THE EFFECT OF FETOMATERNAL BLEEDING ON THE RISK OF ADVERSE PREGNANCY OUTCOME IN PATIENTS WITH ELEVATED 2ND-TRIMESTER MATERNAL SERUM ALPHA-FETOPROTEIN LEVELS

OBJECTIVE: Unexplained maternal serum alpha-fetoprotein elevation has been associated with an increased risk of intrauterine growth retardat ion, preterm delivery, and intrauterine fetal death. The purpose of th is study was to determine whether patients with evidence of recent fet omaternal bleeding as a cause of elevated maternal serum alpha-fetopro tein level are at a lower risk for adverse pregnancy outcome than thos e without such evidence. STUDY DESIGN: Patients with elevated maternal serum alpha-fetoprotein levels who had a singleton viable fetus witho ut ultrasonographically detectable anomalies were offered inclusion in this study. Study participants had blood drawn for fetal cell analysi s before amniocentesis. The pregnancy outcomes of patients with eviden ce of fetomaternal bleeding were compared with those of patients witho ut. RESULTS: Of 229 patients, 109 (47.6%) had evidence of fetomaternal bleeding as a possible cause of elevated maternal serum alpha-fetopro tein. Of these, 86 (78.9%) had a normal pregnancy outcome compared wit h 84 of 120 (70.0%) with a negative stain for fetal cells (p not signi ficant). There was no significant difference in the incidence of prete rm delivery (14 [12.8%] vs 15 [12.5%]), intrauterine growth retardatio n (5 [4.6%] vs 9 [7.5%]); or intrauterine fetal death (4 [3.7%] vs 8 [ 6.6%]) when patients with a positive stain for fetal cells were compar ed with those with a negative stain. CONCLUSION: Among patients with e levated maternal serum alpha-fetoprotein levels, those with evidence o f recent fetomaternal bleeding do not appear to be at decreased risk f or adverse pregnancy outcome compared with those without such evidence .