AMNIOTIC FLUID ACETYLCHOLINESTERASE ELECTROPHORESIS AS A SECONDARY TEST IN THE DIAGNOSIS OF ANENCEPHALY AND OPEN SPINA BIFIDA IN EARLY PREGNANCY: Report of the Collaborative Acetylcholinesterase Study

Abstract

Fifteen centres collaborated in a study to determine the value of amniotic fluid acetylcholinesterase (AChE) electrophoresis in the diagnosis of fetal open neural-tube defects (NTDs) between 13 and 24 weeks of gestation among women with positive amniotic fluid alpha-fetoprotein (AFP) results. Pregnancies with positive amniotic fluid AFP results were identified from about 34 000 tested; on average they had values greater than the 99·6th percentile for non-NTD pregnancies. Amniotic fluid samples were available from 1099 pregnancies with positive AFP results, and the percentages which yielded positive AChE results were as follows: anencephaly 99·6% (476/478); open spina bifida 99·4% (333/335); non-NTD pregnancies (i) without serious malformation and not ending in miscarriage 6% (8/125), (ii) without serious malformation but ending in miscarriage 47% (34/73), (iii) exomphalos 75% (47/63), (iv) congenital nephrosis 0% (0/11), (v) other serious malformations 50% (7/14). The gel-AChE test was thus found to be very effective when applied to amniotic fluid samples with positive AFP