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Management Strategy In Pregnancies With Elevated Second-Trimester Maternal Serum Alpha-Fetoprotein Based On A Second Assay.
MedLine Citation:
PMID:  23313312     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To assess maternal-fetal outcomes in pregnancies associated with persistently elevated second-trimester maternal serum alpha-fetoprotein (MSAFP). STUDY DESIGN: A retrospective cohort study in 658 patients with MSAFP ≥ 2.5 MoM, performed at routine Down syndrome screening. MSAFP was assayed a second time in 341 of them. Outcomes were recorded in all cases. RESULTS: The group with unexplained MSAFP persistently ≥ 2.5 MoM was associated with more pregnancy complications 37/92 (40.2%) as fetal death, pre-eclampsia, intrauterine growth restriction and congenital nephrotic syndrome, compared with the group with MSAFP that returned to a normal level 37/226 (16.4%) (P < 0.001). CONCLUSION: When MSAFP returns to a normal level on a second assay, the risk of adverse outcome significantly decreases, but these pregnancies are still at risk of complications and therefore need close surveillance. Repeat MSAFP assay allows identification of patients who should be offered amniocentesis to evaluate the risk of nephrotic syndrome and epidermolysis bullosa. AFP should be monitored in pregnancies associated with unexplained high MSAFP. A management strategy based on ultrasound examination, second MSAFP assay and amniocentesis is proposed to improve prenatal counseling and management of such pregnancies. However, a prospective study remains necessary to evaluate it.
Authors:
Emmanuel Spaggiari; Marie Ruas; Sophie Dreux; Anne-Sylvie Valat; Isabelle Czerkiewicz; Fabien Guimiot; Thomas Schmitz; Anne-Lise Delezoide; Françoise Muller
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-10
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  -     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Mosby, Inc. All rights reserved.
Affiliation:
Developmental Biology, AP-HP, Robert Debré Hospital, Paris, France; University Paris Diderot and Paris Sorbonne-Cité, Paris, France. Electronic address: spaggiari2002@yahoo.fr.
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