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Re: Abnormal Triple Screen & AFPFrom: Snorklesue@aol.comWed Mar 5 17:32:23 1997
How high was the msAFP? In pts with normal fetal anatomy but elevated msAFP and normal amniotic fluid AFP (therefore called unexplained elevated msAFP) tend to have poor outcomes including PTD, placental abruption, and IUGR(Unexplained Elevations of msAFP by Katz et al. in Obstetrical and Gynecological Survey vol.45 no.11 pg 719). Some other study quotes increased incidence of fetal loss, low birth weight, neonatal death (Outcome of Pregnancy in Patients With Unexplained Elevated or Low levels of msAFP by Burton in Obstetrics & Gynecology vol.72 no.5 pg709) There are other articles that are older in my possession if you're interested, but the Katz article is a nice review. Transfer of AFP to maternal bloodstream is in 94% via diffusion from the fetal circulation, and 6% via transmembranous transport from the amniotic cavity. Strong association between elevated AFP and fetomaternal hemorrhage, fetus could be having nephrotic syndrome, or not recycling or resorbing AFP (duodenal atresia) Management recommendations that I've seen but most say individualize (?) - serial US for growth, careful FHx of congenital nephrosis (fetal kidneys with nephrotic syndrome will look normal on US), dermatologic diseases, cocaine use in pt, or h/o hepatitis in pt (can produce maternal AFP endogenously) amnio even with normal level II (as elevated msAFP can be associated with other chromosomal anomalies such as triploidy), maternal anti-phospholipid antibodies and lupus anticoagulants( some associations noted). Hope this helps the abnl msAFP part. Susan Lee,MD Womack medcen NC - where the dogwoods are blooming these days.
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