Testing in pregnancy

Question 1

Causes of elevated msAFP?

Answer 1

• Wrong dating (fetus older) MCC
• Multiple gestations
• NTDs
• Abdominal wall defects, cystic hygroma, fetal skin defects, sacrococcygeal teratoma
• Decreased maternal weight
• Oligohydramnios

Question 2

Causes of low msAFP?

Answer 2

• Wrong dating MCC
• Chromosomal trisomies (21 and 18)
• Molar pregnancy
• Fetal death
• Increased maternal weight

Question 3

Androgen effect on fetus?

Answer 3

Masculinization of female fetus, labial fusion

Question 4

Alcohol effect on fetus?

Answer 4

Fetal alcohol syndrome
IUGR
Microcephaly

Question 5

Phenytoin effect on fetus?

Answer 5

Fetal hydantoin syndrome:
IUGR
Microcephaly
Facial defects
Developmental delay possible

Question 6

Lithium

Answer 6

Ebstein anomaly

Question 7

Methotrexate effect on fetus?

Answer 7

Skeletal and limb defects

Question 8

Retinoic acid effects of fetus?

Answer 8

Facial defects

NTDs

Question 9

ACE-I effects on fetus?

Answer 9

Skull anomalies
Limb defects
Miscarriage
Renal tubule dysgenesis, renal failure in neonate, oligohydramnios (baby can’t pee)

Question 10

Warfarin effect on fetus?

Answer 10

CNS and skeletal defects

Question 11

VPA and carbamazepine effects on fetus?

Answer 11

NTDs

Question 12

Abnormal msAFP level next step?

Answer 12

U/s to look for wrong dating, defects, or twin gestation

Amnio also offered if u/s isn’t juicy enough

Question 13

Teratogen during first two weeks?

Answer 13

All or nothing- death or nothing

Question 14

Risk for a pregnancy with increased msAFP?

Answer 14

WE DON’T KNOW WHY BUT…

• Stillbirth
• Growth restriction
• Preeclampsia
• Placental abruption

Question 15

When is organogenesis?

Answer 15

15-60 days of life (so after that first two week window of all or nothing teratogens)