many women with fetal trisomy 18, according to a study of 45,145 women. Trisomy means the fetus has three chromosomes instead of two. The triple screen measures the level of alpha-fetoprotein, unconjugated estriol, and human chorionic gonadotropin in the woman's blood.

Edwards' syndrome

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