Endometrial hyperplasia and adenocarcinoma during tibolone (Livial) therapy.

Abstract

duction. Although this would be consistent with the rise in MSAFP that is well described in association with invasive techniques, such as chorion villus sampling, in multifetal pregnancy reduction care was taken to avoid puncture of the placentae of the surviving fetuses. Therefore, the high levels of MSAFP are unlikely to be the consequence of disruption in the feto-maternal barrier and chronic leakage from the live fetuses to the mother across the placenta; the half-life of alpha-fetoprotein in the maternal circulation is only four to five days (Sappala & Ruoslahti 1973). Furthermore, there was a significant association between MSAFP and number of dead fetuses. The most likely explanation for high MSAFP following reduction is increased concentration of alpha-fetoprotein in the amniotic fluid due to tissue breakdown from the dead fetuses; MSAFP returns to the normal range 8 to 12 weeks after the reduction because by this time there is complete resorption of the dead fetuses. Previous studies have reported high levels of alpha-fetoprotein in the amniotic fluid of twin pregnancies after the spontaneous