title: The role of ultrasonography and amniocentesis in the evaluation of pregnancies at risk for neural tube defects.
abstract: To assess the relative efficacy of amniocentesis versus targeted (detailed) ultrasonography, 225 patients referred because of an elevated maternal serum alpha-fetoprotein level (79.6%) or a family history of neural tube defect (20.4%) were evaluated. Ultrasonographic examination alone detected all 26 fetal abnormalities (11 cases of anencephaly, 10 cases of open spina bifida, and five other anomalies). Twenty-eight patients declined amniocentesis; all had normal pregnancy outcomes. Of the 167 patients with apparently normal fetal anatomy by sonography, seven had elevated alpha-fetoprotein levels but no acetylcholinesterase in the amniotic fluid. Six of these pregnancies resulted in normal infants; one infant had congenital nephrosis. The remaining 160 patients had normal sonograms with normal amniotic fluid alpha-fetoprotein levels and no fetal malformations at delivery. Although these results suggest that targeted ultrasonography by experienced personnel is a reasonable alternative to amniocentesis in evaluations for neural tube defects, the availability, cost-effectiveness, and diagnostic accuracy of this approach must be well documented in large prospective studies.
authors: Department of Obstetrics and Gynecology, University of Virginia, Charlottesville 22908.
authors: W A
authors: WA
authors: Hogge
authors: S
authors: S
authors: Thiagarajah
authors: J E
authors: JE
authors: Ferguson
authors: P T
authors: PT
authors: Schnatterly
authors: G M
authors: GM
authors: Harbert
mesh_terms: D000110:Acetylcholinesterase / Q000032:analysis; D000649:Amniocentesis / Q000592:standards; D005260:Female; D006801:Humans; D009401:Nephrosis / Q000151:congenital / Q000175:diagnosis; D009436:Neural Tube Defects / Q000175:diagnosis*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D013673:Technology Assessment, Biomedical; D014463:Ultrasonography / Q000592:standards; D014768:Virginia; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins; D000110:Acetylcholinesterase