Keep in mind that the AFP is a SCREENING test not a diagnostic test.  As a
screening test, an abnormal result is not an indication of a problem but an
indication that more testing is needed.  I always tell my OB patients this
and also that the most common reason for an "abnormal result" is a
miscalculation of the due date.

The AFP test is as much as a legal issue as anything.  Doctors have been
successfully sued for not offering the AFP test, when it turned out at
delivery that the infant had Downs or a neural tube defect.  I tell the
patients that the AFP test is required to be offered to them but that it is
their decision whether to have it or not.  Many of my parents to be tell me
that they would not consider an abortion even if there is determine to be a
defect on confirmatory AFP testing follow-up.

I recommend the AFP testing to the parents because if a neural tube defect
is detected, I feel that it would be in the child's best interest to
deliver at a neonatal center rather than at our small local hospital.
 Since the discovery of a neural tube defect would change my plan of care
for the child-mother pair I feel that the test is worthwhile.

Jon Ahrendsen MD FAAFP
Clarion, Iowa