Heinonen S, Ryynänen M, Kirkinen P, Saarikoski S
Department of Obstetrics and Gynecology, University Hospital of Kuopio, Finland.
Prenat Diagn. 1996 Jul;16(7):635-9. doi: 10.1002/(SICI)1097-0223(199607)16:7<635::AID-PD923>3.0.CO;2-V.
This study was undertaken to investigate the association between uterine anomalies and unexplained elevated maternal serum alpha-fetoprotein (MSAFP) concentrations during the early second trimester. The incidence of uterine anomalies was retrospectively evaluated among pregnant women showing elevated (> 2.5 multiples of the median) mid-trimester maternal serum AFP (N = 312) concentrations in otherwise normal singleton pregnancies and then compared with that amongst patients from the same clinic showing normal serum AFP results (N = 28410). Basic clinical data of the study group were also analysed. The rate of diagnosed developmental uterine malformations in patients showing elevated MSAFP levels was 1 in 31, whereas the rate in the control group was 1 in 710 (3.2 per cent vs. 0.14 per cent). The relative risk was 22.1 [95 per cent confidence interval (CI) 11.1-43.7]. Amniotic fluid (AF) concentrations of AFP were normal in the study group. Our preliminary observations suggest that elevated MSAFP in the second trimester may in some cases be explained as being solely a result of uterine anomaly. The fetal to maternal transfer of AFP occurs by a transplacental, not a transamniotic, route, since AFAFP concentrations were normal. Consequently, obstetricians taking care of these patients should take this possibility into account.
本研究旨在调查孕中期早期子宫异常与不明原因的母体血清甲胎蛋白（MSAFP）浓度升高之间的关联。对单胎妊娠情况正常但孕中期母体血清甲胎蛋白浓度升高（>2.5倍中位数）的孕妇（N = 312）子宫异常的发生率进行回顾性评估，然后与同一诊所血清甲胎蛋白结果正常的患者（N = 28410）进行比较。还分析了研究组的基本临床数据。MSAFP水平升高的患者中诊断出的子宫发育畸形发生率为1/31，而对照组为1/710（3.2%对0.14%）。相对风险为22.1 [95%置信区间（CI）11.1 - 43.7]。研究组羊水（AF）中甲胎蛋白浓度正常。我们的初步观察表明，孕中期MSAFP升高在某些情况下可能仅由子宫异常导致。由于羊水甲胎蛋白浓度正常，甲胎蛋白从胎儿到母体的转移是通过胎盘途径，而非羊膜途径。因此，照顾这些患者的产科医生应考虑到这种可能性。
