Alpha‐fetoprotein, vaginal bleeding and pregnancy risk

Abstract

To assess the interrelation between maternal serum alphafetoprotein (MSAFP) levels and vaginal bleeding as a combined pregnancy risk factor, we studied 6829 singleton pregnancies without fetal malformations during the second trimester. The predictive powers of the two risk factors, analysed separately, are consistent with published reports in relation to fetal death and low birthweight. Until now, however, these two risk factors have not been analysed together. The present study demonstrates that MSAFP and vaginal bleeding are largely independent of each other as predictors of fetal death, relative risks being 0.7 (MSAFP <0.7 multiples of the median (MOM), vaginal bleeding absent), 3.5 (MSAFP <2.0 MOM vaginal bleeding present), 5.8 (MSAFP 22.0 MOM, vaginal bleeding absent), and 12.6 (MSAFP 22.0 MOM, vaginal bleeding present). Corresponding risks for low birthweight are: 0.7, 1-8, 2.5 and 1.6 (mean birthweights in the four categories are 3516 g, 3407 g, 3238 g, and 3176 g).

The Effect of Vaginal Bleeding on Parameters Used in the First Trimester Fetal Aneuploidy Screening Test

“…Vajinal kanamanın etiyolojisi tam olarak aydınla-tılmamıştır fakat en önemli nedenlerinden biri maternal-fetal yüzdeki desidual damarların ayrılma-sıdır (6,7). Daha önce yapılan çalışmalarda maternal serum Alfa -fetoprotein (AFP) düzeylerinin vajinal kanamadan etkilenebileceği gösterilmiştir (8)(9)(10) . Ayrıca vajinal kanama öyküsü olan hastalarda bazı çalışma-larda serum serbest β-hCG seviyelerinde ve PAPP-A seviyelerinde yükseklik saptanmış olup (11,12) , serum seviyelerinin etkilenmediğini de gösteren çalışmalar mevcuttur (13) .…”

Very low versus undetectable maternal serum alpha‐fetoprotein values and fetal death

“…Twenty of the 66 pregnancies (30 per cent) with MSAFP values < 5 ng/mL were non-viable, as opposed to six of the 143 pregnancies (4 per cent) with MSAFP values in the 5-9 ng/mL range. Our screening population has an overall fetal non-viability rate of 1.3 per cent (Haddow et al, 1986). All 20 of the non-viable pregnancies in the undetectable MSAFP category were non-viable at the time of ultrasound, in contrast to two of the six pregnancies in the 5-9 ng/mL category.…”

“…The recently discovered association between low maternal serum alpha-fetoprotein (MSAFP) levels and Down syndrome (Merkatz et al, 1984;Cuckle et al, 1984) has added another dimension to the MSAFP screening process and has also led to renewed interest in other pregnancy-related events that occur in conjunction with these low measurements. Overall, pregnancies with MSAFP values below 0.5 multiples of the median (MOM) are not at increased risk for non-viability (Haddow et al, 1986), but pregnancies with very low MSAFP levels (10 ng/ml or less) are at increased risk. Several published studies (Kjessler et al, 1977;Bennett et al, 1979; Haddow and Wald, 1981 ;Stein et al, 1981;Burton et al, 1983;Davenport and Macri, 1983) dealing with very low MSAFP levels ( Table 1) have consistently identified a high likelihood that viable pregnancies in this group had been assigned incorrect gestational dates and the probability for non-viable pregnancies was increased.…”

Taking account of vaginal bleeding in screening for Down's syndrome

“…In selecting studies to investigate the relation between vaginal bleeding and AFP level we specifically excluded hospitalised women with a high spontaneous abortion rate. In one of the studies we did select it was possible to analyse the results after excluding fetal losses (Haddow et al 1986). The rate of vaginal bleeding among women with viable pregnancies was 16 % (50/305) in those with AFP levels over two multiples of the normal median and 8.1 % (523/6432) in the remainder, an excess similar to that in the total series.…”

“…There were three suitable studies of AFP (Haddow et al 1986; Bernstein et al 1992; Williams et al 1992) but none for hCG and uE 3 . We supplemented the available AFP results and provided data on hCG and uE 3 from the routine Down's syndrome screening tests carried out at 15 to 22 weeks of gestation on women having antenatal care at the St. James's University Hospital, Leeds.…”