| Case 38 3/15/99 Neurology of Pregnancy |
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| Case discussion This 24-year-old woman (gravida 3, para 0, therapeutic abortion 2) was referred to the UCDMC Prenatal Diagnosis Clinic for evaluation of increased maternal serum alpha fetoprotein (AFP) identified as part of a routine screening program. Previous abortions had been for non-medical reasons and no congenital malformations had been identified in her own or her husband's family. The gestation was estimated clinically to be 21-23 weeks. Fetal ultrasound revealed a biparietal skull diameter of 4. cm and femur length of 3.1 cm, consistent with 19.2 weeks gestation. Ultrasound also revealed dilated lateral cerebral ventricles and splayed lower spinal vertebrae. The maternal serum AFP was 296.75 ng/ml or 5.18 multiples of the median for the gestational age (53.19 ng/ml). Amniocentesis was performed. Amniotic fluid AFP was 9100 ng/ml, greater than 3.38 multiples of the median. Amniotic fluid acetylcholine esterase was positive (normally no ACh E is present). Pathologic Case Correlate: Neuropath Case X1 |