Amniotic fluid levels of fibrin(ogen) degradation fragment E and alpha-fetoprotein in normal pregnancy and with fetal neural tube defect.

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.

Circulating levels of fibrin/fibrinogen degradation fragment E measured by radioimmunoassay in pre-eclampsia.

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.

Letter: IUD and congenital malformation.

PIP: We were interested to read the paper by Dr. Herbert Barrie (February 28, p. 488) of 2 cases of infants with limb reduction deformity born to mothers who were using copper-containing IUDs. We present a further case in which this association was observed. The affected infant was born in 1975 to a 24-year-old Nigerian woman. The mother's 1st pregnancy was uneventful. At 37 weeks' gestation the Copper 7 was partly extruded from the cervix and was easily removed. 2 days later labor started spontaneously and the child was delivered normally. The male infant cried well at birth. It weighed 2820 gm and the head circumerence was 35 cm. The child's head, face, trunk, and right upper limb were normal. The other limbs had severe reduction deformities. The left radius was absent and there were only 2 fingers on the left hand. Both lower limbs were abnormal: the left had a single slender long bone articulating with the foot, which was markedly dorsiflexed and had only 2 toes; on the right the femur was angulated, the fibula was absent, and only 4 metatarsals were present with 4 toes. The child has made satisfactory progress and gained 1 kg in the first 3 months. The abnormalities described are more extensive than those described by Dr. Barrie. This infant will never achieve a normal gait, and will remain severely handicapped.^ieng

Levels of alpha-fetoprotein in maternal blood as a screening test for fetal neural-tube defect.

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 clinico-pathological study of vulval dermatoses.

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.