The association of abnormal alpha-fetoprotein and adverse pregnancy outcome: Does increased fetal surveillance affect pregnancy outcome?

OBJECTIVE: Our purpose was to investigate whether adverse outcomes associat ed with elevated maternal serum a-fetoprotein levels may be prevented by in tensive antenatal monitoring. STUDY DESIGN: Records of patients with elevated maternal serum a-fetoprotei n values of greater than or equal to2.0 multiples of the median between 199 5 and 1999 were reviewed. Pregnancy histories were analyzed to determine wh ether intensive antenatal monitoring (twice-weekly nonstress tests and dete rminations of the amniotic fluid index) would have detected the adverse out comes when routine obstetric care would have missed them. Women with elevat ions explained by multiple gestations, structural abnormalities, or a fetal death were excluded. RESULTS: The study enrolled 136 patients. Twenty-three patients were exclud ed because of multiple gestations, structural or chromosomal abnormalities, or fetal death or for lack of available follow-up. Seventy-eight patients had no perinatal complications, but 12 of these patients underwent heighten ed surveillance. One of these patients was subjected to an induction of lab or. Thirty-five pregnancies had complications (21 with preterm labor, 7 wit h pregnancy-induced hypertension, 6 with growth restriction or oligohydramn ios, 1 with abruptio placentae, and 1 with vasa previa). Of these 35 pregna ncies, 22 were followed up with routine obstetric care and 13 with heighten ed surveillance. Heightened surveillance did not achieve earlier or improve d detection in this group. These results suggest that routine pregnancy man agement is an adequate strategy for providing care to pregnant patients wit h unexplained elevated maternal serum a-fetoprotein levels. Adverse outcome s were detected with routine pregnancy management or were undetectable even with intensive management. CONCLUSION: Increased risks of pregnancy-induced hypertension, preterm deli very, intrauterine growth restriction, intrauterine fetal death, oligohydra mnios, and abruptio placentae are associated with elevated maternal serum a lpha -fetoprotein levels. However, in our study, routine pregnancy manageme nt was an acceptable method of detecting these adverse outcomes when they w ere detectable.