Simpson J L, Palomaki G E, Mercer B, Haddow J E, Andersen R, Sibai B, Elias S
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA.
Am J Obstet Gynecol. 1995 Dec;173(6):1742-8. doi: 10.1016/0002-9378(95)90420-4.
Our purpose was to determine whether third-trimester maternal serum alpha-fetoprotein predicts adverse perinatal outcome and whether use of both second- and third-trimester maternal serum alpha-fetoprotein enhances the positive predictive value for various abnormal outcomes.
A cohort study with obstetric outcome assessed by chart analysis after delivery was performed at Regional Medical Center (Memphis, Tennessee), a hospital staffed by university-based physicians serving a large urban population with many indigent patients. A total of 650 women attending prenatal clinics in the above setting with a singleton pregnancy without a neural tube defect, contributing a maternal blood samples in both the second and third trimesters, and delivered in the above hospital participated. Various pregnancy outcomes were correlated with maternal serum alpha-fetoprotein levels in the second and third trimesters and in both.
In the third trimester no significant associations were found between maternal serum alpha-fetoprotein elevations and pregnancy complications. In the second trimester elevation ( > or = 2.0 multiples of the median) were, by contrast, significantly associated with preterm premature rupture of the membranes, preterm birth, and low birth weight. No association was found with certain other complications. When second-trimester data were grouped according to the types of complications occurring in individual women, only preterm premature rupture of the membrane proved statistically significant.
Second-trimester but not third-trimester maternal serum alpha-fetoprotein is significantly elevated with preterm premature rupture of the membranes, preterm birth, and low birth weight; in this cohort study no association was found with preeclampsia, oligohydramnios, or polyhydramnios.
我们的目的是确定孕晚期母血清甲胎蛋白是否能预测不良围产期结局，以及同时使用孕中期和孕晚期母血清甲胎蛋白是否能提高各种异常结局的阳性预测值。
在田纳西州孟菲斯地区医疗中心进行了一项队列研究，分娩后通过图表分析评估产科结局。该医院由大学医生组成，服务于有大量贫困患者的城市人口。共有650名在上述环境中参加产前诊所的单胎妊娠妇女，且无神经管缺陷，在孕中期和孕晚期均提供了母血样本，并在上述医院分娩，参与了研究。将各种妊娠结局与孕中期和孕晚期以及两者的母血清甲胎蛋白水平进行关联分析。
在孕晚期，未发现母血清甲胎蛋白升高与妊娠并发症之间存在显著关联。相比之下，在孕中期，甲胎蛋白升高（≥中位数的2.0倍）与胎膜早破、早产和低出生体重显著相关。未发现与其他某些并发症有关联。当根据个体妇女发生的并发症类型对孕中期数据进行分组时，仅胎膜早破在统计学上具有显著意义。
孕中期而非孕晚期母血清甲胎蛋白与胎膜早破、早产和低出生体重显著升高有关；在这项队列研究中，未发现与子痫前期、羊水过少或羊水过多有关联。
