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

In a study group of 1,66 patients with unusually high maternal serum α-fetoprotein values ≥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 the median. Fetal anomalies composed a significantly greater proportion (p < 0.0001) of positive findings in the study group than the group with maternal serum α-fetoprotein values of ≥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 < 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 < 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 < 0.029 and < 0.01-1). Diagnosticians evaluating patients with unusually elevated maternal serum α-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.