The role of ultrasonography and amniocentesis in the evaluation of pregnancies at risk for neural tube defects

Hogge, W. Allen; Thiagarajah, Siva; Ferguson, James; Schnatterly, Patricia T.; Harbert, Guy M.

doi:10.1016/0002-9378(89)90348-7

Cited by 29 publications

(8 citation statements)

References 5 publications

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“…Targeted sonography, initially suggested as the next step in evaluating cases of elevated amniotic fluid AFP levels, became the procedure of choice, preempting amniocentesis because of its higher specificity for open neural tube defects and other abnormalities associated with elevated maternal serum AFP levels. [20][21][22] During the last decade, amniocentesis performed to specifically evaluate AFP has been largely replaced by detailed imaging studies without losing diagnostic acumen and with a reduction of risk as well as increased patient acceptance.…”

Section: Discussionmentioning

confidence: 99%

A reappraisal of amniotic fluid alpha‐fetoprotein measurement at the time of genetic amniocentesis and midtrimester ultrasonography.

Silver

Leeth

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2001

J of Ultrasound Medicine

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Objective. To evaluate the contemporary utility of amniotic fluid α-fetoprotein measurement as a complementary test for fetal abnormalities at the time of invasive genetic testing. Methods. A review of amniotic fluid α-fetoprotein test results was conducted to determine the frequency with which elevated α-fetoprotein values added independent diagnostic information and altered clinical management. Amniotic fluid specimens processed for α-fetoprotein between 1995 and 1998 were included. Elevated α-fetoprotein cases were classified as either incidental to the fetal abnormality diagnosed or central to the identification of a fetal anomaly on the basis of whether an ultrasonographic examination had already identified the anomaly before amniocentesis. The costs associated with α-fetoprotein testing were used to estimate the expenditure per pregnancy in which elevated α-fetoprotein values would add discriminatory diagnostic value. A hypothetical national cost model was constructed to explore the utility of selective rather than routine amniotic fluid α-fetoprotein measurement. Results. Eighty-two (3%) of 2769 amniotic fluid α-fetoprotein values were elevated. In only 1 instance was the elevated result found to be partially discriminatory (e.g., an established diagnosis of microcephaly with an associated small encephalocele identified after the elevated amniotic fluid α-fetoprotein value prompted repeated ultrasonographic assessment). Sixty-one other neural tube defects were detected by ultrasonography alone (myelomeningocele, n = 28; anencephaly, n = 24; and encephalocele, n = 9). Thus, an elevated α-fetoprotein result added diagnostic precision in only 1 (0.036%) of 2769 cases. Cost estimates suggested that routine amniotic fluid α-fetoprotein assessment resulted in a $219,000 expenditure per informative case. Conclusions. Routine measurement of amniotic fluid α-fetoprotein during amniocentesis may not be warranted in centers with expertise in targeted ultrasonographic imaging.

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Section: Discussionmentioning

confidence: 99%

A reappraisal of amniotic fluid alpha‐fetoprotein measurement at the time of genetic amniocentesis and midtrimester ultrasonography.

Silver

Leeth

Check

2001

J of Ultrasound Medicine

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“…An increase in amniotic fluid and in maternal serum is associated with fetal abnormalities (mainly neural tube and abdominal wall defects) (Brock and Sutcliffe, 1972;Palomaki et al, 1988). However, its role in the detection of these abnormalities has been superseded by considerable developments in ultrasonography (Hogge et al, 1989;Sepulveda et al, 1995).…”

Section: Introductionmentioning

confidence: 99%

Amniotic fluid alpha-fetoprotein is not a useful biological marker of pregnancy outcome

et al. 1999

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The aim of our study was to determine if the amniotic fluid alpha‐fetoprotein (AFP) level could be a useful predictive biochemical marker of pregnancy outcome. Amniotic fluid AFP measurement was prospectively carried out over a three‐year period. After excluding factors susceptible to modifying AFP measurements, 587 subjects with gestational age between 14 and 20 weeks were selected to compare the amniotic fluid AFP mean levels depending on the occurrence of an adverse outcome. No significant associations between amniotic fluid AFP level and poor pregnancy outcome, i.e. pre‐eclampsia, preterm delivery, premature rupture of fetal membranes, fetal growth retardation and placental abnormalities were observed. The routine measurement of amniotic fluid alpha‐fetoprotein during an amniocentesis procedure was not considered useful in predicting pregnancy complications. Copyright © 1999 John Wiley & Sons, Ltd.

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“…Therefore, the crucial point is represented by the quality of US scanning that can be offered. The detection rate of fetal malformation is reported to be satisfactory and it is particularly true for the type of abnormalities that are usually associated with elevated AF AFP, namely NTDs or abdomimal wall defects [8]. On the other hand, as it is not conceivable to perform amniocentesis to assess AF AFP in the general population, it should be necessary to first have a mass screening policy based on MS AFP assay.…”

Section: Fetal Structural Abnormalitiesmentioning

confidence: 99%

“…After the availability of high resolution ultrasonic equipment, the identification of indirect signs of NTDs and the improvement in the expertise of the operators, both the sensitivity and specificity of ultrasound (US) examinations have become very satisfactory [4]. As a consequence the role and utility of routine AFP assay at the time of midtrimester genetic amniocentesis have become less important [5,6], also after the recognition of an elevated maternal serum AFP [7,8]. However, in 1992 Platt et al [9], on the basis of their experience stated that ultrasonography is inadequate for the detection of all cases of spina bifida.…”

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confidence: 99%

Does Amniotic Fluid Alpha-Fetoprotein Have Diagnostic or Prognostic Value at the Time of Second Midtrimester Genetic Amniocentesis?

et al. 2002

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In order to assess the usefulness of amniotic fluid α-fetoprotein (AFP) levels at the time of midtrimester genetic amniocentesis, 4,430 cases were retrospectively studied to compare the high, normal or low AFP values with the karyotype characteristics and fetal anatomy using ultrasound (US) scanning and confirmed by postnatal evaluation or necroscopy in the case of termination of pregnancy. All the cases presenting malformations were correctly diagnosed by US examinations. AFP levels over the 2nd standard deviation (SD) were found in 112 cases (2.52%) and below the 2nd SD in 11 cases (0.24%). The characteristics of these cases are presented and discussed. According to our results, it is concluded that routine assessment of AFP at the time of midtrimester genetic amniocentesis, if coupled with optimal US scanning, is no longer justified.

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The role of ultrasonography and amniocentesis in the evaluation of pregnancies at risk for neural tube defects

Cited by 29 publications

References 5 publications

A reappraisal of amniotic fluid alpha‐fetoprotein measurement at the time of genetic amniocentesis and midtrimester ultrasonography.

A reappraisal of amniotic fluid alpha‐fetoprotein measurement at the time of genetic amniocentesis and midtrimester ultrasonography.

Amniotic fluid alpha-fetoprotein is not a useful biological marker of pregnancy outcome

Does Amniotic Fluid Alpha-Fetoprotein Have Diagnostic or Prognostic Value at the Time of Second Midtrimester Genetic Amniocentesis?

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