Maternal Serum Alpha Fetoprotein Versus Ultrasound Criteria in Prediction of Outcome in Pregnancies with Suspected Morbid Adherence of the Placenta

Purpose: The study aimed at comparing unexplained elevated maternal serum AFP and ultrasound criteria in predicting the maternal outcome at delivery in patients with suspected morbid placental adherence. Methods: The study was a prospective cohort study carried out at Ain Shams University Maternity Hospital. 60 pregnant women with suspected morbidly adherent placenta by trans-abdominal ultrasound had their maternal serum alpha-fetoprotein (MSAFP) levels measured. Women for with other causes for MSAFP elevation were excluded. Statistical analysis was performed by chi-square test, Fisher’s exact test, Student’s t-test, and odds ratio calculation. Results: In our study a sonographic score !3 was associated with morbid adherence at a sensitivity of 82.6%, specificity of 92.1%, positive predictive value [PPV] of 97.4%, negative predictive value [NPV] of 61.9%, positive likelihood ratio [LR+] of 11.6, and a negative likelihood ratio [LR–] of 0.2, while a MSAFP 2MOM was associated with morbid adherence of placenta at a sensitivity of 93.3%, specificity of 71.4%, PPV of 91.3%, NPV of 71.4%, LR+ of 3.2, and LR– of 0.1. Moreover we found that MSAFP 2MOM was associated with 3-fold, 7-fold, 2-fold, and 3-fold increase in intra-operative placental adherence, bladder injury, postpartum hemorrhage and caesarian hysterectomy respectively. Conclusion: An unexplained elevated MSAFP level 2MoM, which is an objective method can be a more useful method in predicting intra-operative morbid placental adherence and intraoperative complications in cases of suspected morbidly adherent placenta.