The Incidence of Fetal Chromosomal Anomaly and Perinatal Outcome in Pregnancy with Unexplained Abnormal Serum Alpha-Fetoprotein ( Msafp ) Levels

Kim, J H; Chung, S R; Kim, S R; Hwang, J H; Hwang, Y Y; Lee, C K; Cho, Y H

Abstract

PURPOSE: The purpose of this study was to investigate the incidence of fetal chromosomal abnormality and perinatal outcome in pregnancy with unexplained midtrimester abnormal maternal serum alpha-fetoprotein (MSAFP) level.
METHODS
Eighty eight patients with high (> 2.5 MoM) (n=42) or low (< 0.5 MoM) AFP (n=46) but without any abnormal fetal sonographic findings underwent amniocentesis at 14~20 weeks of pregnancy at the department of Obstetrics and Gynecology, Hanyang university hospital between January 1992 and June 1997. Their chromosomal analyses and perinatal outcomes were reviewed retrospectively.
RESULTS
The incidence of abnormal karyotyping was 3.4% (3/88). In high MSAFP group, it was 2.4% (1/42) and in low MSAFP group, it was 4.3% (2/46). Three abnormal karyotypes were 47 XXY, 46 XX inv (9), and 46 XY inv (9). Abnormal perinatal outcomes were found in 20.5% (18/88). In high MSAFP group, one congenital anomaly (2.4%), 2 intrauterine fetal deaths (4.8%), 4 IUGRs (9.5%), 2 PIHs (4.8%), 3 preterm deliveries (7.1%) were found. In low MSAFP group, 1 intrauterine fetal death (2.2%), 2 IUGRs (4.4%), 1 PIH (2.2%), 1 LGA (2.2%) were found.
CONCLUSION
The risk of chromosomal abnomality were increased 4~7 times in patients with unexplained abnormal AFP level. So, amniocentesis and fetal karyotyping are recommended for these patients. Furthermore, close observation were needed for pregnancy with abnormal MSAFP because perinatal outcomes were poorin this group.