NBME Form 14 Step 2 Practice Test

The initial evaluation for increased serum alpha-fetoprotein (AFP) concentrations in pregnant women is to perform ultrasonography. This imaging technique is essential because it helps confirm gestational age and determine the number of fetuses. Elevated AFP levels can indicate various conditions, including neural tube defects or multiple gestations, so establishing an accurate gestational age and verifying whether there is more than one fetus is crucial for interpreting the significance of the elevated AFP. Ultrasonography can also help in identifying any structural anomalies in the fetus that could explain the elevated levels.

Maternal serum screening is typically done before considering further diagnostic procedures, such as amniocentesis, which may be warranted based on findings from the initial evaluation. Similarly, while a non-stress test can be useful later in pregnancy to assess fetal well-being, it is not part of the initial management for elevated AFP levels.