Obstetrics- AFP
harry206 - 05-13-09 07:46

A 31-year-old Caucasian woman who is in her 19th week of gestation comes to the office to discuss the results of a slightly elevated serum AFP. She has been followed since her seventh week of pregnancy. Ever since she learned that women must start taking folic acid before getting pregnant in order to avoid congenital defects, she has been concerned about the possibility of having a baby with neural tube defects. Because she just started taking folic acid during her second month of pregnancy and one of her friends had a child with spina bifida, she requested her alpha-fetoprotein (AFP) levels to be tested. She has no other medical problems. She does not use alcohol, tobacco or illicit drugs. Her family history is not significant. She is currently not taking any medications, except for folic acid. The physical examination reveals clear lung fields, and normal first and second heart sounds. The abdomen is soft and non-tender. The uterine size, fetal movements and fetal cardiac activity are all normal. Neurologic examination reveals no abnormalities. Her serum AFP level is slightly elevated, reaching 2.7 MoM (normal values: less than 2.5 MoM). Which of the following is the most appropriate next step in management?