Raised maternal serum AFP, oligohydramnios and poor fetal outcome

Malformations and deformations in abdominal pregnancy

Abdominal gestation is a relatively uncommon complication of pregnancy. Previous reports describe a high incidence of fetal deformations and mortality as well as maternal mortality. A case of twin abdominal gestation is presented and the literature concerning abdominal pregnancy since 1809 is reviewed. The survival rate of liveborn infants of 30 or more weeks gestation was 63%. The maternal mortality rate since 1809 was 18.2%, but this has decreased to 4.5% during the last 20 years. The combined rate of malformations and deformations in the infants was 21.4%. The most common deformations observed were facial and/or cranial asymmetry and various joint abnormalities. Among the most common malformations were limb deficiency and central nervous system malformations. Proposed mechanisms of compression and vascular disruption are discussed.

Outcomes in patients with unusually high maternal serum alpha-fetoprotein levels

In a study group of 166 patients with unusually high maternal serum alpha-fetoprotein values greater than or equal to 5 multiples of the median, 110 (66%) patients had a condition affecting obstetric care compared with 14% in the 2.5 to 2.9 range, 26% in the 3.0 to 3.9 range, and 30% in the 4 to 4.9 range of multiples of median. Fetal anomalies composed a significantly greater proportion (p less than 0.0001) of positive findings in the study group than the group with maternal serum alpha-fetoprotein values of greater than or equal to 2.5 to 4.9 multiples of the median. Fetal death either before 20 weeks or of one twin occurred significantly more often in the study group (p less than 0.0001). Neural tube defects (21%) and fetal death before 20 weeks (19%) were the most common findings in the study group. There was not a statistically significant difference (p less than 0.53) in pregnancy complications or in late complications between the two groups although oligohydramnios and abdominal pregnancies occurred more often in the study group (p less than 0.029 and less than 0.011). Diagnosticians evaluating patients with unusually elevated maternal serum alpha-fetoprotein values must be aware of the usual differential diagnosis as well as rarer causes. One must recognize that finding an unaffected fetus does not preclude the subsequent development of a pregnancy complication.

Elevated maternal serum alpha-fetoprotein levels and oligohydramnios: poor prognosis for pregnancy outcome

The outcome of 21 pregnancies with elevated maternal serum alpha-fetoprotein levels associated with oligohydramnios was studied. Seven of the 21 pregnancies ended in spontaneous abortion or intrauterine fetal death before week 24 of pregnancy. Five patients experienced premature labor between 24 and 26 weeks of gestation; each fetus was either stillborn or died in the immediate neonatal period. Four patients were delivered of infants after 32 weeks of gestation; each infant was either stillborn or died in the immediate neonatal period. Four patients electively had their pregnancies terminated. One patient was delivered at term of a healthy, growth retarded male infant who on follow-up at age 17 months was developmentally normal. Only three cases were associated with a fetal defect. Patients should be counseled that, even in the absence of a demonstrable cause for diminished amniotic fluid on ultrasonography, raised maternal serum alpha-fetoprotein levels coupled with oligohydramnios seem to carry a poor prognosis.