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Evaluation of Actual Maternal Serum Alpha-Fetoprotein (MSAFP) Levels in Placental Abruption and Associations with Adverse Outcomes

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Abstract

To evaluate the relationship between the actual maternal serum alpha-fetoprotein (MSAFP) levels and maternal, fetal, and neonatal outcomes in patients diagnosed with placental abruption. This prospective case-control study included 40 patients who presented at the Perinatology Department between December 15, 2018, and September 01, 2019, were diagnosed with placental abruption and underwent cesarean section delivery at ≥ 34 weeks, and 41 healthy individuals without any additional systemic pathologies, who had a cesarean section under elective conditions. The patient demographic data, MSAFP levels, and maternal, fetal, and neonatal results were compared. Correlation analyses were applied between the MSAFP levels and demographic characteristics, birthweight, Apgar scores, and transfusion requirement in the group with placental abruption. MSAFP levels (ng/ml) were significantly higher in the group with placental abruption than in the healthy control group (299.1 ± 214 and 156.2 ± 52.3, p = 0.012). In the neonatal results, birthweight and 1st and 5th minutes Apgar scores were lower in the group with placental abruption than in the control group (p = 0.025 and p < 0.001). The neonatal intensive care unit admission rate was higher in the group with placental abruption than in the healthy control group (p = 0.017 and p = 0.002). A statistically significant, negative correlation was found between MSAFP and 1st and 5th minutes Apgar scores (r = − 0.526, r = − 0.522 and p < 0.001, p = 0.001, respectively). The data obtained in this study suggest that MSAFP, which is a simple test, can be used in the clinical management of suspicious placental abruption or antepartum hemorrhage of unknown origin and the prediction of neonatal prognosis.

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References

  1. Ruiter L, Ravelli AC, de Graaf IM, Mol BW, Pajkrt E. Incidence and recurrence rate of placental abruption: a longitudinal linked national cohort study in the Netherlands. Am J Obstet Gynecol. 2015;213(4):573.e1-8.

  2. Ananth CV, Keyes KM, Hamilton A, Gissler M, Wu C, Liu S, et al. An international contrast of rates of placental abruption: an age-period-cohort analysis. PLoS One. 2015;10(5):e0125246.

    Article  Google Scholar 

  3. Tikkanen M. Placental abruption: epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand. 2011;90(2):140–9.

    Article  Google Scholar 

  4. Anderson E, Raja EA, Shetty A, Gissler M, Gatt M, Bhattacharya S, et al. Changing risk factors for placental abruption: a case crossover study using routinely collected data from Finland. Malta and Aberdeen. PLoS One. 2020;15(6):e0233641.

    Article  CAS  Google Scholar 

  5. Mei Y, Lin Y. Clinical significance of primary symptoms in women with placental abruption. J Matern Fetal Neonatal Med. 2018;31(18):2446–9.

    Article  Google Scholar 

  6. Oyelese Y, Ananth CV. Placental abruption. Obstetrics and gynecology. 2006;108(4):1005–16.

    Article  Google Scholar 

  7. Shinde GR, Vaswani BP, Patange RP, Laddad MM, Bhosale RB. Diagnostic performance of ultrasonography for detection of abruption and its clinical correlation and maternal and foetal outcome. J Clin Diagn Res. 2016;10(8):Qc04-7.

  8. Practice Bulletin No. 187. Neural tube defects. Obstet Gynecol. 2017;130(6):e279–e90.

    Article  Google Scholar 

  9. Sharony R, Dayan D, Kidron D, Manor M, Berkovitz A, Biron-Shental T, et al. Is the ratio of maternal serum to amniotic fluid AFP superior to serum levels as a predictor of pregnancy complications? Arch Gynecol Obstet. 2016;293(4):767–70.

    Article  CAS  Google Scholar 

  10. Odendaal HJ, Geerts L, Nel DG, Brink LT, Hitchcock E, Groenewald CA. Effects of alcohol, cigarettes, methamphetamine and marijuana exposure during pregnancy on maternal serum alpha-fetoprotein levels at 20-24 weeks’ gestation. Journal of pediatrics & neonatal care. 2018;8(1).

  11. Bartha JL, Comino-Delgado R, Arce F. Maternal serum alpha-fetoprotein in placental abruption associated with preterm labor. Int J Gynaecol Obstet. 1997;56(3):231–6.

    Article  CAS  Google Scholar 

  12. Ngai I BP, Chazotte C, Merkatz I, Garry D. Maternal serum alpha-fetoprotein (MSAFP) and placental abruption poster session number 122 American Journal of Obstetrics and Gynecology January 2012 S67.

  13. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149–60.

    Article  Google Scholar 

  14. Wilmink FA, Pham CT, Edge N, Hukkelhoven C, Steegers EAP, Mol BW. Timing of elective pre-labour caesarean section: a decision analysis. The Australian & New Zealand journal of obstetrics & gynaecology. 2019;59(2):221–7.

    Article  Google Scholar 

  15. Lees CC, Stampalija T, Baschat A, da Silva CF, Ferrazzi E, Figueras F, et al. ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2020;56(2):298–312.

    Article  CAS  Google Scholar 

  16. Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2016;48(3):333–9.

    Article  CAS  Google Scholar 

  17. Ananth CV, Lavery JA, Vintzileos AM, Skupski DW, Varner M, Saade G, et al. Severe placental abruption: clinical definition and associations with maternal complications. Am J Obstet Gynecol. 2016;214(2):272.e1-.e9.

  18. Charbit B, Mandelbrot L, Samain E, Baron G, Haddaoui B, Keita H, et al. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemost. 2007;5(2):266–73.

    Article  CAS  Google Scholar 

  19. Ananth CV, Smulian JC, Srinivas N, Getahun D, Salihu HM. Risk of infant mortality among twins in relation to placental abruption: contributions of preterm birth and restricted fetal growth. Twin Res Hum Genet. 2005;8(5):524–31.

    Article  Google Scholar 

  20. Sheiner E, Shoham-Vardi I, Hadar A, Hallak M, Hackmon R, Mazor M. Incidence, obstetric risk factors and pregnancy outcome of preterm placental abruption: a retrospective analysis. J Matern Fetal Neonatal Med. 2002;11(1):34–9.

    Article  CAS  Google Scholar 

  21. Tikkanen M. Etiology, clinical manifestations, and prediction of placental abruption. Acta Obstet Gynecol Scand. 2010;89(6):732–40.

    Article  Google Scholar 

  22. Tanacan A, Beksac MS, Orgul G, Duru S, Sener B, Karaagaoglu E. Impact of extractable nuclear antigen, anti-double stranded DNA, antiphospholipid antibody, and anticardiolipin antibody positivity on obstetrical complications and pregnancy outcomes. Human antibodies. 2019;27(2):135–41.

    Article  CAS  Google Scholar 

  23. Beksac MS, Tanacan A, Ozten G, Cakar AN. Low-dose low-molecular-weight heparin prophylaxis against obstetrical complications in pregnancies with metabolic and immunological disorder-associated placental inflammation. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2020:1–8.

  24. Rood K, Stiller R. Hereditary persistence of alpha-fetoprotein: a rare cause for unexplained alpha-fetoprotein elevations in pregnancy. Conn Med. 2013;77(1):43–5.

    PubMed  Google Scholar 

  25. Kofinas A, Kofinas G, Sutija V. The role of second trimester ultrasound in the diagnosis of placental hypoechoic lesions leading to poor pregnancy outcome. J Matern Fetal Neonatal Med. 2007;20(12):859–66.

    Article  Google Scholar 

  26. Abdalla N, Bachanek M, Trojanowski S, Cendrowski K, Sawicki W. Placental tumor (chorioangioma) as a cause of polyhydramnios: a case report. Int J Womens Health. 2014;6:955–9.

    Article  Google Scholar 

  27. Huang T, Hoffman B, Meschino W, Kingdom J, Okun N. Prediction of adverse pregnancy outcomes by combinations of first and second trimester biochemistry markers used in the routine prenatal screening of Down syndrome. Prenatal diagnosis. 2010;30(5):471–7.

    Article  Google Scholar 

  28. Toivonen S, Heinonen S, Anttila M, Kosma VM, Saarikoski S. Reproductive risk factors, Doppler findings, and outcome of affected births in placental abruption: a population-based analysis. Am J Perinatol. 2002;19(8):451–60.

    Article  Google Scholar 

  29. Dugoff L, Hobbins JC, Malone FD, Porter TF, Luthy D, Comstock CH, et al. First-trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications: a population-based screening study (the FASTER Trial). Am J Obstet Gynecol. 2004;191(4):1446–51.

    Article  CAS  Google Scholar 

  30. Florio P, Severi FM, Bocchi C, Luisi S, Petraglia F. Abruptio placentae and highest maternal serum activin A levels at mid-gestation: a two cases report. Placenta. 2003;24(2-3):279–80.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Perinatology, Ankara City Hospital, 06800, Bilkent, Ankara, Turkey

    Seyit Ahmet Erol, Orhan Altinboga, Betul Yakistiran & Filiz Halici Ozturk

  2. Department of Obstetrics and Gynecology, Faculty of Medicine, Bozok University, Yozgat, Turkey

    Emre Baser

  3. Department of Perinatology, Etlik Zubeyde Hanim Women’s Health Care, Training and Research Hospital, University of Health Sciences, Ankara, Turkey

    Ali Turhan Caglar

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  1. Seyit Ahmet Erol
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  2. Orhan Altinboga
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  4. Filiz Halici Ozturk
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Contributions

Seyit Ahmet EROL: Original draft preparation, literature search, writing, data collection.

Orhan ALTINBOGA: Analysis/interpretation, reviewing, and editing.

Betul YAKISTIRAN: Data collection.

Filiz HALICI OZTURK: Data collection.

Emre BASER: Analysis/interpretation.

Ali Turhan CAGLAR: Conceptualization, methodology, visualization, reviewing, and editing.

Corresponding author

Correspondence to Seyit Ahmet Erol.

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Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the ethics committee of the University of Health Sciences, Zekai Tahir Burak Women’s Health Training and Research Hospital.

Informed Consent

The participants included in the study were informed of the study and their consent were obtained.

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The authors declare no competing interest.

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Erol, S.A., Altinboga, O., Yakistiran, B. et al. Evaluation of Actual Maternal Serum Alpha-Fetoprotein (MSAFP) Levels in Placental Abruption and Associations with Adverse Outcomes. SN Compr. Clin. Med. 3, 611–617 (2021). https://doi.org/10.1007/s42399-021-00794-7

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