Mennuti M T, Brummond W, Crombleholme W R, Schwarz R H, Arvan D A
Obstet Gynecol. 1980 Jan;55(1):48-54.
Maternal serum alpha-fetoprotein (AFP) elevation following midtrimester genetic amniocentesis (post-AFP) was studied as an indicator of fetal-to-maternal bleeding (FMB). A post-AFP elevation was observed in 28 of 333 (8.4%) consecutive patients who before the procedure had preliminary placental localization by ultrasound and a normal serum AFP concentration (pre-AFP) for the gestational age. The absolute elevations of post-AFP and serial AFPs and the correlation with placental localization all suggest that this is related to FMB. The frequency of spontaneous abortion in patients with an elevation of post-AFP (4 of 28 cases, 14.29%) as opposed to the frequency of those patients who did not demonstrate this phenomenon (3 of 305, 0.98%) was significantly different. The higher frequency of anterior placental implantations in the former group suggests that preliminary placental localization by ultrasound may be important when counseling the patient concerning the risk of amniocentesis. The implications of these findings regarding Rh sensitization and the need for Rh immunoglobulin prophylaxis following this procedure are discussed.
将孕中期遗传羊膜腔穿刺术后母血清甲胎蛋白（AFP）升高（AFP术后）作为胎儿-母体出血（FMB）的一项指标进行了研究。在333例连续病例中，有28例（8.4%）观察到AFP术后升高，这些患者在手术前通过超声进行了初步胎盘定位，且其血清AFP浓度（AFP术前）在相应孕周时处于正常水平。AFP术后及系列AFP的绝对升高情况以及与胎盘定位的相关性均表明，这与FMB有关。AFP术后升高的患者中自然流产的发生率（28例中有4例，14.29%）与未出现此现象的患者（305例中有3例，0.98%）相比有显著差异。前一组中前置胎盘植入的发生率较高，这表明在向患者咨询羊膜腔穿刺术风险时，通过超声进行初步胎盘定位可能很重要。讨论了这些发现对于Rh致敏的意义以及该手术后进行Rh免疫球蛋白预防的必要性。
