Raised maternal serum alpha-fetoprotein, oligohydramnios, and the fetus

Doppler ultrasound assessment of fetal and uteroplacental circulations in severe second trimester oligohydramnios

Doppler blood flow studies in 41 pregnancies with oligohydramnios in the second trimester found abnormal patterns in all 14 pregnancies with intrauterine growth retardation but in only one of nine pregnancies with premature rupture of the membranes, and one of 10 with fetal renal defects. Mixed patterns were found in a heterogeneous group of fetuses with other malformations or intrauterine infection. Unlike previous reports a diagnosis was achieved in all pregnancies, suggesting that Doppler studies should be an integral part of the antenatal investigation in such pregnancies.

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.

Familial renal abnormalities associated with the oligohydramnios tetrad secondary to renal agenesis and dysgenesis

Thirty-four families of index cases with the oligohydramnios tetrad secondary to renal agenesis/dysgenesis were screened for renal abnormalities using Real Time ultrasonography. The index cases were separated into two groups. Group 1 consisted of cases of perinatally lethal renal disease and Group 2 of cases of renal dysgenesis secondary to the urethral obstruction malformation. Renal ultrasound screenings of 23 families in Group 1 demonstrated two previously unidentified cases of unilateral renal agenesis in siblings. Screening of 11 families in Group 2 revealed one sibling with a hydronephrotic kidney and one parent with an ectopic pelvic kidney. There is a recurrence risk of 3.5-5% in families with perinatal lethal renal disease and an increased risk of silent renal anomalies in first degree family members. The recurrence risk is low in families of infants with renal dysgenesis secondary to the urethral obstruction malformation, but immediate family members are at increased risk of structural and functional urinary anomalies. Routine renal ultrasound screening of first degree relatives of infants with lethal renal agenesis and dysgenesis is recommended.

Maternal serum alpha-fetoprotein screening for neural tube defects. Report of a combined study in Germany and short overview on screening in populations with low birth prevalence of neural tube defects

The basis of maternal serum alpha-fetoprotein (AFP)-screening for neural tube defects is discussed. A report is given of a large scale screening study in the Federal Republic of Germany combining the experiences in Giessen and Hannover on over 50,000 pregnant women, about evenly distributed among both centers. Published and known forthcoming data from other low incidence populations, particularly of European countries, are reviewed briefly. The conclusion is reached that general screening could effectively be instituted and in the final result should also be cost-beneficial.

Raised maternal serum AFP, oligohydramnios and poor fetal outcome

Six women who had an ultrasound scan examination in early pregnancy on account of a high serum alpha-fetoprotein level were noted to have little or no amniotic fluid. This paper gives details of the six pregnancies, two of which were extrauterine; only one of the six infants survived.