A 38-year-old primigravida returns to the clinic at 16 weeks gestation for an alpha-fetoprotein test.She asks a nurse, "Why do lI need this test?".Which response would be most appropriate for the nurse to make?

Physiologic jaundice is a common condition in newborns that occurs when the baby’s blood contains an excess of bilirubin, a yellow pigment produced during the normal breakdown of red blood cells.In the womb, the mother’s liver removes bilirubin for the baby, but after birth the baby’s own liver must take over this function.Because the baby has more red blood cells than an adult and their liver is still immature, they may not be able to process all the bilirubin and it may build up in their skin and eyes, causing a yellowish appearance.

Choice A is wrong because it is not an increase in neonatal metabolism that causes physiologic jaundice, but rather a decrease in hepatic metabolism of bilirubin.

Choice C is wrong because it describes a different type of jaundice called hemolytic jaundice, which occurs when there is an incompatibility between the blood types of the mother and the baby, leading to an immune reaction that destroys the baby’s red blood cells faster than they can be replaced.

Choice D is wrong because it confuses the reticuloendothelial system with the hepatic system.

The reticuloendothelial system is a network of cells and tissues that are involved in immune responses and phagocytosis (the ingestion of foreign particles or cells).

The hepatic system is the system of organs and structures that are involved in liver functions, such as bile production and detoxification.

Normal ranges for bilirubin levels in newborns are 1 to 12 mg/dL (17 to 205 micromol/L) for total bilirubin and 0.2 to 1.4 mg/dL (3 to 24 micromol/L) for direct bilirubin.

Physiologic jaundice usually peaks at 3 to 5 days after birth and resolves by 2 weeks of age.

It does not require treatment unless the bilirubin levels are very high or rising rapidly, which may indicate a more serious condition or a risk of brain damage.

The correct answer is choice D: “This test is used to identify fetal abnormalities.” Alpha-fetoprotein (AFP) is a protein produced by the fetus that can be measured in the mother’s blood.

Abnormal levels of AFP may indicate a problem with the development of the baby’s brain, spine, or other organs.

This test is usually done between 15 and 20 weeks of gestation.

Choice A is wrong because AFP does not measure the baby’s maturity.

It is not related to the gestational age or the lung development of the fetus.

Choice B is wrong because AFP is not a routine test for all pregnant women over thirty years of age.

It is an optional screening test that may be offered to women who have a higher risk of having a baby with a birth defect, such as those who have a family history, a previous affected pregnancy, or certain ethnic backgrounds.

Choice C is wrong because AFP is not recommended for people with a history of infertility.

It does not assess the fertility status of the mother or the father.

It only measures the level of a fetal protein in the mother’s blood.