The roles of ultrasonography and amniocentesis in evaluation of elevated maternal serum alpha-fetoprotein

Article Abstract:

When alpha-fetoprotein (AFP), a protein made by the fetus, appears in large amounts in the mothers blood, it usually means that something is wrong with the fetus. All pregnant women are offered testing for AFP between weeks 15 and 20 of pregnancy. A positive test result (high levels of AFP) can be caused by abnormal development of the fetal nervous system (neural tube defect), a misdiagnosis of the age of the fetus, multiple fetuses, abdominal wall defects, kidney or intestine abnormalities, and fetal death. When a pregnant women tests positive for high AFP levels, ultrasound can be used to further examine the fetus for abnormalities, and amniocentesis (analysis of a sample of amniotic fluid that surrounds the fetus) can be used to test for genetic defects. At the University of California, Davis Medical Center, between 1986 and 1989, 681 pregnant women with high levels of AFP were referred for ultrasonography and possible amniocentesis. Forty-two percent of these women had abnormal ultrasound findings. There were 33 cases of fetal death, 29 cases of neural tube defects, 20 cases of abdominal wall defects, 22 cases of oligohydramnios (abnormally low amounts of amniotic fluid), and 21 cases of placental abnormalities. Sixty-five percent of the women underwent amniocentesis, and 13 additional abnormalities were identified that were not detected by ultrasound, including three additional cases of neural tube defects. Elective abortion was performed in 31 cases of neural tube defects and in 14 cases of abdominal wall defects. Of the patients with oligohydramnios, there were five spontaneous abortions, four elective abortions, and one neonatal death. Of the women who had normal amniocentesis tests, 95 percent gave birth to normal babies and 5 percent had fetal death or birth defects. There were only five cases of birth defects that were not detected by ultrasound or amniocentesis. It is concluded that pregnant women should be tested for AFP and ultrasound should be the first test performed if the AFP test is positive. Amniocentesis can be used to confirm the results of the ultrasound, and should be used when a women with high AFP levels has a normal ultrasound test. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Ultrasound imaging, Measurement, Fetus, Alpha fetoproteins

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Ultrasonography-guided early amniocentesis in singleton pregnancies

Article Abstract:

Fetal abnormalities can be detected using various methods of prenatal diagnosis, some of which are performed earlier in pregnancy than others. Since termination of pregnancy because of an abnormality is safer when performed earlier in pregnancy, early prenatal diagnosis is advantageous. Amniocentesis is traditionally performed between 16 and 18 weeks of pregnancy. During amniocentesis, a needle is inserted into the abdomen, which penetrates the amniotic membranes and removes a small sample of amniotic fluid for chromosomal and biochemical analysis. The needle is guided by ultrasonography, the use of high frequency sound to visualize internal structures. The results of amniocentesis continuously guided by ultrasonographic imaging and performed before 15 weeks of pregnancy are reported. Of the 527 amniocentesis procedures performed at this early stage of pregnancy, 48.4 percent were performed at 14 weeks, 40.8 percent were performed at 13 weeks, and the remainder were performed between 10 and 12 weeks of pregnancy. Amniotic fluid was successfully obtained after the first needle insertion in 92 percent of the cases. Discolored amniotic fluid, a sign of a pregnancy complication, was present in 27 cases (5.1 percent). Of the 517 cases with complete follow-up information, 10 (1.9 percent) resulted in miscarriage before the 28th week of pregnancy, one (0.2 percent) miscarriage occurred after 28 weeks of pregnancy, and one (0.2 percent) baby was stillborn; the overall rate of fetal death following amniocentesis was 2.3 percent. Although it is known that approximately 15 to 20 percent of recognized pregnancies result in spontaneous fetal loss, in four cases the miscarriage occurred within two weeks after the amniocentesis and these miscarriages were probably related to the procedure. In the remaining eight cases, the loss was probably not related to the procedure. This study reports an overall loss rate of 2.3 percent, which is lower than previously reported (4.7 percent). It is thought that continuous ultrasonographic guidance reduced the risk of miscarriage after amniocentesis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Usage, Diagnosis, Causes of, Birth defects, Fetal death, Prenatal ultrasonography, Ultrasonics in obstetrics

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Stab wounds to the neck: role of angiography

Article Abstract:

During a seven year period 45 patients with 61 stab wounds to the neck were received by a rural hospital. The patients were evaluated by clinical examination and received angiograms into their vessels (X-ray examination of the vessels of their neck using injection of a dye that can be seen by X-ray). Correlations between the angiograms and the other physical data was used to examine the degree to which vessels are damaged during such traumatic injuries and to explore the possibility that some vessel damage may be undetected by simpler examinations. Although eighteen of the stab wounds were associated with serious findings, only two wounds involved significant damage to the vascular system. The other 43 wounds were associated with only minor physical damage to the neck of the patients. These results demonstrate that occult damage to the vessels of the neck is highly unlikely in patients with only minor physical findings, and that angiography is unwarranted in these patients.

Case studies, Injuries, Wounds and injuries, Angiography, Neck, Neck injuries

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