title: Establishment of a collaborative university-commercial maternal serum alpha-fetoprotein screening program: a model for tertiary center outreach.
abstract: Expansion of the availability of tertiary level services beyond major medical centers has proved to be a major problem in health care delivery. Routine maternal serum alpha-fetoprotein screening for neural tube defects, and now also for aneuploidy, is a classic example in which there has been a schism between the clinical expertise to manage such a program within a tertiary level reproductive genetics center and the ability to reach patients in regions that are not routinely accessible to the tertiary center. To address this problem we have established a collaborative university-commercial laboratory statewide maternal serum alpha-fetoprotein program that we believe can serve as a model for others. In the first 4 months since its implementation, the program volume has increased tenfold. The detection frequency of neural tube defects has been consistent with that of other programs (1/1690). Three aneuploid karyotypes were found in amniotic fluid of 118 women less than 30 years old who underwent genetic amniocentesis because of a low maternal serum alpha-fetoprotein value. Thus we conclude that: the establishment of a joint university-commercial maternal serum alpha-fetoprotein program may provide a successful model for efficient tertiary center outreach, assessment of our data suggests that a population at high risk for abnormal fetuses can be identified among patients not generally considered at high risk, low maternal serum alpha-fetoprotein values may likely be a more important public health measure than high ones.
mesh_terms: D000293:Adolescent; D000328:Adult; D000649:Amniocentesis; D000782:Aneuploidy; D005260:Female; D005865:Gestational Age; D006801:Humans; D008403:Mass Screening; D008423:Maternal Age; D008824:Michigan; D009436:Neural Tube Defects / Q000235:genetics / Q000517:prevention & control*; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011933:Reagent Kits, Diagnostic; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D011933:Reagent Kits, Diagnostic; D000509:alpha-Fetoproteins