A pregnant client's ?-fetoprotein (AFP) returns elevated. The couple ask the health care worker to explain what this means. Which of the following is the best response?
A) "This means you need to decrease your protein intake to prevent renal problems in your baby."
B) "Elevated levels means your baby is at risk of having a neural tube defect like spina bifida (an opening in the spine)."
C) "This means your baby has Down syndrome. We won't know how severe until after you give birth."
D) "This is normal. The problem is if it is low, that means your baby will be born with trisomy 18 and will be retarded."
Ans: B
Feedback:
Maternal and amniotic fluid levels of AFP are elevated in pregnancies where the fetus has a neural tube defect (i.e., anencephaly and open spina bifida) or certain other malformations such as an anterior abdominal wall defect in which the fetal integument is not intact. Screening of maternal blood samples usually is done between weeks 16 and 18 of gestation. Although neural tube defects have been associated with elevated levels of AFP, decreased levels have been associated with Down syndrome.
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