MSAFP screening is an accepted component of the prenatal evaluation of all obstetric patients. Several aspects of MSAFP screening are controversial, such as cost-effectiveness, given the low incidence (1-2/1,000 gravidas) of fetal NTDs in the general obstetrical population; weight correction of MoM values; use of an abnormal low MSAFP cutoff to investigate Down syndrome; and reporting of risk data for open NTDs, VWDs, and Down syndrome. Nevertheless, MSAFP testing is a standard of care, both in the civilian and military medical communities. Therefore, the critical decision facing military medical treatment facilities is not whether to offer MSAFP testing, but, rather, how will results for this test be provided? The options available include in-house testing and the significantly more expensive ship-out testing to a fee-for-service reference laboratory. We suggest that MSAFP testing can be cost-effectively and reliably performed in-house by military medical treatment facilities, provided that appropriate resources are available and the guidelines indicated above are adhered to for ensuring the accuracy and reproducibility of MSAFP and AFAFP test results.
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