Raised amniotic fluid concentrations of alpha-fetoprotein in a twin pregnancy.
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Biomedical subjects
Publications and source records attributed to P C Leighton.
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Amniotic fluid levels of alpha-fetoprotein (AFP) and fibrin(ogen) degradation fragment E (FgE) were measured in 214 normal subjects and 27 pregnancies associated with an abnormal fetus (open neural tube defect or exomphalos). AFP levels showed no overlap between the normal and abnormal groups, thus confirming the reliability of the AFP assay in the detection of these abnormalities. FgE levels however showed considerable overlap and could not be used as a diagnostic parameter. Agarose gel chromatography of the amniotic fluid revealed the presence of large molecular weight FgE related antigen in open neural tube defect suggesting that leakage of proteins from exposed capillaries is responsible for the elevation of amniotic fluid protein levels.
Levels of fibrin/fibrinogen degradation products have been measured by a sensitive and specific radioimmunoassay in pregnancies associated with pre-eclampsia or essential hypertension. The incidence of elevated levels was low (2-4%) in mild and moderate cases, and rather higher (30%) in severe cases. In no patients were the levels consistently elevated prior to the onset of clinical signs.
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A range has been established for maternal plasma-alpha-fetoprotein (A.F.P.) levels in normal pregnancies (930 women). A.F.P. levels between 10 and 40 weeks gestation were examined in 51 pregnancies associated with fetal neural-tube defect. In 96% of cases (20 anencephalus, 6 spina bifida) examined between 16 and 26 weeks of gestation A.F.P. levels were above the 95th centile of the normal range. It is suggested that measurement of A.F.P. in maternal blood should become a screening test in all pregnancies, and a scheme for the futher investigation of patients with abnormal results is described.
A long-term review of 108 women suffering from various forms of vulval dermatosis is described and a detailed analysis of those with chronic hypertrophic vulvitis, lichen sclerosus et atrophicus, and neurodermatitis is made. One case of neurodermatitis and two cases of lichen sclerosus progressed to carcinoma but no case of chronic hypertrophic vulvitis became malignant. It is possible that vulval dermatoses occur more commonly in the nulliparous than in the parous women and there is a slight preponderance of women who are blood group A. It is suggested that the term "leukoplakia" should be abandoned and that vulval lesions should be described in precise and meaningful histological terms.
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