Maternal serum alpha-fetoprotein (AFP) is used as a screening tool in identifying risk of fetal anomalies. Raised AFP levels greater than 2.5 Multiples of Median (MoM) are associated with adverse perinatal outcomes. These include risk of miscarriage, preterm delivery, low birth weight, pre-ecclampsia, oligohydramnios and placental abruption. There is also a known association of markedly elevated AFP levels with congenital nephrosis. We identified a case with a successful pregnancy outcome where 80 MoM of AFP was noted during the second trimester screening. The risk factors identified were nulliparity and smoking. This level of AFP has not been documented before and we have limited evidence on the effects of such a high level of AFP on the pregnancy. Here we discuss the challenges of investigations and management of this pregnancy on limited information available.
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