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Old June 29th 05, 12:23 AM
oregonchick
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"Circe" wrote in message
news:%pkwe.3632$Qo.2525@fed1read01...
"oregonchick" wrote in message
...
My ob casually asked me as I was preparing to leave my last appt if I
wanted to have this test done. I had never heard of it before, and I
asked her to explain. She mentioned it was to find out if the baby was
at risk of spinal cord problems, but didn't really elaborate. She seemed
busy and annoyed at the question. Is this something that everyone has
done?

In a nutshell, the AFP is a blood test performed on the mother at around
mid-pregnancy. The blood is analyzed and higher/lower concentrations of
certain hormones *can* be indicative that the fetus is at a
higher-than-expected risk of some types of defects, including spina bifida
and trisomy (Down Syndrome, which is T21, being the most common). If the
result of an AFP test is "positive" for any of these conditions, further
testing can be done (amniocentesis in the case of a trisomy, high level
ultrasound in the case of spina bifida) to determine whether or not there
is actually a problem.

It is important to understand that the AFP is only a screening test. A
"positive" result on the test does not mean there is certainly something
wrong, only that the amount of hormone in your blood stream suggests a
higher-than-expected chance that there is something wrong. The AFP is
generally recommended because it is a non-invasive test that poses no
risks to the fetus or the mother, but tends to be fairly accurate in
identifying women for whom further, more invasive testing (read amnio)
might be warranted. That doesn't mean that most women who are referred for
further testing due to AFP results wind up having babies with problems,
but rather that most women who *do* have babies with these sorts of
problems are identified by the AFP.

Before consenting to taking the AFP, you need to decide whether or not you
would consent to further testing if the result is positive. It's also
worth noting that the results are considerably less accurate for women
over about 37-38--the tendency is for almost all tests done on women above
that age bracket to come back positive. Also, the usefulness of the AFP as
a test for spina bifida is somewhat overrated, IMO. Unless you would not
have a standard anomaly scan at 20ish weeks of pregnancy, it isn't likely
to result in finding a problem you wouldn't otherwise have discovered. So
what the AFP is *really* doing for you is screening for trisomies.

I am sorry to hear that your practitioner did not explain all of this to
you and that she seemed annoyed by the question. This is not appropriate
behavior on the part of a physician, IMHO. In addition to evaluating
whether or not you want the AFP, I would recommend evaluating whether or
not you wish to continue in the care of a practitioner who does not answer
your questions and treats you rudely. That does not seem like a
particularly positive harbinger for her bedside manner or her ability to
get informed consent before performing other procedures when you are
giving birth.
--
Be well, Barbara


Thank you so much for the clear explanation. It sounds like a worthwhile
and noninvasive test, better safe than sorry! As for my practicioner, I
feel a little helpless when it comes to that situation. I have an hmo, and
I've seen a few different OB's through my plan. I'm really not impressed
with any of them. I wish I could find a private birthing center in my
area - I am willing to pay out of pocket. But how does one locate such
services. I'm in Portland, OR, so there should be something like that here.

Betsy