title: Alpha-fetoprotein detection of neural tube defects and the impact of standard ultrasound.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX TX 75235-9032, USA. jodi.dashe@utsouthwestern.edu
authors.forename: Jodi S
authors.initials: JS
authors.lastname: Dashe
authors.forename: Diane M
authors.initials: DM
authors.lastname: Twickler
authors.forename: Rigoberto
authors.initials: R
authors.lastname: Santos-Ramos
authors.forename: Donald D
authors.initials: DD
authors.lastname: McIntire
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Ramus
mesh_terms: 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*
chemical_list: D000509:alpha-Fetoproteins