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Re: Help!! Positive Alpha-fetoprotein screeningFrom: anonymous@obgyn.netSun, 19 Apr 1998 20:09:55 -0500 (CDT)
Regarding the AFP and/or triple screen tests: All pregnant women, regardless of age, are offered a blood test called a triple screen (which consists of levels of estriol, alpha fetoprotein, and HCG), or, in some cases, an alpha fetoprotein test alone (AFP). Contrary to popular belief, this test does *not* tell you whether or not your baby has Down syndrome, spina bifida, or any other condition. What is does is gives you a risk of having these conditions. If the risk is greater than a statistical cutoff, you are offered other tests to pin down the diagnosis. The first thing we do when we receive an abnormal triple screen test is to make sure the patient's age and due date were recorded correctly. If incorrect, the computer at the lab will calculate the risk incorrectly. If these are right, then the patient is offered genetic counseling, where she sits down with a genetics expert to review the family history. Then, a "targeted" ultrasound is performed. This is a special ultrasound performed (hopefully) on an advanced ultrasound machine, where the baby's face, palate, hands, fingers, spine, brain, heart, etc are carefullyl evaluated. This is not the same as an ultrasound where the doctor or sonographer puts the probe on the abdomen and says "it's a girl" then turns off the machine! Targeted ultrasounds typically take 20-30 minutes (often more) to complete. If the ultrasound is not helpful, or if the family wants the best possible testing, they should have an amniocentesis. I am reluctant to contradict the input from women posting the the forum, but a recent contributer stated that an amnio is a painful test, and that in her case it came back with insufficient cells to make a diagnosis. I feel bad that this happened, but this is exceptionally rare. Amnio's can be uncomfortable, and in some cases may hurt, but the majority of women tell me "that's it?" after it's done. Perhaps their understandable anxiety over having a needle placed into the abdomen was more than the actual pain they experienced! Whatever the reason, some women have multiple amnio's done during their pregnancy (for certain high risk conditions) and do just fine. The amnio is close to, but never exactly, 100% accurate. No medical test is perfect. The amnio will examine the baby's cells, and determine the genetic makeup. It also looks at the fluid to determine if the baby has spina bifida. The bad part of triple screen/AFP testing is that there are false-positives. This means that some with with an abnormal test will have perfectly normal babies, and will be afraid for "no reason" until the normal amnio or ultrasound results come in. This is an unfortunate side-effect of medical testing, which, again, is never perfect. We would rather scare some folks who actually have normal babies than tell women the babies are normal when they actually are not. So, we lean towards the false positive results. The decision to have this test is very personal. It does help your doctor or midwife, who may request a c/section if the baby has spina bifida, or who may order special heart ultrasounds if the baby has Down syndrome. Good luck with your pregnancy, and thank you for the opportunity to address the issue of triple screen testing.
-- Ashley Hill David Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, Florida
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