Unexplained elevated maternal serum α-fetoprotein and/or human chorionic gonadotropin and the risk of adverse outcomes

Chandra, Sujata; Scott, Heather; Dodds, Linda; Watts, C.D.; Blight, Claire; Hof, Michiel Van den

doi:10.1067/s0002-9378(03)00769-5

Cited by 109 publications

(84 citation statements)

References 17 publications

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“…Among the diseased babies were the ones with fetal respiratory distress, asphyxiation, intracranial hemor rhage and convulsions, all resulting from hypoxia. The connection between the level of HCG markers in maternal serum on the one hand and complications in pregnancy on the other has been mentioned in various reference books (19)(20)(21)(22). In this research, the condition of fetal hypoxia has been statistically much more often observed in pregnancies with the increased level of HCG markers over 2 MOM than in the control group (p > 0.01).…”

Section: Discussionmentioning

confidence: 54%

False Positive Values of Biomarkers of Prenatal Screening on Chromosomopathy as Indicators of a Risky Pregnancy

Durkovic¹,

Anđelić²,

Mandić³

et al. 2011

Journal of Medical Biochemistry

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Kratak sadr`aj: Kod 2000 trudnica ura|en je u prvom trimestru trudno}e genetski skrining na hromozomopatije odre |ivanjem biomarkera Pregnancy associated plasma protein-A i free-beta-HCG u maternalnom serumu. Posle dobijanja normalnog kariotipa fetusa, patolo{ke vrednosti bio markera su korelisane sa drugim poreme}ajima trud no }e kako bi se ispitali mogu}i uzroci pozitivnog genetskog skrinin ga. Otkriveno je ukupno 340 la`no pozitivnih nalaza biomar kera (17%). Zna~ajan udeo imao je povi{eni free-beta--HCG (48,24%). Utvr|ena je zna~ajna povezanost (p>0,01) povi {enog free-beta-HCG i krvarenja u trudno}i. U 78,52% trudno}a sa patolo{kim biomarkerima nastale su kompli kacije: 13,82% MISSed, 10,88% spontani poba ~aj, 8,82% indu kovani prekid trudno}e zbog anomalija ploda i 45% poro |aja sa poreme}ajem fetalnog vitaliteta. Rezultati istra`i vanja su pokazali veoma zna~ajnu poveza nost (p>0,01) izme|u pove}ane vrednosti biomarkera free-beta-HCG i fetalne hipoksije. La`no pozitivan genetski skri ning uzrok o van povi{e nim free-beta-HCG mo`e da bude pokazatelj pla centarne disfunkcije i poreme}aja fetalnog vitaliteta.

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Section: Discussionmentioning

confidence: 54%

False Positive Values of Biomarkers of Prenatal Screening on Chromosomopathy as Indicators of a Risky Pregnancy

Durkovic¹,

Anđelić²,

Mandić³

et al. 2011

Journal of Medical Biochemistry

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“…42,43 Pregnancies complicated by increased levels of maternal serum alpha-fetoprotein (MSAFP) unexplained by incorrect dates, multifetal gestation, or birth defects have an increased risk of adverse pregnancy outcomes, including preterm birth associated with abruption and preterm ruptured membranes. 44 An elevated MSAFP may also occur with the demise of an unrecognized or vanishing twin, another risk factor for preterm birth. 45 …”

Section: Identification Of Women With a Prior Preterm Birthmentioning

confidence: 99%

Care for Women with Prior Preterm Birth

Iams

2010

Preterm Birth

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Women who have delivered an infant between 16 and 36 weeks' gestation have an increased risk of preterm birth in subsequent pregnancies. The risk increases with more than 1 preterm birth and is inversely proportional to the gestational age of the previous preterm birth. African American women have rates of recurrent preterm birth that are nearly twice that of women of other backgrounds. An approximate risk of recurrent preterm birth can be estimated by a comprehensive reproductive history, with emphasis on maternal race, the number and gestational age of prior births, and the sequence of events preceding the index preterm birth. Interventions including smoking cessation, eradication of asymptomatic bacteriuria, progestational agents, and cervical cerclage can reduce the risk of recurrent preterm birth when employed appropriately. Keywordscerclage; prevention; progesterone; recurrent; preterm birth; risk estimation Efforts to reduce the incidence of preterm birth cannot yet be called successful but have produced sufficient information to justify management suggestions for clinicians, not only for strategies that do not work but also for those that do. The quality and number of clinical trials of interventions intended to reduce the incidence and/or morbidity of preterm birth has risen substantially in recent years, yielding data that can improve care for women at risk.An important advance has been the revision of the traditional model of preterm birth in which painful contractions or preterm membrane rupture were understood as the most common initial steps preceding cervical change. This concept has been challenged by observations from several clinical studies:• Drugs that arrest or inhibit uterine contractions can delay delivery but do not reliably reduce or prevent preterm birth. [1][2][3][4][5] • Assessment of contraction frequency is not a useful test to predict preterm birth, 6 and its use to detect and arrest initial or recurrent episodes of preterm labor does not affect the rate of preterm birth. [7][8][9] • Antibiotics that eradicate microorganisms associated with preterm birth also do not reliably reduce, and may sometimes increase, the incidence of preterm birth, especially in women with intact membranes. [10][11][12][13][14][15][16][17] • Progestational agents such as 17α-hydroxy-progesterone caproate reduce recurrent preterm birth in some women with a prior preterm birth, 18,19 especially those with early preterm birth 20 and short cervix, 21 but have no effect on preterm birth in multiple gestations. 22,23 NIH Public Access Author ManuscriptAm J Obstet Gynecol. Author manuscript; available in PMC 2013 May 09. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript• Cervical cerclage can reduce recurrent preterm birth in women with a prior preterm birth and short cervix 24,25 but increases the risk of preterm birth in women with multiple gestation who also have a short cervix. 24 These findings suggest the following 4 substantive changes in the "contractions change the cervi...

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“…Pregnancies characterized by elevated levels of MShCG and free ␤ -hCG at mid-trimester are at increased risk for adverse pregnancy course and outcome as well as Down syndrome fetuses [4,[10][11][12][13][14][15][16][17] . These associations were related to maldevelopment of the placenta, resulting in placental insufficiency, and as a consequence severe preeclamptic toxemia, IUGR and antepartum fetal death [4,11,13,14] .…”

Section: Discussionmentioning

confidence: 99%

Adverse Outcome of Pregnancies with Extremely High Levels of Maternal Serum Human Chorionic Gonadotropin

Sharony

Itzhaky²,

Amiel³

et al. 2008

Fetal Diagn Ther

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Background: The associated risk of elevated levels of maternal serum human chorionic gonadotropin (MShCG) with pregnancy complications was reported in many studies. However, the outcome of pregnancies with extremely high levels of MShCG was never independently studied. Methods: We report on 6 out of 45,990 studied patients with extremely high levels of MShCG (>15 multiples of the medians) analyzed during the second trimester. Results: Although our patient population was composed of more Jewish than Arab pregnant women, all those patients were Arabs. Overall, the prognosis of those pregnancies was poor. In 1 case, an antepartum fetal death occurred, 2 had premature deliveries (one of the newborns had severe failure to thrive), and 2 delivered small for gestational age babies. In 5 of these 6 cases, no specific diagnosis was established. One case was complete hydatidiform mole with a coexisting normal fetus. Conclusions: We recommend that these patients undergo counseling in which the predicted outcome will be described. In addition, a follow-up of high-risk pregnancy should be implemented: sonographic evaluation should be performed, initially to rule out a molar gestation. The patients should then be followed for growth restriction and they should be monitored to rule out other pregnancy complications such as premature labor and antepartum fetal death. Finally, the overrepresentation of Arabs among our affected patients raises the question of a possible genetic tendency for increased MShCG levels especially in the extreme level group.

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Unexplained elevated maternal serum α-fetoprotein and/or human chorionic gonadotropin and the risk of adverse outcomes

Cited by 109 publications

References 17 publications

False Positive Values of Biomarkers of Prenatal Screening on Chromosomopathy as Indicators of a Risky Pregnancy

False Positive Values of Biomarkers of Prenatal Screening on Chromosomopathy as Indicators of a Risky Pregnancy

Care for Women with Prior Preterm Birth

Adverse Outcome of Pregnancies with Extremely High Levels of Maternal Serum Human Chorionic Gonadotropin

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