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Re: Abnormal triple screeFrom: AFPPLUS3@aol.comWed Feb 25 14:05:06 1998
In a message dated 98-02-25 12:52:50 EST, you write: << I have a patient who is a 31 year old g3p0 @ 18 weeks. She is on syntrhoid, pregnancy otherwise uncomplicated. No bleeding. Her tripple screen showed: AFP: 2.6 MoM Estriol: 2.16 MoM HcG: 7.33 MoM Utrasound shows no placental or fetal abnormalities. The lady is heavy and the sonographers raised a question of cleft lip and palate which could no be confirmed. The fingers look normal as does the head, heart and spine. Would you recommend amnio? Fetal assessment (NST's etc) later? Any special studies? Thanks in advance,
Gary Kleinman
>> Firstly, this patient is at increase risk for ONTD (using a cutoff of 2.0-2.5 MoM), and on that basis should be offered U/S [screening] (done) and then at least offered genetic counseling with regards to the risks and benefits of amniocentesis (diagnostic). Given the medians being reported to you by your lab, you haven't given the risk reported for fetal Down syndrome ? Was the post test risk (biochemical & maternal age) of the patient greater than or equal to that of a 35 year old (Gold standard in the USA). If yes then she should be counseled as to the risks and benefits of amniocentesis. However, with these values I am a little more worried about Triploidy (our lab exp), but the U/S you state is "no placental or fetal abnormalities" seen. I think the Ref. given by art fougner, md (SonoScan/Genetic Sciences) are very good ones and if you havent had a chance to read them you might enjoy them. It might have been interesting to see what her inhibin A levels were? Did she have a first trimester U/S, (Twins)?and now One fetus? Is this a IVF preg? If patient has amnio please let us all know what happened... Leonard H. Kellner, MS Adm. Director Reprod. Genetics Department of Ob-Gyn Montefiore Medical Center, Bronx NY
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