[CG] Unexplained Raised Maternal Serum Alpha-Fetoprotein

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The association between unexplained MSAFP (1% overall obstetric population) and adverse antenatal outcomes has been recognised for several years. Specifically, an increased risk of fetal death, fetal growth restriction, preterm birth and pre-eclampsia have been described.

The higher the level of MSAFP the greater the risk of an adverse outcome. Once the MSAFP is >4 MOM there is a 41% fetal loss rate and a 60% rate of preterm delivery among the survivors.

If the human chorionic gonadotrophin (HCG) is also elevated the risk is further increased.

Management of women with an increased MSAFP (>2 MOM):

1. Offer detailed anomaly scan.
2. Offer scans in third trimester to assess growth and fetal wellbeing (see algorithm).
3. Women should be reviewed after each scan at a consultant clinic.
4. Deliver by EDD