A maternal serum alpha-fetoprotein test indicates an elevated level. It is repeated and again is reported as higher than normal. What is the next step in the assessment sequence to determine the well-being of the fetus?
1. Percutaneous umbilical blood sampling
2. Ultrasound for fetal anomalies
3. Biophysical profile for fetal well-being
4. Amniocentesis for genetic anomalies
2
1. Incorrect. Indications for use of PUBS include prenatal diagnosis of inherited blood dis-orders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of fetuses with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.
2. Correct. If AFP findings are abnormal, follow-up procedures include genetic counseling for families with a history of NTD, repeated AFP, ultrasound examination, and possibly, am-niocentesis.
3. Incorrect. A BPP is a method to assess fetal well-being in the third trimester.
4. Incorrect. Prior to the possibility of an amniocentesis being performed, the patient would first have an ultrasound for direct visualization of the fetus.
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