Alpha-fetoprotein (AFP) tests in pregnancy

Maternal Serum Alpha-Fetoprotein Screening (MSAFP)

Alpha-fetoprotein (AFP) tests in pregnancy

MSAFP is a screening test that examines the level of alpha-fetoprotein in the mother’s blood during pregnancy. This is not a diagnostic test.  It is often part of the triple screen test that assesses whether further diagnostic testing may be needed.

What is a screening test?

It is very important to remember what a screening test is before getting one performed. This will help alleviate some of the anxiety that can accompany test results.

Screening tests do not look only at results from the blood test.  They compare a number of different factors (including age, ethnicity, results from blood tests, etc…) and then estimate what a person’s chances are of having an abnormality.

These tests DO NOT diagnose a problem; they only signal that further testing should be done.

How is the MSAFP performed?

Blood is drawn from veins in the mother’s arm and sent off to a laboratory for analysis. Results are usually returned between one and two weeks.

When is MSAFP performed?

MSAFP may be performed between the 14th and 22nd weeks of pregnancy, however, it seems to be most accurate during the 16th to 18th week.  Your levels of AFP vary during pregnancy so accurate pregnancy dating is imperative for more reliable screening results.

All pregnant women should be offered the MSAFP screening, but it is especially recommended for:

What does the MSAFP test look for?

Alpha-fetoprotein (AFP) is found in both fetal serum and also amniotic fluid.

This protein is produced early in gestation by the fetal yolk sac and then later in the liver and gastrointestinal tract. The true function of AFP is unknown.

We do know that this protein’s level increases and decreases during certain weeks of pregnancy which is why accurate pregnancy dating is crucial.

The AFP test is measuring high and low levels of alpha-fetoprotein.  The results are combined with the mother’s age and ethnicity in order to assess the probabilities of potential genetic disorders.

High levels of AFP may suggest the developing baby has a neural tube defect such as spina bifida or anencephaly.

High levels of AFP may also suggest defects with the esophagus or failure of your baby’s abdomen to close. However, the most common reason for elevated AFP levels is inaccurate dating of the pregnancy.

Low levels of AFP and abnormal levels of hCG and estriol may indicate the developing baby has Trisomy 21( Down syndrome), Trisomy 18 (Edwards Syndrome) or another type of chromosome abnormality.

Abnormal levels may also be a result of the following:

What do MSAFP results mean?

It is important to remember that the AFP is a screening test and not a diagnostic test. This test only notes that a mother is at risk of carrying a baby with a potential disorder.

There are approximately 25 to 50 abnormal test AFP results for every 1,000 pregnancies tested.

Of these abnormal results, only 1 in 16 to 1 in 33 will actually have a baby that has been affected by a neural tube defect or other condition.

75% to 90% of babies with neural tube defects are discovered through AFP screening.Click To Tweet

Abnormal test results warrant additional testing for making a diagnosis.

A more conservative approach involves performing a second MSAFP or complete triple screen test followed by a high definition ultrasound.

If the testing still maintains abnormal results, a more invasive procedure such as amniocentesis may be performed.

Invasive procedures should be discussed thoroughly with your healthcare provider. It is also important to talk through further testing with your partner. Additional counseling and discussions with a counselor, social worker or minister may prove helpful.

What are the risks and side effects of MSAFP to the mother or baby?

Except for the discomfort of drawing blood, there are no risks or side effects associated with the MSAFP.

What about further testing?

MSAFP is a routine test that is not an invasive procedure and poses no known risks to the mother or baby. The MSAFP results may warrant additional testing.

The reasons to pursue further testing or not may vary from person to person and couple to couple. Performing further testing allows you to confirm a diagnosis and then provides you with certain opportunities:

  • Pursue potential medical interventions that may exist
  • Begin planning for a child with special needs
  • Start addressing anticipated lifestyle changes
  • Identify support groups and resources
  • Make a decision about carrying the child to term

Some individuals or couples may elect not to pursue further testing for various reasons:

  • They are comfortable with the results no matter what the outcome is
  • Because of personal, moral, or religious reasons, making a decision about carrying the child to term is not an option
  • Some parents choose not to allow any testing that poses any risk of harming the developing baby

It is important to discuss the risks and benefits of further testing thoroughly with your healthcare provider. Your healthcare provider will help you evaluate if the benefits from the results could outweigh any risks from the procedure.

Compiled using information from the following sources:

1. William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 13.

2. Mayo Clinic Complete Book of Pregnancy & Baby’s First Year Johnson, Robert V., et al, Ch. 6.

Source: https://americanpregnancy.org/prenatal-testing/maternal-serum-alpha-fetoprotein-screening/

AFP Blood Test During Pregnancy

Alpha-fetoprotein (AFP) tests in pregnancy

  • How It's Done
  • What the Results Mean
  • What Happens Next

Unborn babies normally make alpha-fetoprotein (AFP), and it shows up in their mother's blood. Checking the level of AFP in a mom-to-be can show if her baby may have problems with their neural tube, what will become the brain and spinal cord.

AFP is one of the blood tests you have in a triple screen or quad screen. You can choose to get an AFP test or not. A genetic counselor can help you decide.

You do a maternal serum alpha-fetoprotein test when you're about 4 months pregnant.

A technician uses a needle to take a small sample of blood from a vein in your hand or arm. You may feel a small skin prick and have a little bruising or bleeding where the needle goes in. Then they'll send your blood to the lab.

A negative or normal test usually means your baby oeds not have genetic abnormalities.

A positive test with a high AFP suggests a birth defect spina bifida. That's typically a result of 2.5 times or more than the “average” level of AFP you'd expect to see at that point in your pregnancy.

A positive test with low AFP could mean a problem Down syndrome or Edwards syndrome.

Don't worry if your test isn't normal. AFP only tells you there's a chance for a problem, not that there is one.

High AFP could mean you're further along than you thought, because your level keeps going up throughout your pregnancy. Your baby may make more AFP than normal, or you could be having twins (two babies make more AFP than one). Other things, including your race, weight, and having diabetes, can also affect your result.

Sometimes you can get a false positive. That means the test says something's wrong when it's not. Your doctor will probably want to double-check your results. Another test often shows your baby is healthy.

When your AFP is too high or low, you can have more tests to find out why.

Your doctor will ly do an ultrasound to confirm how long you've been pregnant and how many babies there are. They'll also look closely for birth defects.

One of the next steps might be to see if there's AFP in the fluid around your baby with a test called amniocentesis. Your doctor uses a long, thin needle to go through your belly into the amniotic sac and take a small amount of fluid for the lab to check.

You may need to talk to a genetic counselor, who can help you understand your results and answer your questions.

If your baby might be born too early, your doctor will watch you closely.

If tests show your baby has a birth defect or other problem, you'll have to make difficult decisions. Talk to a specialist about what you can expect and what your options are so you can make the best choices for your family.

SOURCES:

LabTestsOnline.org: “Second Trimester Maternal Serum Screening.”

Maryland Department of Health: “AFP Testing for Improved Pregnancy Outcome.”

Mayo Medical Labs: “Test ID: MAFP – Alpha-Fetoprotein (AFP), Single Marker Screen, Maternal, Serum.”

American Pregnancy Association: “Maternal Serum Alpha-Fetoprotein Screening (MSAFP).”

Maryland Perinatal Associates: “Maternal Serum AFP Screening.”

UpToDate: “Open neural tube defects: Risk factors, prenatal screening and diagnosis, and pregnancy management.”

NHS Choices: “Amniocentesis.”

© 2019 WebMD, LLC. All rights reserved.

Source: https://www.webmd.com/baby/afp-blood-test-pregnancy

The Second Trimester

Alpha-fetoprotein (AFP) tests in pregnancy

Prenatal screening is important during your second trimester simply because many conditions can only be detected during this time. Finding out about many conditions early can allow your medical team to better plan ahead for how to mitigate or treat it.

Some of the conditions that can be detected during the second trimester can be found below. 

The risk of producing a child with Down syndrome or an open neural tube defect concerns many parents. These risks can be assessed by screening the level of alpha-fetoprotein (AFP) in the mother’s bloodstream, which can be measured between the 15 and 21 week of pregnancy.

Open Neural Tube Defects

AFP screening can detect pregnancies with open neural tube defects because these defects allow greater than normal amounts of AFP to cross into the mother’s bloodstream.

There are two types of open neural tube defects: an absence of the skull, known as anencephaly, and an open spine, known as spina bifida.

These defects generally occur without warning and in families without an affected family member.

Most women who have AFP testing will have normal results, meaning that their risk of having a baby with anencephaly or spina bifida is very low. The screening detects 80 percent of pregnancies with open neural tube defects.

Abnormal Results

If the AFP level is higher than expected, the possibility of twins or incorrect dating (being further along in pregnancy than expected) must first be ruled out by an ultrasound. A repeat AFP blood test is usually performed if neither twins nor incorrect dating is found by the ultrasound.

If a woman has elevated AFP levels on repeat testing or the first AFP level is very high, she will be offered further information and testing to evaluate the baby for abnormalities.

 It's important to note that most women who have elevated AFP levels will have healthy babies.

 Elevations can often be explained by the differences in placentas and the amount of AFP that is allowed to cross into the mother’s bloodstream.

Down Syndrome

The AFP level and other blood levels also are used to detect pregnancies at increased risk for Down syndrome, a birth defect resulting in mental retardation. Down syndrome, open neural tube defects, generally occurs without warning or in families without an affected family member.

The risk of having a baby with Down syndrome increases as women age.

While it's routine to offer prenatal testing, such as amniocentesis, to all women 35 years of age and older, Down syndrome pregnancies in women under 35 generally remain undetected until delivery unless a blood screening has been done.

Trisomy 18

Low AFP, hCG, and estriol levels are used to detect pregnancies at increased risk for trisomy 18, a birth defect that causes mental retardation, and in most cases, death. This screening will detect 60 percent of pregnancies with trisomy 18.

If you have questions about screening or diagnostic tests in pregnancy, please call the MUSC Health Prenatal Wellness Center at 843-792-1200.

Source: https://muschealth.org/medical-services/womens/pregnancy/second-trimester

Alpha-fetoprotein (AFP) tests in pregnancy

Alpha-fetoprotein (AFP) tests in pregnancy

When you are pregnant, substances from your fetus (developing baby) mix with your own blood. One of these substances is alpha-fetoprotein. Alpha-fetoprotein (AFP) is produced by the fetus and can be detected in a blood sample from you. If your doctor recommends an AFP test, it is usually done between weeks 16 and 18 of pregnancy (during the second trimester).

The results of your AFP blood test can alert your doctor to possible birth defects. A high level of AFP can be an indication of a neural tube defect such as spina bifida. It can also indicate chromosomal problems in the developing baby.

However, it’s important to note that high levels of AFP can also be present for other reasons.

  • The level of AFP in your bloodstream increases substantially in the fourth to sixth months of pregnancy, so if you have a high result it may indicate that your pregnancy is further advanced than you realised and your due date needs to be calculated again.
  • If you are carrying twins your AFP will also be high.

These days, many pregnant women in Australia will have screening tests in the first trimester of pregnancy, which includes an ultrasound scan that will determine the age of the fetus and whether you are pregnant with twins.

Understanding AFP tests

An AFP test is only a screening test – the most it can do is point to a possible problem. If the results of an AFP test point to a problem, other tests will be needed to confirm the results.

In most cases, AFP test results are normal. Even when they are not normal, the results of follow-up tests are most often normal.

When are AFP tests done?

An AFP blood test can be done in the second trimester as one of several tests used to screen for chromosome conditions and neural tube defects.

What do abnormal AFP test results mean?

Most AFP results are negative (normal). This means the test results are within the normal range for your stage of pregnancy.

Sometimes results are positive (abnormal). Often, this is simply because:

  • your due date is different than first thought; or
  • you are pregnant with twins.

Sometimes, abnormal results mean that the fetus may have one of the following problems:

  • neural tube defects (problems with the spine, such as spina bifida);
  • defects in the wall of the abdomen; or
  • chromosomal defects, such as Down syndrome).

AFP tests may be done together with other blood tests that measure your blood levels of 2 pregnancy hormones. These hormone levels help determine the risk of the baby having Down syndrome.

How accurate are AFP tests?

AFP test results can sometimes be wrong. These are called false negatives or false positives. Be sure to ask your doctor or obstetrician any questions you have about your results.

Follow-up tests

If your test results are abnormal, you will be offered more tests. These additional tests can confirm whether there really is a problem or whether everything is normal. The tests include the following.

  • Ultrasound scan: this uses sound waves to create an image of the fetus.
  • Recalculated AFP: a second AFP test, used if ultrasound shows that your due date is different than first thought or that you have twins.
  • Amniocentesis: this is a test of the fluid that surrounds the fetus in the womb.

Should I have an AFP test?

Having an AFP test is up to you and, all screening tests, it is optional. An AFP test can warn you about some fetal birth defects. In Australia, an ultrasound scan at 18-20 weeks if often done instead of AFP tests.

Here are some more facts to help you decide if you want to have the test.

  • An AFP test causes no health risk to you or the fetus.
  • An AFP test can only point to possible problems with the fetus.
  • If the test points to a possible problem, other tests will be needed to confirm the AFP results.
  • Even AFP test results that are normal cannot tell for sure that the fetus is healthy.

The 18 to 20 week ultrasound scan can detect abnormalities hinted at by an AFP test.

Other prenatal screening tests

There are several other screening tests that are available to pregnant women to help detect possible birth defects. Check with your doctor about which tests are most suitable for you. These tests may be recommended as an alternative to, or in addition to, AFP tests.

Screening for chromosomal abnormalities

There are tests that can screen for Down syndrome in the first trimester of pregnancy and are more accurate than AFP tests.

A first trimester prenatal test that involves a blood test (performed at 9 to 13 weeks), combined with a special ultrasound scan called a nuchal translucency scan (performed at 11 to 13 weeks) has largely replaced the AFP test as a screening test for Down syndrome. It also screens for several other chromosomal abnormalities.

Cell-free DNA-based screening, also called noninvasive prenatal testing (NIPT), is a newer test that became available in Australia in 2013. This test involves analysing a blood sample for cell-free fetal DNA – small fragments of the developing baby’s DNA that are found in the mother’s bloodstream.

cf-DNA-based screening is very accurate and can be done from 10 weeks to screen for several genetic and chromosomal conditions including Down syndrome. It is sometimes offered as a follow-up test after other screening tests have shown that there is an increased risk of a chromosomal abnormality.

Until recently the testing was carried out overseas, but there are now laboratories in Australia that do this test. However, the test remains expensive and is not available in all areas.

Doctors usually recommend having a 11-13 week ultrasound in addition to NIPT.

Screening for neural tube defects

An ultrasound scan performed at 18-20 weeks (second trimester) can be done instead of, or in addition to, AFP tests to check for neural tube defects. In some cases, an amniocentesis test may be recommended as a follow-up test.

AFP tests and/or ultrasound scan should still be offered to women who have had first trimester screening.

What next?

The AFP test is just one of many tests you may have while pregnant. It is certainly not essential. Most women’s AFP test results are normal. Even if they are not, the chances are high that your baby is healthy. Ask your doctor or obstetrician any questions you have about this or any of the other tests that are offered during pregnancy.

References

1. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Prenatal screening and diagnostic testing for fetal chromosomal and genetic conditions (current July 2018). https://www.ranzcog.edu.

au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Prenatal-screening-(C-Obs59)-July18.pdf?ext=.pdf (accessed Sep 2018).
2. BMJ Best Practice. Routine antenatal care (reviewed August 2018). https://bestpractice.bmj.com (accessed Sep 2018).
3. Woolcock J, Grivell R.

Noninvasive prenatal testing. AFP 2014;43(7):432-4. https://www.racgp.org.au/afp/2014/july/noninvasive-prenatal-testing/ (accessed Sep 2018).

Source: https://www.mydr.com.au/tests-investigations/alpha-fetoprotein-afp-tests-in-pregnancy

What Can an AFP Test Tell You About Your Baby?

Alpha-fetoprotein (AFP) tests in pregnancy

 Getty images

When you’re pregnant, there are a variety of tests that are offered at different points throughout your prenatal care. These are generally screening tests, as opposed to diagnostic tests.

What’s the difference between the two? Screening tests are generally given to a wide variety of people, including asymptomatic people, to look for early diseases or problems, or to identify any possible risk factors for a condition. A diagnostic test determines whether a condition is present.

A diagnostic test is more definitive with 100 percent accuracy, whereas a screening test has a wide margin of error and is typically used as a precursor to diagnostic tests if need be.

One of the screening tests that is typically done during pregnancy is the alpha-fetoprotein (AFP) test, also called the maternal serum alpha-fetoprotein (MSAFP) test.

It’s generally done as part of the triple screen test, which also contains an hCG test and estriol test, and helps to screen for possible birth defects.

The triple screen is most accurate if it’s done between the 16th and 18th weeks of pregnancy, but can be done anywhere between 15 and 22 weeks of pregnancy. If there are any abnormal results in the screening tests, further testing and follow up are performed.

The AFP test is a simple blood test that measures the amount of alpha-fetoprotein in your blood. While the exact function of AFP is unknown, it is made by the fetal liver, and the level of AFP rises and falls at specific times in the pregnancy.

High levels of AFP—when it should be lower—might indicate genetic disorders or conditions, including spina bifida, anencephaly, certain structural defects, or some chromosomal abnormalities, though low levels are associated with Down syndrome.

However, because it’s merely a screening test, it can’t tell you what exactly is going on, or whether the fetus definitely has any of these issues. Diagnostic tests would be needed for more definitive answers. There are also false-positives, which are often the result of pregnancy dating being inaccurate. If you’re having multiples, this also affects the AFP screening.

The AFP test is a simple blood test where blood is drawn from a vein and sent to a lab. Results usually take two weeks or less.

Since the timing of this test is crucial, it is usually done between the 15th and 20th weeks of pregnancy.

Because it’s just a regular blood draw, there are no risks to you, besides the general blood test risks (i.e., soreness at injection site, bruising), or to your fetus.

If the AFP test comes back showing elevated levels, you might need another AFP, along with a high definition ultrasound. These will make sure the dating of the pregnancy is correct, and look at fetal structures the skull and spine. If there are still any uncertainties or causes for concern, your doctor or midwife might suggest a more invasive diagnostic test an amniocentesis.

You do have the option to decline further testing; that is your choice.

Some people find it helpful to have as much information as possible in order to think about potential medical interventions, seek out support groups or resources, and be able to plan for a child with special needs.

Some people want to know the information in order to make a decision about whether or not to carry the fetus to term. Other people decide to wait until the baby is born to deal with these issues, should they be necessary—and that’s okay.

If you’re nervous about the AFP, or if the screening test came back and warrants further follow up, talk with your healthcare provider. If you have a partner, talk with them about your feelings regarding any possible AFP results, what that might mean, and how it will affect you.

It’s important to remember that the AFP test is not diagnostic, and isn’t perfect. It can be helpful to be informed but know that the results aren’t always accurate.

Your healthcare provider can tell you more about the test, how it helps inform further diagnostic testing and any risks that further testing might entail.

Thanks for your feedback!

What are your concerns?

Source: https://www.verywellfamily.com/what-can-an-afp-test-tell-you-about-your-baby-4172777

Alpha Fetoprotein (AFP, Maternal Serum Alpha Fetoprotein, MSAFP)

Alpha-fetoprotein (AFP) tests in pregnancy

Alpha-fetoprotein (AFP) is a plasma protein produced by the embryonic yolk sac and the fetal liver. AFP levels in serum, amniotic fluid, and urine functions as a screening test for congenital disabilities, chromosomal abnormalities, as well as some other adult occurring tumors and pathologies.

This tumor marker is a glycoprotein encoded by the AFP gene on chromosome 4q25. Prenatal levels in developing human embryo rise from the end of the first trimester and begin to fall after 32 weeks of gestation. Maternal serum AFP forms part of the triple or quadruple screening tests for fetal anomaly.

[1][2][3]

A blood sample is collected from the vein using aseptic techniques and observing universal precautions. Serum alpha levels are measured either as part of a maternal triple or quadruple screening test or for other diagnostic purposes in non-pregnant female or male patients.

Urine samples collected in plain or universal bottles may also be assayed for alpha-fetoprotein levels, although this may be significantly lower in comparison to serum levels.

Amniocentesis is needed to be able to assay alpha-fetoprotein levels in the amniotic fluid. A diagnostic amniocentesis involves the use of an ultrasound-guided, hollow needle through the maternal anterior abdominal wall into the amniotic cavity to draw out amniotic fluid for AFP immunoassay.[4][5][6]

Blood sample collection (phlebotomy):

  1. Introduce yourself to the patient and confirm the patient's name and date of birth.

  2. Explain procedure to the patient, warning patient of possible discomfort from the needle prick.

  3. Position patient appropriately, exposing the upper arm.

  4. Follow hand washing and basic universal precautions.

  5. Tie the tourniquet around the upper arm.

  6. Identify a prominent vein and clean with an alcohol swab.

  7. Introduce the needle attached to a vacutainer.

  8. Remove tourniquet and remove needle after obtaining a sample.

  9. Apply cotton ball to needle site with pressure to stop bleeding. 

  10. Label sample bottles appropriately.

  11. Send a sample for AFP assay.

Procedure for amniocentesis (done from 15 weeks gestation):

  1. Introduce yourself and confirm the patient's identity and gestational age of the pregnancy.

  2. Conduct pretest counseling. This usually includes genetic counseling as well.

  3. Obtain informed consent.

  4. Follow hand washing and universal precautions.

  5. Position patient appropriately.

  6. Clean exposed area of the abdomen.

  7. Use a local anesthetic if necessary.

  8. Carefully introduce the ultrasound-guided, hollow needle through the anterior abdominal wall into the amniotic cavity.

  9. Aspirate 15 ml to 20 ml of amniotic fluid.

  10. Send for AFP assay.

The following are reasons for AFP assay:

  • Advanced maternal age
  • Previous births with chromosomal or birth defect (e.g., neural tube defects)
  • Family history of chromosomal or birth defects (e.g., downs syndrome,  spina bifida)
  • screening for cancers (e.g., liver, testicular, ovarian)
  • To evaluate progress of anti-cancer treatment

 Pregnant maternal serum AFP levels elevated:

  • Neural tube defects (e.g., spina bifida, anencephaly)
  • Omphalocele
  • Gastroschisis

Pregnant maternal serum AFP low levels:

Non-pregnant female or male adult AFP elevated:

  • Hepatocellular cancer
  • Metastatic liver cancer
  • Liver cirrhosis
  • Hepatitis
  • Germ cell tumors
  • Yolk sac tumor
  • Ataxia telangiectasia

Typical findings include:

  • Alpha-fetoprotein levels in men and non-pregnant women vary for age and race but mostly range from 0 ng/ml to 40 ng/ml.
  • Maternal AFP levels in pregnancy start to rise from about 14th week of gestation up until about 32 weeks gestation. Between week 15 and 20 weeks, levels usually range between 10 ng/ml to 150 ng/ml.
  • Adult blood levels of greater than 200 ng/ml in patients with liver cirrhosis strongly indicate hepatocellular carcinoma.

The following have been implicated in false-positive results:

  • Two weeks after radiodiagnosis involving the use of radioactive tracers
  • Multiple gestations
  • Gestational diabetes
  • Cigarette smoking
  • Race (slightly higher levels in black women, and lower in women of Asian descent as compared to whites)
  • AFP levels are also adjusted for weight

Risks associated with phlebotomy include:

  • Phlebitis
  • Abnormal bruising and bleeding in patients with clotting disorders or those taking blood thinners.

The risk associated with amniocentesis:

  • Miscarriage
  • Preterm delivery

Phlebotomy for the purpose of blood alpha fetoprotein assay requires little or no preparations as this is largely safe when performed by qualified health workers. However, patients need to be counseled on the possible discomfort from the needle prick, although mostly bearable. Patients must also be asked about their use of blood thinners (e.g., aspirin, warfarin).

Patients must also be given appropriate information regarding possible outcomes and implications of the test.

It is pertinent to explain that this is a screening test. Depending on the outcome, more tests may be ordered for the purpose of establishing a diagnosis. A negative test does not necessarily indicate no risk as very low maternal blood alpha-fetoprotein is associated with an increased incidence of Down syndrome. Hence, a low maternal blood alpha-fetoprotein should also be investigated.

Patients having amniocentesis must be duly counseled about the procedure, as well as, the associated risks. There is a risk of obstetric mishap following amniocentesis; a miscarriage can happen in less than 1% of cases. Some other very rare complications of amniocentesis are preterm labor, infection (amnionitis), iatrogenic trauma, or injury to the developing fetus or mother.

Following amniocentesis patients may experience some cramp- discomfort in the first few hours but are usually allowed to go home after a short rest. Oral paracetamol (acetaminophen) may be prescribed. Patients should report back to the hospital in case of vaginal bleeding, vaginal discharge, or increasing abdominal cramps.

Maternal blood AFP levels often as part of triple (AFP, Estriol, and hCG) or quadruple (AFP, implies Estriol, hCG and Inhibin A) screening test for birth defects. Levels are usually interpreted for age, race, weight, and gestational age. The elevated levels imply a significant risk of having birth defects, hence, further evaluation may be required to assess the level of risk.[7][8]

A significant amount of patients with elevated maternal AFP do not develop birth defects, but there may be an increased risk of obstetric complications premature rupture of membrane, placenta accreta, increta, and packet.

Low maternal AFP levels may be suggestive of risk for Down syndrome.

In nonpregnant women and men, elevated levels are seen in cancers, especially, liver cancer. Levels greater than 200 ng/ml in cirrhotic patients suggest hepatocellular carcinoma. Elevated alpha-fetoprotein levels can also be found in testicular and ovarian carcinoma.

AFP levels may also be used to evaluate response to anti-cancer therapy.

To access free multiple choice questions on this topic, click here.

1.Sharony R, Dayan D, Kidron D, Manor M, Berkovitz A, Biron-Shental T, Maymon R. Is the ratio of maternal serum to amniotic fluid AFP superior to serum levels as a predictor of pregnancy complications? Arch. Gynecol. Obstet. 2016 Apr;293(4):767-70. [PubMed: 26453361]2.Öztürk H, Erkaya S, Altınbaş S, Karadağ B, Vanlı Tonyalı N, Özkan D. The role of unexplained high serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) levels in the second trimester to determine poor obstetric outcomes. Turk J Obstet Gynecol. 2014 Sep;11(3):142-147. [PMC free article: PMC5558324] [PubMed: 28913007]3.Rood K, Stiller R. Hereditary persistence of alpha-fetoprotein: a rare cause for unexplained alpha-fetoprotein elevations in pregnancy. Conn Med. 2013 Jan;77(1):43-5. [PubMed: 23427373]4.Gkogkos P, Androutsopoulos G, Vassilakos P, Panayiotakis G, Kourounis G, Decavalas G. Mid-trimester maternal serum AFP levels in predicting adverse pregnancy outcome. Clin Exp Obstet Gynecol. 2008;35(3):208-10. [PubMed: 18754295]5.Chen CP, Chern SR, Cheng SJ, Chang TY, Yeh LF, Lee CC, Pan CW, Wang W, Tzen CY. Second-trimester diagnosis of complete trisomy 9 associated with abnormal maternal serum screen results, open sacral spina bifida and congenital diaphragmatic hernia, and review of the literature. Prenat. Diagn. 2004 Jun;24(6):455-62. [PubMed: 15229846]6.Shipp TD, Wilkins-Haug L. The association of early-onset fetal growth restriction, elevated maternal serum alpha-fetoprotein, and the development of severe pre-eclampsia. Prenat. Diagn. 1997 Apr;17(4):305-9. [PubMed: 9160381]7.Benn PA, Horne D, Briganti S, Rodis JF, Clive JM. Elevated second-trimester maternal serum hCG alone or in combination with elevated alpha-fetoprotein. Obstet Gynecol. 1996 Feb;87(2):217-22. [PubMed: 8559527]8.Wenstrom KD, Owen J, Davis RO, Brumfield CG. Prognostic significance of unexplained elevated amniotic fluid alpha-fetoprotein. Obstet Gynecol. 1996 Feb;87(2):213-6. [PubMed: 8559526]

Source: https://www.ncbi.nlm.nih.gov/books/NBK430750/

First-trimester maternal serum alpha-fetoprotein is not a good predictor for adverse pregnancy outcomes: a retrospective study of 3325 cases

Alpha-fetoprotein (AFP) tests in pregnancy

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Source: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-2789-2

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