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Re: Abnormal Triple Screen & AFPFrom: ATB28@aol.comTue Mar 4 06:24:48 1997
In a message dated 97-03-03 17:32:38 EST, mike@sccsi.com (Dr. Michael Hunter) writes: << any reports or studies concerning the outcome of patients with abnormal trisomy screen and elevated AFP >> Mike: There have been numerous reports in the literature over the last decade regarding the association of increased MSAFP - performed alone - and adverse pregnancy/perinatal outcome. Lately several additional studies (both retrospective and prospective) have shown that the same holds true for MSAFP performed as part of multiple marker screening (triple or double test). Of particular concern are those patients who, when undergoing triple marker screening, have a test which identifies the pregnancy at increased risk for BOTH NTD and chromosome abnormalities; i.e., increased MSAFP (the former) and increased hCG (the latter). But what do you do? Neither the ACOG nor most consults advocate any *specific* course of action - because none has yet been proved superior to others. "Increased surveillance" are the watchwords of the day, however you accomplish that in your practice. This *may* be a role for fetal fibronectin, owing to the well-documented increased risk for preterm labor/preterm delivery in these patients. Since IUGR is also a "common" finding in such patients, serial fundal height measurements, u/s examinations for growth (you've already ruled out anomalies, right), kick counts, NST/BPP might also be appropriate - consult with your local resources re: their specific recommendations, but watch the patient carefully! And good luck... Allan T. Bombard, MD Reproductive Genetics/Obs-Gyn AECOM/MMC Bronx, NY
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