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Re: Worries regarding: elevated AFP From: ATB28@aol.com Mon Mar 29 21:38:13 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: deisenberg@email.com: "cervicitis" Previous message: barbara nesbitt: "FW:information about non-hodgkin lymphoma of the uterus" Maybe in reply to: Malcolm Griffiths: "Worries regarding: elevated AFP" Next in thread: Braun, R. Daniel: "Re: Worries regarding: elevated AFP" In a message dated 3/29/1999 12:12:00 PM Pacific Standard Time, Malcolm@MGRIFF22.demon.co.uk writes: << Thank you for your opinions on the elevated amniotice >fluid AFP with normal serum AFP. To answer the >questions raised: the amnio was for maternal age >35, the triple screen was done even though amnio was >planned because of the studies showing that elevated >SERUM afp with nl amnio indicates increased risk of >IUGR and IUFD. I find this rather worrisome! Do you have data on the positive and negative predictive value, sensitivity and specificity of this test for IUGR and IUFD? Have you looked at cost-effectiveness? Do they vary with maternal age/race/weight/BMI? Seems to me that the physician/patient and her physician are reaping the rewards of over-reaching the reasonable use of the test - leading to worry for both of them! >> Poppycock! I agree with Malcolm. The best reference regarding outcomes in patients with increased AF-AFP and normal AcHE is a study published by Barbara Crandall in Prenatal Diagnosis (?'97? ?'98?...don't have my journals here at home). Only documented adverse outcome (again, neg AcHE and no fetal hemoglobin...most increased AF-AFP is due to fetal blood contamination) was IUGR, particularly with AF-AFP > 5.0 MoM. Best management is periodic ultrasound looking at AFV and fetal growth; with antenatal testing for placental insufficiency *if* IUGR becomes manifest. Sorry to be so late in the queue. I've been out sailing.... Allan Bombard, MD Oakland, CA Next message: deisenberg@email.com: "cervicitis" Previous message: barbara nesbitt: "FW:information about non-hodgkin lymphoma of the uterus" Maybe in reply to: Malcolm Griffiths: "Worries regarding: elevated AFP" Next in thread: Braun, R. Daniel: "Re: Worries regarding: elevated AFP"

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