A nurse is caring for a client in an antepartum clinic following a maternal serum alpha-fetoprotein screening.
The nurse should recognize that an elevated alpha-fetoprotein level is suggestive of which of the following?

Choice A rationale

An elevated maternal serum alpha-fetoprotein (MSAFP) level is a significant biomarker that can suggest an increased risk of open neural tube defects (NTDs), such as spina bifida or anencephaly. Alpha-fetoprotein is a protein produced by the fetal liver and yolk sac; in cases of open NTDs, larger amounts leak into the amniotic fluid and subsequently cross into the maternal bloodstream, resulting in higher MSAFP levels. Further diagnostic tests like ultrasound or amniocentesis are typically recommended to confirm the diagnosis.

Choice B rationale

Phenylketonuria (PKU) is an inherited metabolic disorder characterized by the inability to metabolize the amino acid phenylalanine. This condition is diagnosed through newborn screening tests that measure phenylalanine levels in the blood, not by maternal serum alpha-fetoprotein screening. MSAFP is not a marker for metabolic disorders like PKU, as it is primarily indicative of fetal structural anomalies, particularly neural tube defects.

Choice C rationale

Trisomy 21, also known as Down syndrome, is a chromosomal disorder caused by the presence of an extra copy of chromosome 21. While MSAFP is part of the "triple screen" or "quad screen" used for aneuploidy screening, an elevated MSAFP level alone is typically associated with neural tube defects. In cases of Trisomy 21, MSAFP levels are usually *lower* than normal, in conjunction with altered levels of other markers like human chorionic gonadotropin (hCG) and unconjugated estriol.

Choice D rationale

Hemophilia is a genetic bleeding disorder caused by a deficiency in specific clotting factors, primarily factors VIII or IX. This condition is inherited in an X-linked recessive pattern and is diagnosed through specialized blood tests that measure clotting factor activity. Maternal serum alpha-fetoprotein screening is not used to detect hemophilia, as it is a marker for fetal structural integrity, particularly concerning neural tube and abdominal wall defects.

Choice A rationale

Requesting a parent to verify the newborn's name is an important part of the identification process, but it is not the primary method for confirming identity directly on the newborn. Verifying identity relies on objective comparison of identifying markers on both the infant and the parent for accuracy.

Choice B rationale

Checking the newborn's footprint sheet with the medical record is a valid identification method, but typically occurs when the newborn is admitted or for more permanent records. For immediate transport, a direct comparison of armbands between the newborn and parent is the most efficient and readily verifiable method.

Choice C rationale

Asking a parent to state the newborn's date of birth provides information about the newborn. However, this relies on parental recall and is not a direct physical confirmation of the newborn's identity. Physical identifiers like matching band numbers offer a more secure and immediate verification.

Choice D rationale

Comparing numbers on the newborn's band to the parent's band is the most secure and immediate method to confirm identity prior to transport. This ensures that the correct newborn is being given to the designated parent, preventing potential mix-ups and upholding critical safety protocols in maternity care.