Got a call from the Dr's office today to come in tomorrow because my wife's quad screen came back with an elevated AFP level.

Arfcom docs - I've read about this today on the internet, and I know the doc will explain stuff tomorrow, but is this something that is not often seen unless there really is a problem, or is this something that often turns out to be no big deal?

My wife and I are kind of freaking out right now, and I'm the kind of guy that likes to know the score and put a number on a risk.  

Been there, done that. We had the same with one of my kids. According to my sister who is a maternity nurse, they come back false positives a lot. They will usually tell you that they want to do a high resolution ultrasound to look for defects associated.

It scared us enough that my wife endured amniocentesis, which from what the doc's told us, was the only way to rule out the genetic problems associated with an elevated AFP. Everything on all of the tests came back normal and we went on to have a healthy 9lb 1oz baby boy.

It's hard not to freak, believe me, I know that. Try not to worry until the doc's tell you there is something to worry about.

We have refused the test every time it was suggested, as it would make no difference to us, we would not terminate a pregnancy for any reason.

And as already stated, there are too many false positives to even be considered a reliable test at all.

We know more than one couple that tested high and went on to have a normal child, as a matter of fact I don't know of any that have been high, that had problems.

Thanks for the reassuring words, guys.  I appreciate hearing your story and that everything turned out fine.

My wife and I just had twins. We got the AFP test but knew in advance that the false (+) rate is very, very high. We debated not getting it at all because of that reason. The question is what would you do if the amnio is positive also. If it would not change any of your plans, then there is not much reason to pursue it.

Quoted: Got a call from the Dr's office today to come in tomorrow because my wife's quad screen came back with an elevated AFP level. Arfcom docs - I've read about this today on the internet, and I know the doc will explain stuff tomorrow, but is this something that is not often seen unless there really is a problem, or is this something that often turns out to be no big deal? My wife and I are kind of freaking out right now, and I'm the kind of guy that likes to know the score and put a number on a risk.

It is my understanding that the circumstances have to be "just right" for that test.  A few days outside the "right dates" and the values will be off and you will get flagged.  A friend of mine was flagged...did the amnio at which time the accompanying ultrasound revealed the reason for the off numbers....she was not as far along as they thought.
Twins will also throw the numbers off..

I am sure ARDOC has a bit more info, he should wander in soon....

Be prepared for the worst. God bless.

Quoted: Got a call from the Dr's office today to come in tomorrow because my wife's quad screen came back with an elevated AFP level. Arfcom docs - I've read about this today on the internet, and I know the doc will explain stuff tomorrow, but is this something that is not often seen unless there really is a problem, or is this something that often turns out to be no big deal?

"Of the positive test results, 90% of these babies will not have any anomalies."

from
pregnancy.about.com/cs/afp/a/afptesting.htm

Looks like you've already gotten decent advice. Probably no suprise if you checked it out. Don't put a lot of stock in the test at this point. It is a screening tool of low specificity.

I will leave further details to ARDOC as this is clearly his bag and I'm sure he will be along soon.
Best of luck, bud.

As DrJarhead stated, its a high sensitivity, low specificity test.

The best way to understand this is what I tell my patients.

There are 200 fish in a pond.  There are 199 salmon and 1 trout.  You really want to catch that trout.  To make sure you get it and insure a high success rate you use a really big net.  You get that trout but unfortunately you also get a whole bunch of salmon as well.

That is the essence of this test.   Because its so sensitive you catch a lot of false negatives.  You get a higher rate of catching a real abnormality however.  The majority of the positives will be normals.

An amniocentesis is the next order of business.  A Karyotype will be done once the sample is collected.  Its high sensitivity and high specificity.  So its very accurate and very precise.  Mistakes are rare here.  If you get a Downs in this case, you got a Downs.

Second its what has also been pointed out.  A lot of my patients dont believe in abortion.  If you are not going to react to the results of the test, i. e. a termination.  Why take the test at all.

The Quad screen is an ELECTIVE test. Its not mandatory.  

ETA:  A high AFP is a usual indicator of an open neural tube defect.  Dudodenal atresia or esphageal defects.  A low one indicates Downs usually.

content.dmc.org/default.aspx?pageid=P06799

Quoted: We have refused the test every time it was suggested, as it would make no difference to us, we would not terminate a pregnancy for any reason. And as already stated, there are too many false positives to even be considered a reliable test at all. We know more than one couple that tested high and went on to have a normal child, as a matter of fact I don't know of any that have been high, that had problems.

Same here.  Not worth the headaches.

Stuff like this is the worst thing for your wife to be dwelling on.  Stress is the worst thing for pregnancies.

Quoted: Second its what is pointed out.  A lot of my patients dont believe in abortion.  If you are not going to react to the results of the test, i. e. a termination.  Why take the test at all. The Quad screen is an ELECTIVE test. Its not mandatory.

I have been asking myself that same question - we figured that if something was going to be wrong, we'd want to know, but I think in the end it's putting a lot of unnecessary stress on us.  After her miscarriage last year, we are pretty gunshy (and this is our first child).  At some point, it may be better to say to hell with the tests.

We have been taking any and all tests, took another Down's test last month as well which showed 1 in 10,000 chance.  Not sure what it's called but it consisted of some blood blots and a measurement via unltrasound of some skin folds on the neck.  The Dr that did that test said "there is no way this baby will be abnormal, everything looks great".  

The AFP level is elevated, which supposedly can indicate an increased risk of spina bifida or something of that nature.  The shitty thing about tests like this is the statistics game you get into - for example f the risk of an amnio-induced miscarriage is "x", at what point do you go for it just to know?  And how do you balance the results of the quad test into the aggregate of all the other test results?  Risk is my job, and because of that I have been pressing our doctor for numbers and percentages, but this is getting to be something that has us both stressed out all the time.


Thank a ton for the explanation ARDOC - that puts my mind at ease at least.

Dude forget about it and go have a beer.  Its out of your hands now.

Ask her doctor about doing a level 2 ultrasound before doing the amnio. Most neural tube defects can be detected with the level 2, which is usually done by a Perinatologist, not a regular OB. There are other reasons to consider amnio; Yes, termination may be an option, (personal decision for your family, not me or anyone else on this board) but also if you find that your baby does have a problem, you'll know about it and be able to prepare and get the necessary specialized care. If you do decide to have the amnio, just realize there is a risk and weigh the risk with the possible benefits. Also make sure the doctor who performs the amnio is experienced and has done the procedure many times. My wife said to give you this link:

http://bbs.babycenter.com/board/3366

There are lots of stories from women who have received abnormal AFP results. We wish you the best.

Quoted: Ask her doctor about doing a level 2 ultrasound before doing the amnio. Most neural tube defects can be detected with the level 2, which is usually done by a Perinatologist, not a regular OB. There are other reasons to consider amnio; Yes, termination may be an option, (personal decision for your family, not me or anyone else on this board) but also if you find that your baby does have a problem, you'll know about it and be able to prepare and get the necessary specialized care. If you do decide to have the amnio, just realize there is a risk and weigh the risk with the possible benefits. Also make sure the doctor who performs the amnio is experienced and has done the procedure many times. My wife said to give you this link: http://bbs.babycenter.com/board/3366 There are lots of stories from women who have received abnormal AFP results. We wish you the best.

That info is not 100% correct.

MFM does LEVEL III ultrasounds for fetal anatomy and amnios and cardiac echos for fetal anomalies. At such an early gestation MFM would naturally do her amnio not her doctor, thats taken for granted.  Level I and II ultrasounds are done routinely by any regular OB and ultrasound tech.  Googled info off the internet is not always correct.

Quoted: Quoted: Ask her doctor about doing a level 2 ultrasound before doing the amnio. Most neural tube defects can be detected with the level 2, which is usually done by a Perinatologist, not a regular OB. There are other reasons to consider amnio; Yes, termination may be an option, (personal decision for your family, not me or anyone else on this board) but also if you find that your baby does have a problem, you'll know about it and be able to prepare and get the necessary specialized care. If you do decide to have the amnio, just realize there is a risk and weigh the risk with the possible benefits. Also make sure the doctor who performs the amnio is experienced and has done the procedure many times. My wife said to give you this link: http://bbs.babycenter.com/board/3366 There are lots of stories from women who have received abnormal AFP results. We wish you the best. That info is not 100% correct. MFM does LEVEL III ultrasounds for fetal anatomy and amnios and cardiac echos for fetal anomalies. At such an early gestation MFM would naturally do her amnio not her doctor, thats taken for granted.  Level I and II ultrasounds are done routinely by any regular OB and ultrasound tech.  Googled info off the internet is not always correct.

Obviously you are the expert.....
I just wanted to say with baby #3...we were schedule for a level 2 and fetal survey scan (I think that is it was called)....I was shocked to find out NO doc would be present.....it would be taped, noted by the tech and then sent to a RADIOLOGIST(doctor of radiology) for reading....(although they did say if he wasnt busy he would actually attend but no guarantees)
I was shocked because the sole reason for this scan was to check for cardiac abnormalities and it was not going to be read by a cardiologist of any kind.
I called DFD#2 diagnosing cardiologist and asked if this was normal procedure (well I emailed him) he did confirm in my county it was but then set up the ultrasound in his county at a maternal fetal medicine office...to which he attended.  So the ultrasound ended up with a maternal fetal medicine specialist and a PC...quite a switch from "just a tech"

Quoted: Quoted: Quoted: Ask her doctor about doing a level 2 ultrasound before doing the amnio. Most neural tube defects can be detected with the level 2, which is usually done by a Perinatologist, not a regular OB. There are other reasons to consider amnio; Yes, termination may be an option, (personal decision for your family, not me or anyone else on this board) but also if you find that your baby does have a problem, you'll know about it and be able to prepare and get the necessary specialized care. If you do decide to have the amnio, just realize there is a risk and weigh the risk with the possible benefits. Also make sure the doctor who performs the amnio is experienced and has done the procedure many times. My wife said to give you this link: http://bbs.babycenter.com/board/3366 There are lots of stories from women who have received abnormal AFP results. We wish you the best. That info is not 100% correct. MFM does LEVEL III ultrasounds for fetal anatomy and amnios and cardiac echos for fetal anomalies. At such an early gestation MFM would naturally do her amnio not her doctor, thats taken for granted.  Level I and II ultrasounds are done routinely by any regular OB and ultrasound tech.  Googled info off the internet is not always correct. Obviously you are the expert..... I just wanted to say with baby #3...we were schedule for a level 2 and fetal survey scan (I think that is it was called)....I was shocked to find out NO doc would be present.....it would be taped, noted by the tech and then sent to a RADIOLOGIST(doctor of radiology) for reading....(although they did say if he wasnt busy he would actually attend but no guarantees) I was shocked because the sole reason for this scan was to check for cardiac abnormalities and it was not going to be read by a cardiologist of any kind. I called DFD#2 diagnosing cardiologist and asked if this was normal procedure (well I emailed him) he did confirm in my county it was but then set up the ultrasound in his county at a maternal fetal medicine office...to which he attended.  So the ultrasound ended up with a maternal fetal medicine specialist and a PC...quite a switch from "just a tech"

Well the tech will make you or break you.  A good tech is worth their weight in gold and then some.  A good tech will make a mediocre doctor look like a star.

But its not uncommon these days for a woman with any red flags in her OB care to go to MFM.  Fetal cardiac echos are not routinely read by none MFM doctors anymore.

Quoted: Got a call from the Dr's office today to come in tomorrow because my wife's quad screen came back with an elevated AFP level. Arfcom docs - I've read about this today on the internet, and I know the doc will explain stuff tomorrow, but is this something that is not often seen unless there really is a problem, or is this something that often turns out to be no big deal? My wife and I are kind of freaking out right now, and I'm the kind of guy that likes to know the score and put a number on a risk.

As others said, high false positives, really high, so high I would have skipped it and done the amnio we eventaully paid for as a first screen.

Worst part is the wait on the amnio results, insist on as fast as possible.

And good luck, prayers sent.

BTW, ours is now 4.5 and totally normal, well, for someone related to me.

i think some people miss the point of the AFP test.

it is a screening tool..
a screening tool should..

the test only shows that certain issues need to be looked at more thoroughly.

ARDOC is on the money with the comparison of the "net"..

screening tests have a wide net of variables.

Went to the doc today - the cutoff for normal/abnormal is 2.5 (I think 2.5 std deviations from the mean) and my wife's was 2.55.  The Dr did an ultrasound and found no abnormalities, but referred us to a Perinatologist next week for a more detailed ultrasound.  Knowing the risks of an amnio, we would almost certainly not get one.

Thanks to you guys, I was much more informed and had much less anxiety going into this.  We'll be seeing that PN in Denver next week.

Quoted: Quoted: Ask her doctor about doing a level 2 ultrasound before doing the amnio. Most neural tube defects can be detected with the level 2, which is usually done by a Perinatologist, not a regular OB. There are other reasons to consider amnio; Yes, termination may be an option, (personal decision for your family, not me or anyone else on this board) but also if you find that your baby does have a problem, you'll know about it and be able to prepare and get the necessary specialized care. If you do decide to have the amnio, just realize there is a risk and weigh the risk with the possible benefits. Also make sure the doctor who performs the amnio is experienced and has done the procedure many times. My wife said to give you this link: http://bbs.babycenter.com/board/3366 There are lots of stories from women who have received abnormal AFP results. We wish you the best.

That info is not 100% correct. MFM does LEVEL III ultrasounds for fetal anatomy and amnios and cardiac echos for fetal anomalies. At such an early gestation MFM would naturally do her amnio not her doctor, thats taken for granted.  Level I and II ultrasounds are done routinely by any regular OB and ultrasound tech. Googled info off the internet is not always correct.[/quote]

ARDOC............None of my post was from Googled information, it's from personal experience. I'm no MD, but my wife has had more Level 2s than I care to recall, all done by a Perinatologist. It may not be standard practice everywhere for the Peri to do the level 2, but that is how it is done where we live. I would never use Googled info to give advice on something I have no experience with.

PeteCO, I am glad your u/s today found no abnormalities, and I hope that your appt with the Perinatologist for the more detailed u/s goes well. Keep us posted.

-Gary