El. Butler et al., Association between maternal serum alpha-fetoprotein and adverse outcomes in pregnancies with placenta previa, OBSTET GYN, 97(1), 2001, pp. 35-38
Objective: To determine whether increased maternal serum alpha-fetoprotein
(MSAFP) level at 15-20 weeks' gestation is a marker of adverse outcomes in
women with placenta previa at delivery.
Methods: We conducted a retrospective cohort study of singleton pregnancies
complicated by placenta previa, diagnosed sonographically, and confirmed a
t delivery. All women had MSAFP screening at 15-20 weeks' gestation and del
ivered nonanomalous live-born infants at or after 24 weeks' gestation.
Results: One hundred seven women with placenta previa delivered during the
study. Fourteen (13%, 95% CI 7%, 21%) had MSAFP at least 2.0 multiples of t
he median (MoM). They were significantly more likely than those with lower
MSAFP levels to have one or more of the following outcomes: hospitalization
for antepartum bleeding before 30 weeks' gestation (50% versus 15%), deliv
ery before 30 weeks' gestation (29% versus 5%), or preterm delivery for pre
gnancy-associated hypertension before 34 weeks' gestation (14% versus none)
. The MSAFP cutoff of 2.0 MoM provided the best combination of sensitivity
and specificity for those outcomes, using receiver operating characteristic
curves.
Conclusion: Women with placenta previa who also have high MSAFP levels are
at increased risk of bleeding in the early third trimester and preterm birt
h. We did not find women who required cesarean hysterectomy, including thos
e with placenta accreta, to consistently have elevated MSAFP. (Obstet Gynec
ol 2001;97:35-8. (C) 2001 by The American College of Obstetricians and Gyne
cologists.)