Impact of Elevated Second Trimester Maternal Serum Alpha-Fetoprotein on Pregnancy Outcome-A Prospective Observational Study

Abstract

Introduction: The major goal behind prenatal screening is to identify and intervene in high risk pregnancy. Measurement of second trimester maternal serum alpha-fetoprotein (MSAFP) has been shown to be useful in screening both for Aneuploidies and neural tube defects7-9. Additionally in Pregnancies with normal fetus, high levels of MSAFP is associated with increased risk of adverse pregnancy and fetal outcome. Aim: To determine the association between the second trimester MSAFP and adverse pregnancy outcome. Method: This Prospective observational study was conducted in 200 antenatal women of gestational age between 14-24 weeks, with singleton pregnancy. Determination of maternal serum AFP levels was carried out and were followed till delivery. Fetal outcome was reported in terms of live birth, still birth, neonatal death. Results: The mean age of study subjects with MSAFP?2MoM was slightly higher compared to those with MSAFP>2 MoM and the difference was not statistically significant (P>0.05).The frequency of pregnancy outcomes were as following; 10(5%) Pre-eclampsia, 20(10%)Preterm labour, 7(3.5%)PROM ,18(9%) Oligohydraminos, 2(1%)Still birth.There were significant correlation between Preterm labour, Pre-eclampsia, Oligohydramnios and higher MSAFP levels and was statistically significant. But corelation between PROM, Still birth and MSAFP levels were not significant. Conclusion: Unexplained elevated second trimester MSAFP is associated with adverse pregnancy outcomes such as preeclampsia, oligohydramnios and preterm labour. So it would be worthwhile for screening pregnant women in second trimester for MSAFP, as it would help to identify high risk pregnancies