Mid-Trimester Maternal Serum hCG and AFP Levels: Clinical Significance and Prediction of Adverse Pregnancy Outcome

Abstract

ContextMaternal serum human Chorionic Gonadotropin (hCG) and Alpha Fetal Protein (AFP) were originally introduced to detect trisomy 21 and neural tube defects. However, in the absence of aneuploidy or neural tube defects, mid-trimester maternal serum hCG and/or maternal serum AFP associated with adverse pregnancy outcomes. Pregnancies with unexplained mid-trimester elevation in maternal serum hCG and/or maternal serum AFP, are at increased risk for pregnancy complications resulting from placental insufficiency.Evidence AcquisitionMid-trimester maternal serum hCG>2.5 MoM associated with an increased risk for pregnancy complications including: late fetal loss, gestational hypertension, preeclampsia, intrauterine growth restriction (IUGR), preterm delivery and intrauterine fetal death(IUFD). Mid-trimester maternal serum AFP levels >2.5 MoM are thought to reflect a defect in placentation and associated with an increased risk for pregnancy complications including: late fetal loss, gestational hypertension, preeclampsia, IUGR, preterm delivery and IUFD.ResultsCombined mid-trimester elevation in maternal serum hCG and AFP levels suggest a more complex type of placental pathology. They have stronger association with pregnancy complications including: late fetal loss, gestational hypertension, preeclampsia, IUGR, preterm delivery and IUFD.ConclusionsMid-trimester maternal serum hCG or AFP levels alone cannot detect all pregnant women with increased risk to develop pregnancy complications. Multiparameter testing of placental function in mid-trimester (maternal serum hCG and AFP screening, uterine artery Doppler and placental morphology) may allow us to identify women with increased risk to develop severe placental insufficiency and pregnancy complications. However, future prospective studies are needed to confirm the prognostic significance of multiparameter testing of placental function in mid-trimester.

Is unexplained elevated maternal serum alpha-fetoprotein still important predictor for adverse pregnancy outcome?

“…In this study, the upper limit of MSAFP MoM, adjusted according to the gestational age, maternal weight, smoking habits and diabetes status, was accepted as 2.0 MoM [11].…”

Magnetic resonance imaging in the differential diagnosis of true placenta accreta: a clinical case

“…К сожалению, часто такой результат неспецифичен и не позволяет исключить трофобласти-ческую опухоль (ТО), хотя и исключает диагноз «нерас-пределенные продукты зачатия», для которого харак-терно снижение ХГЧ [8].…”

Uteri̇n Arter Doppler, Afp Ve Β-Hcg’ni̇n Peri̇natal Sonuçlar Açisindan Değerlendi̇ri̇lmesi̇

“…Plasental patoloji çalışmaları, açıklanamayan ikinci trimester AFP yüksekliği olanlarda koryonik villit ve plasental vasküler lezyonlar olduğunu göstermiştir. Artmış olan AFP düzeyinin bu lezyonların sonucu mu yoksa sebebi mi olduğu ise tam bilinmemektedir (13). Bu çalışma, 16-18. gebelik haftaları arasında öl-çülen AFP ve β-hCG ile 22-24. gebelik haftaları arasında yapılan uterin arter Doppler bulguları-nın kötü perinatal sonuçlar ile ilişkili olup olmadığını saptamayı amaçlamaktadır.…”