Alpha-fetoprotein detection of neural tube defects and the impact of standard ultrasound.
OBJECTIVE
The purpose of this study was to evaluate neural tube defect (NTD) detection according to whether serum alpha-fetoprotein (AFP) screening or standard ultrasound are performed.


METHODS
Prenatal and neonatal datasets were reviewed to identify pregnancies with NTDs from 1 institution between January 2000 and December 2003. AFP screening was offered < 21 weeks and considered elevated if > or = 2.50 multiples of the median. Standard ultrasound was performed for specific indications in low-risk pregnancies.


RESULTS
There were 66 NTDs, 1 per 950 deliveries. AFP sensitivity was 65%. If the gestational age used for AFP calculation was confirmed with ultrasound, sensitivity improved to 86%. The sensitivity of standard ultrasound was 100%, P < .001 compared with AFP screening. NTDs detected with standard ultrasound were identified later in gestation, as examinations were performed for other indications.


CONCLUSIONS
Standard ultrasound improved NTD detection over AFP screening alone, by improving AFP test sensitivity and identifying NTDs in low-risk pregnancies.
Dashe
Jodi S
JS
Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX TX 75235-9032, USA. jodi.dashe@utsouthwestern.edu
Twickler
Diane M
DM
Santos-Ramos
Rigoberto
R
McIntire
Donald D
DD
Ramus
Ronald M
RM
D000328:Adult; D042241:Early Diagnosis; D005260:Female; D005865:Gestational Age; D006801:Humans; D016013:Likelihood Functions; D009436:Neural Tube Defects / Q000097:blood / Q000175:diagnosis*; D011247:Pregnancy; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000592:standards; D000509:alpha-Fetoproteins / Q000032:analysis*
D000509:alpha-Fetoproteins