Unexplained elevated maternal serum alpha-fetoprotein in singleton pregnancies as a predictor of fetal risk.

OBJECTIVE: The aim of the study was to evaluate the significance of unexplained elevated maternal serum alpha-fetoprotein in singleton pregnancies as a predictor of fetal risk.
METHOD: A retrospective study of 1582 consecutive women who attended the antenatal clinic at Oldham and District General Hospital, Oldham, UK, over a 6-month period. One hundred pregnant women with elevated serum alpha-fetoprotein concentrations were classified as the index group and were matched against a control group. All the women in the index group underwent amniocentesis and detailed ultrasonography. The incidence of antepartum hemorrhage (placental abruption and placenta previa), preterm labor and intrauterine growth restriction (IUGR) in the two groups was analyzed and the results subjected to X2 analysis.
RESULTS: None of the patients in the index group had chromosomal abnormalities or birth defects. IUGR occurred in 18 (18%) of the index group babies but in only four (2%) in the control group (P < 0.0000006). Placental abruption occurred in five (5%) in the index group compared with two (2%) in the control group (P < 0.03), while preterm labor occurred in nine (9%) in the index group compared with two (2%) in the control group (P < 0.005).
CONCLUSION: Women with unexplained elevated maternal serum alpha-fetoprotein are at increased risk of preterm labor, antepartum hemorrhage (placental abruption) and IUGR.