When is the MSAFP test done during pregnancy? Minor discomforts such as those associated with a regular blood test might occur. Healthy adults should have very low levels of AFP. Disclaimer: This information is just a guide, and is not a substitute for medical advice from a qualified professional. This distribution of “likely” fetal anomalies is especially germane to the sonologist examining women with elevated MS-AFP. If the AF-AFP is elevated (≥ 2.0 MoM), a targeted fetal sonogram (level 2) is offered. In some cases, the precise mechanism for the fetomaternal transfer is not known (proximal gut obstruction, renal agenesis), and may be secondary to diminished fetal gut degradation or elevated fetal serum concentrations of AFP. Men, non-pregnant women, and children. An AFP test screens for abnormal levels of AFP. The baby might have an abdominal wall defect, a condition wherein the intestines or other organs are located outside the body. Using this cutoff, ~90% of anencephalic fetuses, 75 to 80% of fetuses with an open spinal defect, 98% of fetuses with gastroschisis, and ~70% of fetuses with omphaloceles will be detected. AFP is produced whenever liver cells are regenerating. An AFP test measures the level of AFP in pregnant women during the second trimester of pregnancy. High levels of AFP can mean one of the following: You are carrying more than one baby. Your individual circumstances and health will have to be taken into consideration before considering AFP values that are abnormally high. Most screening programs in the United States have settled on a serum value of ≥ 2.5 MoM. Detectable quantities of AFP in the MS gradually increase during gestation, peaking at 30 to 32 weeks and declining thereafter. There are several potential ways that fetal AFP can enter the MS in abnormal quantities. It is now required by California state law that women who begin prenatal care before 20 weeks be offered MS-AFP screening. The finding of an elevated level of maternal serum alpha-fetoprotein during the second trimester of pregnancy may indicate that the fetus has died or is about to die. This is a lethal anomaly in which the bony calvarium is absent above the orbits. If MS-AFP is elevated, then a nontargeted, standard antepartum obstetrical sonogram (level 1) is performed for the purpose of identifying easily recognized causes of “false-positives” (gestational age ≥ 2 weeks more advanced than estimated clinically, multiple gestations, fetal death, and obvious fetal defects). 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. The genetic counselor said this indicated a higher risk of spina bifida among other birth defects. The spine should be carefully examined in each fetus, including segment by segment images in the transaxial and sagittal planes from the craniocervical junction through the sacrum. An elevated AFP level may be indicative of one of three things: The mother is farther along in pregnancy than she thought. Most screening programs in the United States have settled on a serum value of ≥ 2.5 MoM. California implemented a statewide screening program in 1986. Of these, babies with actual birth defects are somewhere from 1 in 16 to 1 in 33. You are a smoker, which can cause higher levels of AFP in the blood. Its usually part of whats called a triple screen or quad screen in the second trimester of pregnancy. Some have cautioned against adopting a routine policy of circumventing the amniocentesis because (1) this approach will require a much larger number of targeted sonograms (i.e., 10 times as many), and the larger number of experienced examiners may not be available, or patients may be required to travel a long distance for the targeted sonogram; (2) even experienced examiners, especially as the prevalence of defects falls in the population scanned, may not detect as many defects as AF-AFP testing; and (3) skipping amniocentesis will cause potentially detectable chromosomal abnormalities to be missed.23,2 The last issue remains controversial, and multicenter consensus has not been reached. High AF-AFP plus positive acetylcholinesterase is quite specific for a fetal defect. Sources of Maternal Serum–Alpha-Fetoprotein Several other important fetal anomalies are associated with elevated AFP, and these potential defects should also be sought on the targeted sonogram (Table 17–1). The gestational age of your baby is wrong. Hidden Twins. Alpha-fetoprotein (AFP) is a protein that is normally produced by the fetus' liver. It only means that your doctor is likely to order further tests, such as an ultrasound, to arrive at a diagnosis. Since the results will be available only after a few days, you might be anxious to know about your baby during the waiting period. Two procedures available during pregnancy may help identify problems associated with elevated AFP levels. It would be ideal if a single MS-AFP level could completely segregate normal from abnormal fetuses. A high level of AFP can be an indication of a neural tube defect such as spina bifida. Normal Alpha-Fetoprotein. The process usually takes only a few minutes. The most commonly encountered individual defects are discussed in the following section. It is found in the fluid surrounding the baby in the womb (amniotic fluid). may not detect as many defects as AF-AFP testing; and (3) skipping amniocentesis will cause potentially detectable chromosomal abnormalities to be missed. An AFP test helps your doctor decide if further tests or screenings are required during your pregnancy. Indeed, the United Kingdom has adopted this paradigm and detailed, targeted sonograms are now routinely performed as the second diagnostic step in women with high MS-AFP. Some favor a paradigm in which targeted sonography follows a high MS-AFP, arguing that there is only a very small risk of an abnormal karyotype in a fetus without morphological defects. AFP is present in the fluid around the fetus (amniotic fluid) and a small amount crosses the placenta and moves into the mother's blood stream. Accurate sonographic diagnosis has become extremely important in light of AFP screening in pregnancy. Surgery after birth can help rectify this. The information on this website is of a general nature and available for educational purposes only and should not be construed as a substitute for advice from a medical professional or health care provider. Several other important fetal anomalies are associated with elevated AFP, and these potential defects should also be sought on the targeted sonogram (Table 17–1). Among fetal defects, the most common mechanism is through fetal cutaneous defects. Non-pregnant adults having high proportions of AFP may have diseases related to liver like Cirrhosis. Should you have any concerns about your health, or of that of your baby or child, please consult with your doctor. This test measures the level of AFP in your blood. This can happen because: Also known as the Maternal Serum Alpha-Fetoprotein (MSAFP) test, this is just a screening test, and not a diagnostic one. A high AFP could also mean the mother is carrying twins, according to Kaiser Permanente. However, the most common reason for elevated AFP levels is inaccurate dating of the pregnancy. Your weight will be noted before the blood is drawn, since this is integral to the outcome. The screen doesnt even flag as abnormal until you hit 2.5 so you are just above that. Diagnostic aid in premature rupture of membranes (PROM) A study looking at prolactin, AFP and beta human chorionic gonadotrophin (beta-hCG) in vaginal fluid as markers for diagnosing PROM , showed that AFP had the greatest accuracy (94% sensitivity and specificity). These defects result in leakage of fetal serum proteins into the amniotic fluid, and secondarily into MS. Other abnormalities, including intrinsic placental abnormalities and maternal–fetal hemorrhage, also allow fetal AFP to mix with MS. Less common defects include fetal teratoma (pharyngeal, sacral), defects caused by the amniotic band syndrome (asymmetric cephaloceles, gastropleuralschisis), cystic hygroma, lesions that alter the placentomaternal barrier (e.g., placental chorioangioma, lakes, and abruption/hemorrhage), proximal fetal gut obstructions (e.g., esophageal and duodenal atresias), some renal abnormalities, and oligohydramnios.39 Thus, careful examination of the face, posterior neck, oropharynx, thorax, abdomen (including a normally filled stomach) should be performed.40 The limbs and digits should be assessed for abnormalities suggesting the amniotic band syndrome or the vertebral, anorectal, cardiac, tracheoesophageal fistula, renal, and limb (VACTERL) anomalies association. Elevated maternal serum alpha-fetoprotein (MSAFP) levels have been associated with an increased incidence of both placental sonolucencies and pregnancy complications. AFP is a protein normally made by the baby’s liver. The negative predictive value of a normal AF-AFP is ~97 to 99%, and elevated AF-AFP plus acetylcholinesterase allows > 99% accurate detection of NTDs.19,2 The specificity is 94.9%.20 High-resolution, targeted ultrasonography performed in conjunction with abnormal AF-AFP is also highly accurate in identifying anomalous fetuses (i.e., > 99% accurate).18,2. AFP levels are usually high when a baby is born, but fall to very low levels by the age of 1. However, high levels of AFP can also indicate that the mother is further along in her pregnancy than realized and her due date needs to be recalculated. Maternal AFP serum level is used to screen for Down syndrome, neural tube defects, and other chromosomal abnormalities. This is why AFP can be detected by a blood sample taken from the pregnant mother. The most commonly encountered individual defects are discussed in the following section. Levels of aFP can also be slightly elevated (up to 500 μg/L) in pregnancy, reflecting fetal production, or sometimes higher in several obstetric complications. AFP levels can be measured during pregnancy by taking a sample of either the mother’s blood or the amniotic fluid. Values are expressed as MoMs (multiples of the median) for each specific week of gestation, and values greater than 2.5 MoMs are generally considered elevated. It is optimal to test MS between 16 and 18 weeks. There are chances that AFP results are abnormal for no valid reason. The negative predictive value of a normal AF-AFP is ~97 to 99%, and elevated AF-AFP plus acetylcholinesterase allows > 99% accurate detection of NTDs.19,2 The specificity is 94.9%.20 High-resolution, targeted ultrasonography performed in conjunction with abnormal AF-AFP is also highly accurate in identifying anomalous fetuses (i.e., > 99% accurate).18,2 A positive test with a high AFP suggests a birth defect like spina bifida. Wrap an elastic band around the intended spot, usually on the upper arm, so that the vein is easy to find. Although many patients will elect to have a targeted sonogram instead of amniocentesis, amniotic fluid testing should still be strongly considered in the following patients: (1) fetal position or maternal body habitus precludes an adequate sonographic fetal anatomical survey; (2) equivocal sonographic findings (e.g., abnormal posterior fossa, but spinal defect not seen); (3) experienced sonographic examiner not available; and (4) nonlethal anomaly detected on standard antepartum obstetrical sonogram for which karyotype testing is appropriate.33–35. Some have cautioned against adopting a routine policy of circumventing the amniocentesis because (1) this approach will require a much larger number of targeted sonograms (i.e., 10 times as many), and the larger number of experienced examiners may not be available, or patients may be required to travel a long distance for the targeted sonogram; (2) even experienced examiners, especially as the prevalence of defects falls in the population scanned, may not detect as many defects as AF-AFP testing; and (3) skipping amniocentesis will cause potentially detectable chromosomal abnormalities to be missed.23,2 The last issue remains controversial, and multicenter consensus has not been reached. Alpha-fetoprotein screening is a blood test that checks the level of alpha-fetoprotein in the mothers' blood during pregnancy. Results were fine and so was niece when born. The AFP gene is located on the q arm of chromosome 4 (4q25). Nevertheless, there is a small, but important procedural fetal loss rate, 1/200 (0.5%), associated with amniocentesis. The lab technician drawing your blood will: It is a painless process. This distinction is accomplished by the observation of amniotic fluid above the orbits and the calvarial defect. Amniotic fluid volume should be qualitatively or semiquantitatively assessed in addition to careful examination of the placenta. Ultrasound can also help detect openings along the spine, skull, and abdomen, and other birth defects. It is critical that this be diagnosed accurately because most patients will electively terminate their pregnancies following this diagnosis. 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. Baby Bath Thermometers – Types, Usage and Tips to Choose the... To check for brain and spinal problems in the unborn child, You have a family history of birth defects. 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