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Is there any risk to my pregnancy?

Q: I am a 30 years old pregnant lady. At 18 weeks of pregnancy, I underwent triple test and the results are as follows: AFP - 21 ng/ml, beta-HCG in serum was 5150 miu/ml, B-estradiol - 1200 pg/ml. I would like to know whether my results indicate any risk to my baby or not?

A:The information you have provided is not adequate to conclude anything. This is not like some tests where absolute readings help us make a diagnosis. This is a screening test and an abnormal test only means you need more tests and normal is reassuring and you can avoid more tests. That means you may have normal tests and yet an abnormal baby and vice versa. So it requires a fair degree of expertise and care to interpret these tests. There are two types of tests in clinical medicine we use these days. One is to diagnose diseases, which have a linear or predictable correlation, like if you have a blood sugar which is higher than a particular level (200 mg) you have diabetes, irrespective of any other factor. Most tests these days are not as clear and require very careful interpretation. For example you may have high cholesterol and still live a long life free of heart disease and may have an early heart disease despite a normal cholesterol, though the risk is higher if the cholesterol is high. Abnormalities and the triple test is even more complicated as it does not have a cause effect relationship with abnormal fetus, instead it is what we call a population based test. That means that to say whether it is normal or abnormal one has to have a baseline (median) reading of a large population. The test reading in mol/ml or IU / ml is converted to multiples of Median (MoM) which is then put on complex software to interpret and work out a statistical risk of abnormality in a fetus. That means for each lab we need to know the median for each of the three tests which are worked out after a large population at the same stage of pregnancy is tested using the kits this lab is using and then put on a dedicated software to work out a risk. There fore the information you have provided is inadequate to tell you whether your test is normal or not. You need to give us the Multiples of Median (MoMs) of each of the three tests and we will be able to say whether the test is grossly normal or not. I must add that with MoMs also it is the best that the risk is worked out on the software of the individual lab itself, and your lab is best placed to give you the exact risk. From the information you have provided all I can say at this stage is that the beta HCG seems low and the serum estriol and Alpha Fetoproteins quite normal (based on the levels generally seen in Indian populations but you need to be careful when you interpret these. Normality or abnormality of this test may affect your whole life and that of the family so please do not be in a hurry to take any decisions. And even if the tests are abnormal it does not mean your baby is abnormal it only means you need further tests like an amniocentesis to reach a final diagnosis. These tests are easily available in any large city of India now.


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