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Value of high and low maternal serum α-fetoprotein levels in screening singleton pregnancies
780
Letters
practice in an assay system and clinical reporting protocol for investigational Down syndrome screening" (emphasis added). Indeed, our Research Division has placed announcements concerning requests for proposals in major journals of obstetrics to advance additional free [3-protein research and development. We object to Goodlin's implication of conflict of interest in our publication of the effectiveness of free [3-protein as a marker for Down syndrome. All original scientific contributions emanating from the Research Division of NTD Laboratories, Inc., have been clearly identified as such; the present case is no exception. Surely Dr. Goodlin would not suggest that research scientists with an explicit commercial association be denied the privilege of publication in the professional scientific literature or the benefits derived from peer review of original findings. James N. Macri, PhD, Ramana V. Kasturi, MS, and Edward J. Cook, PhD Research Division, NTD Laboratories, Inc., 383 Old Country Road, Carle Place, NY 11514
Value of high and low maternal serum a-fetoprotein levels in screening singleton pregnancies To the Editors: MiIunsky et al. reported an important prospective study to establish the overall benefits of high, low, and normal maternal a-fetoprotein levels in screening singleton pregnancies (Milunsky A, lick SS, Bruell CL, et al. Predictive values, relative risks and overall benefits of high and low maternal serum a-fetoprotein screening in singleton pregnancies: New epidemiologic data. AM ] OBSTET GYNECOL 1989;161:291-7). We read with great interest this fundamental study, and we wish to comment on the relationship of high maternal serum a-fetoprotein levels and the incidence of fetal chromosome defects. In their Table I they have reported one chromosome anomaly associated with a high maternal serum a-fetoprotein level. In contrast, in their hierarchical Table III this case has not been reported. Furthermore, in their Table IV no probabilities for chromosome defects were given in relation to high maternal serum a-fetoprotein levels. In our opinion chromosome disorders are hierarchically top-ranking obstetric events. Moreover, the possible relationship of high maternal serum a-fetoprotein levels and chromosome defects has attracted the scientific attention of several studies. I. 2 If we consider the one case of chromosome disorder in the 530 cases of high maternal serum a-fetoprotein levels (Table I), then the risk for a woman with a high maternal serum a-fetoprotein level of carrying a fetus with a chromosome defect is 1 in 530. This incidence, without any adjustment for maternal age, fetal structural defects, and amniotic fluid a-fetoprotein levels, is comparable to the incidence of Down syndrome in live-born infants of woman 34 years 01d. 3
September 1991 Am J Obstet Gynecol
We believe that this part of maternal serum a-fetoprotein screening needs more clarification. Demetrios Minaretzis, MD, and Christina Tsionou, MD 1st Obstetrics and Gynecological Department, University of Athens, "Alexandra" Maternity Hospital, 80 Vas. Sophias Ave., 115 28 Athens, Greece
REFERENCES 1. Warner AA, Pettenati Mj, Burton BK. Risk of fetal chromosomal anomalies in patients with elevated maternal serum alpha-fetoprotein. Obstet Gynecol 1990;75:64-6. 2. Borbow M, Lindenbaum RH, Seabright M, Gregson N. Karyotyping amniotic fluids from patients with high serum alpha-fetoprotein. Lancet 1989; 1:606-7. 3. Hook EB. Rates of chromosomal abnormalities of different maternal ages. Obstet Gynecol 1981 ;58:282-5.
Reply To the Editors: We appreciate the detailed reading of our article by Minaretzis and Tsionou, who correctly noted that the single chromosome anomaly reported in Table I is not shown in the hierarchical Table III. Further attention to the table footnotes would clarify their concern. The single chromosome anomaly has been incorporated in the neural tube defect group in the hierarchical table, each case being recorded only once, with neural tube defects taking precedence in being listed first. Table IV reflects this hierarchical tabulation as well and, hence, yielded no calculable odds for chromosome defects in this study in association with high maternal serum a-fetoprotein levels. Clearly, chromosome defects in the absence of any leaking lesions, such as spina bifida, omphalocele, and cystic hygroma, are very uncommon indeed. This observation is in line with those of others who have published on this association. If Minaretzis and Tsionou wish to extrapolate from our data that 1 in 530 women had a chromosome defect, so be it. This figure would not come close to any standard recommendation for amniocentesis for prenatal genetic studies. In essence, fetal chromosome defects and raised maternal serum a-fetoprotein levels are a very infrequent association. Aubrey Milunsky, MB, BCh, DSc Center for Human Genetics, Boston University School of Medicine, 80 E. Concord St., Boston, MA 02118
Laparoscopic ventrosuspensions
To the Editors: I read with great interest the article by Yoong (Yoong AFE. Laparoscopic ventrosuspensions. AM] OBSTET GYNECOL 1990;163:1151-3). This point has been a concern of ours, and our team is quite used to uterine retroversion and its treatment. lOur results are better than Yoong's, perhaps because of the selected cases with which we deal. I have two questions: (1) Dr. Yoong does not specify whether uterine retroversion was observed in each case. (2) There is no mention of pelvic varices in Table III. Is this because none were sought? Laparoscopic ventrosuspension is effective in treating severe dyspareunia and chronic pelvic pain. If the
Letters
practice in an assay system and clinical reporting protocol for investigational Down syndrome screening" (emphasis added). Indeed, our Research Division has placed announcements concerning requests for proposals in major journals of obstetrics to advance additional free [3-protein research and development. We object to Goodlin's implication of conflict of interest in our publication of the effectiveness of free [3-protein as a marker for Down syndrome. All original scientific contributions emanating from the Research Division of NTD Laboratories, Inc., have been clearly identified as such; the present case is no exception. Surely Dr. Goodlin would not suggest that research scientists with an explicit commercial association be denied the privilege of publication in the professional scientific literature or the benefits derived from peer review of original findings. James N. Macri, PhD, Ramana V. Kasturi, MS, and Edward J. Cook, PhD Research Division, NTD Laboratories, Inc., 383 Old Country Road, Carle Place, NY 11514
Value of high and low maternal serum a-fetoprotein levels in screening singleton pregnancies To the Editors: MiIunsky et al. reported an important prospective study to establish the overall benefits of high, low, and normal maternal a-fetoprotein levels in screening singleton pregnancies (Milunsky A, lick SS, Bruell CL, et al. Predictive values, relative risks and overall benefits of high and low maternal serum a-fetoprotein screening in singleton pregnancies: New epidemiologic data. AM ] OBSTET GYNECOL 1989;161:291-7). We read with great interest this fundamental study, and we wish to comment on the relationship of high maternal serum a-fetoprotein levels and the incidence of fetal chromosome defects. In their Table I they have reported one chromosome anomaly associated with a high maternal serum a-fetoprotein level. In contrast, in their hierarchical Table III this case has not been reported. Furthermore, in their Table IV no probabilities for chromosome defects were given in relation to high maternal serum a-fetoprotein levels. In our opinion chromosome disorders are hierarchically top-ranking obstetric events. Moreover, the possible relationship of high maternal serum a-fetoprotein levels and chromosome defects has attracted the scientific attention of several studies. I. 2 If we consider the one case of chromosome disorder in the 530 cases of high maternal serum a-fetoprotein levels (Table I), then the risk for a woman with a high maternal serum a-fetoprotein level of carrying a fetus with a chromosome defect is 1 in 530. This incidence, without any adjustment for maternal age, fetal structural defects, and amniotic fluid a-fetoprotein levels, is comparable to the incidence of Down syndrome in live-born infants of woman 34 years 01d. 3
September 1991 Am J Obstet Gynecol
We believe that this part of maternal serum a-fetoprotein screening needs more clarification. Demetrios Minaretzis, MD, and Christina Tsionou, MD 1st Obstetrics and Gynecological Department, University of Athens, "Alexandra" Maternity Hospital, 80 Vas. Sophias Ave., 115 28 Athens, Greece
REFERENCES 1. Warner AA, Pettenati Mj, Burton BK. Risk of fetal chromosomal anomalies in patients with elevated maternal serum alpha-fetoprotein. Obstet Gynecol 1990;75:64-6. 2. Borbow M, Lindenbaum RH, Seabright M, Gregson N. Karyotyping amniotic fluids from patients with high serum alpha-fetoprotein. Lancet 1989; 1:606-7. 3. Hook EB. Rates of chromosomal abnormalities of different maternal ages. Obstet Gynecol 1981 ;58:282-5.
Reply To the Editors: We appreciate the detailed reading of our article by Minaretzis and Tsionou, who correctly noted that the single chromosome anomaly reported in Table I is not shown in the hierarchical Table III. Further attention to the table footnotes would clarify their concern. The single chromosome anomaly has been incorporated in the neural tube defect group in the hierarchical table, each case being recorded only once, with neural tube defects taking precedence in being listed first. Table IV reflects this hierarchical tabulation as well and, hence, yielded no calculable odds for chromosome defects in this study in association with high maternal serum a-fetoprotein levels. Clearly, chromosome defects in the absence of any leaking lesions, such as spina bifida, omphalocele, and cystic hygroma, are very uncommon indeed. This observation is in line with those of others who have published on this association. If Minaretzis and Tsionou wish to extrapolate from our data that 1 in 530 women had a chromosome defect, so be it. This figure would not come close to any standard recommendation for amniocentesis for prenatal genetic studies. In essence, fetal chromosome defects and raised maternal serum a-fetoprotein levels are a very infrequent association. Aubrey Milunsky, MB, BCh, DSc Center for Human Genetics, Boston University School of Medicine, 80 E. Concord St., Boston, MA 02118
Laparoscopic ventrosuspensions
To the Editors: I read with great interest the article by Yoong (Yoong AFE. Laparoscopic ventrosuspensions. AM] OBSTET GYNECOL 1990;163:1151-3). This point has been a concern of ours, and our team is quite used to uterine retroversion and its treatment. lOur results are better than Yoong's, perhaps because of the selected cases with which we deal. I have two questions: (1) Dr. Yoong does not specify whether uterine retroversion was observed in each case. (2) There is no mention of pelvic varices in Table III. Is this because none were sought? Laparoscopic ventrosuspension is effective in treating severe dyspareunia and chronic pelvic pain. If the