Maternal Serum Alpha Fetoprotein MSAFP

■ Normally, MSAFP begins to rise at 13 weeks and peaks at 32 weeks. It is produced in the placenta.

■ MSAFP screening is most accurate between 16 and 18 weeks.

■ An inaccurate gestational age is the most common reason for an abnormal screen.

High levels are associated with:

■ Neural tube defects (NTDs)

■ Abdominal wall defects (gastrochisis and omphalocele)

■ Placental abnormalities (i.e., abruption)

■ Multiple gestations

Low levels are associated with:

■ One third to one fifth of Down's syndrome fetuses exhibit low MSAFP

The first step in the workup of an abnormal triple screen should be an ultrasound for dating.

Most NTDs are thought to be polygenic or multifactorial.

36 weeks 40 weeks 32 weeks 28 weeks 24 weeks

20 weeks

16 weeks 12 weeks

36 weeks 40 weeks 32 weeks 28 weeks 24 weeks

20 weeks

16 weeks 12 weeks

FIGURE 5-1. Fundal height.

(Reproduced, with permission, from Pearlman MD,Tintinalli JE, eds. Emergency Care of the Woman. New York: McGraw-Hill, 1998:91.)

FIGURE 5-1. Fundal height.

(Reproduced, with permission, from Pearlman MD,Tintinalli JE, eds. Emergency Care of the Woman. New York: McGraw-Hill, 1998:91.)

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