Evaluation of Unexplained Elevated Maternal Serum Alpha-Fetoprotein between 16-18 Weeks’ Gestation and It’s Relation with Pregnancy Outcome

Abstract

Abstract:Background: Maternal serum screening is one of several possible first steps in identifying women whose fetuses are at increased risk for a disorder amenable to antenatal detection. The first test utilized widely was the measurement in maternal serum assay of a fetal–specific protein termed Alpha- fetoprotein (AFP).Objective: To determine whether pregnant women with unexplained elevated maternal serum alpha-fetoprotein levels are at increased risk for adverse perinatal outcome.Designs: A prospective follow up (cohort) study. Setting: The study was carried out in the Department of Obstetrics and Gynecology in Al–Yarmouk teaching Hospital, for the period from June 2002 to November 2003. Patients & Methods: A total of 348 pregnant women of 16-18 weeks of gestation were chosen to participate in this study. A detailed history was taken concentrating on the presence of risk factors for having congenital abnormal baby or poor pregnancy outcome. All the women were offered maternal serum alpha-fetoprotein testing with simultaneous ultrasonography and follow up of them done with observation of their pregnancy outcome.Results: Eighteen of women had increased MSAFP level (2.0 MOM), five cases discovered to have congenital abnormalities, one case was lost from them and the remaining twelve of these women were regarded as unexplained elevated MSAFP. Follow up was done. Eight of them had adverse perinatal outcome and four cases had normal outcome.330 cases were found to have normal MSAFP levels, 61 cases were excluded from the follow up for variable causes, 89 cases were lost and the remaining 180 cases were completed the follow up. 40 of them had adverse pregnancy outcome and 140 cases had normal outcome.Conclusions: It is concluded that women with elevated serum level of AFP in the second trimester with no apparent cause might have adverse outcome for their pregnancy like preterm labor, PROM, PIH, IUGR, and spontaneous abortion.