A maternal serum alpha-fetoprotein (AFP) test indicates an elevated level. It is repeated and again is reported as higher than normal. What would be the next step in the assess-ment sequence to determine the well-being of the fetus?
a. Percutaneous umbilical blood sampling (PUBS)
b. Ultrasound for fetal anomalies
c. Biophysical profile (BPP) for fetal well-being
d. Amniocentesis for genetic anomalies
B
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A Indications for use of PUBS include prenatal diagnosis of inherited blood dis-orders, karyotyping of malformed fetuses, detection of fetal infection, determi-nation of the acid-base status of fetuses with intrauterine growth restriction, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.
B If AFP findings are abnormal, follow-up procedures include genetic counseling for families with a history of neural tube defect, repeated AFP, ultrasound ex-amination, and possibly amniocentesis.
C A BPP is a method of assessing fetal well-being in the third trimester.
D Before an amniocentesis is considered, the woman first would have an ultra-sound for direct visualization of the fetus.
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