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Elevated AFP with ultrasound showing viable single gestation of accurate age
41%
55/135
Elevated AFP with ultrasound showing multiple gestations
1%
1/135
Elevated AFP and PAPP-A
28%
38/135
Elevated AFP alone
11%
15/135
Decreased AFP alone
16%
22/135
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An elevated alpha-fetoprotein (AFP) followed by an US that is unrevealing for the cause of AFP elevation (accurate gestational age; single, viable intrauterine pregnancy; no obvious fetal deformities) is an indication for amniocentesis during the second trimester. Genetic screening should be offered to any woman greater than 35 years old. The screening protocol varies by whether the woman is in the 1st or 2nd trimester. This patient, in the second trimester, would require an initial Quad screen (MSAFP, beta-hCG, inhibin, estriol) followed by an amniocentesis if abnormal. Incorrect Answers Answer 2: An elevated AFP is expected in multiple gestations and is not an abnormal finding requiring amniocentesis. Answer 3: PAPP-A is pregnancy-associated plasma protein A. It is part of 1st trimester screening for Down's Syndrome, so would not be performed with AFP. Answer 4: Ultrasound should be performed to evaluate elevated AFP prior to amniocentesis. Answer 5: Ultrasound should be performed to evaluate decreased AFP prior to amniocentesis.
4.7
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