ABSTRACT
Maternal serum alpha-fetoprotein (AFP) has been used for a long time for the prenatal diagnosis of neural tube defects in women at midtrimester of gestation. But AFP is elevated not only in cases of neural tube defects, but also in fetus with congenital nephrosis, abdominal wall defects, fetal demise, low birth weight or simply erroneously calculated gestational age. So, when maternal serum AFP is increased, gestational age of the fetus must be re-evaluated and targeted ultrasonographic evaluation is indicated to rule out neural tube defects. If NTDs are suspected or ultrasound is non-diagnostic, amniotic fluid AFP are measured and when AF-AFP is elevated, the presence or absence of acetylcholinesterase should be evaluated. The detection rate of open neural tube defects using amniotic acetylcholiesterase is reported to be as high as 96 to 99% with a 0.06% and 0.14% of false positive rate in amniotic fluids non-contaminated and contaminated by blood, respectively. We report a case with elevated mid-trimester MS-AFP, AF-AFP and positive amniotic acetylcholin-esterase, but in which repeated sonographic findings were normal, and result in delivery of a heathy baby without anomalies.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Abdominal Wall , Acetylcholinesterase , alpha-Fetoproteins , Amniotic Fluid , Fetus , Gestational Age , Infant, Low Birth Weight , Nephrosis , Neural Tube Defects , Pregnancy Trimester, Second , Prenatal Diagnosis , UltrasonographyABSTRACT
Maternal serum alpha-fetoprotein (AFP) has been used for a long time for the prenatal diagnosis of neural tube defects in women at midtrimester of gestation. But AFP is elevated not only in cases of neural tube defects, but also in fetus with congenital nephrosis, abdominal wall defects, fetal demise, low birth weight or simply erroneously calculated gestational age. So, when maternal serum AFP is increased, gestational age of the fetus must be re-evaluated and targeted ultrasonographic evaluation is indicated to rule out neural tube defects. If NTDs are suspected or ultrasound is non-diagnostic, amniotic fluid AFP are measured and when AF-AFP is elevated, the presence or absence of acetylcholinesterase should be evaluated. The detection rate of open neural tube defects using amniotic acetylcholiesterase is reported to be as high as 96 to 99% with a 0.06% and 0.14% of false positive rate in amniotic fluids non-contaminated and contaminated by blood, respectively. We report a case with elevated mid-trimester MS-AFP, AF-AFP and positive amniotic acetylcholin-esterase, but in which repeated sonographic findings were normal, and result in delivery of a heathy baby without anomalies.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Abdominal Wall , Acetylcholinesterase , alpha-Fetoproteins , Amniotic Fluid , Fetus , Gestational Age , Infant, Low Birth Weight , Nephrosis , Neural Tube Defects , Pregnancy Trimester, Second , Prenatal Diagnosis , UltrasonographyABSTRACT
OBJECTIVE: To evaluate the perinatal outcomes of twin pregnancies with birth weight discordancy and to determine factors affecting on the outcomes. METHODS: We studied 367 pairs of twin delivered after 28 weeks of gestation at the Ajou University Hospital between June 1994 and June 2000. Twins were stratified into three groups according to the percent difference of birth weight. Birth weight difference less than 15%(concordant) was classified into control group(268 pairs), between 15% and 25% into group 1(72 pairs), and more than 25% into group 2(27 pairs). Perinatal outcomes of each group were assessed retrospectively. RESULTS: In smaller twins, mean birth weight(control vs group 1 vs. group 2 : 2274.3+/-424.9 gm vs. 2012.9+/-303.2 gm vs. 1635.2+/-440.8 gm, p<0.05), duration of neonatal intensive care unit admission(7.6+/-11.5 days vs. 11.6+/-10.8 days vs. 18.6+/-14.4 days, p<0.05), and the frequency of neonatal jaundice(8.6% vs. 12.5% vs. 29.6%, p<0.05), the frequency of small for gestational age infant(8.2% vs. 40.3% vs. 74.1%, p<0.05), and perinatal mortality(2.6% vs. 2.8% vs. 11.1%, p<0.05) in group 2 showed statistically significant difference from control group. No difference was found in larger twins. In multiple logistic regression analysis, independent prognostic factors of discordant twin were gestational age and birth weight. CONCLUSIONS: In twin pregnancies with birth weight discordancy, larger twins showed no difference in perinatal outcomes but smaller twins with birth weight discordancy more than 25% showed significantly higher perinatal mortality and morbidity. However independent prognostic factor was not discordancy itself but gestational age and birth weight.