Objective To determine the association of preterm birth with anti-Mullerian hormone (AMH) levels, both in isolation and in combination with other markers of feto-placental health commonly measured during Integrated Prenatal Screening (IPS) for aneuploidy. Design Retrospective case-control study Setting State of Iowa Patients All pregnant women in Iowa who elected to undergo IPS and who subsequently delivered in Iowa were eligible for inclusion. Cases included women giving birth at <37 weeks gestation, controls included those who delivered at ≥37 weeks gestation. Interventions none Main outcome measure(s) Probability of a preterm birth Results 2nd trimester AMH levels were not associated with preterm birth, either independently or after controlling for other markers of feto-placental health. AMH difference was not associated with preterm birth when modeled alone, but a statistically significant association was found after adjusting for maternal serum alpha-fetoprotein (MSAFP) and maternal weight change between the 1st and 2nd trimester. After stratifying the model by MSAFP level, most of the risk for preterm birth was identified in women with an MSAFP >1 Multiple of the Median (MoM) and who had a stable or rising AMH level in early pregnancy. Conclusions A lack of decline in the AMH level in early pregnancy can be used to identify women with a high probability for preterm birth, especially when MSAFP levels are >1 MoM. Monitoring changes in the AMH level between the 1st and 2nd trimesters of pregnancy may help identify women who would benefit from interventional therapies such as supplemental progesterone.

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During an 18-month period of monitoring at Los Angeles County-University of Southern California Medical Center, two instances of persistent bleeding from the puncture sites in the fetal scalp, which were traced to coagulation abnormalities, and one of accidental breakage and retention of the blade used for scalp puncture were encountered. Whenever fetal blood sampling is performed during delivery, one should be certain that scalp bleeding has stopped. Continuing pressure will generally achieve hemostasis, but at times a surgical clip must be applied. When these measures fail, the infant should be delivered promptly and coagulation studies done. The pediatrician should always be informed when scalp samples have been taken.

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