A 28-Year-Old Woman, Gravida 1 Para 0, Comes to the Office

A 28-year-old woman, gravida 1 para 0, comes to the office for an initial prenatal visit.  The patient has had no vaginal bleeding or abdominal pain and has not yet felt fetal movement.  Menarche occurred at age 13.  She sometimes has heavy menstrual bleeding with passage of clots, and other times she skips her menses.  The patient's estimated gestational age based on her last menstrual period is 16 weeks.  She has type 1 diabetes mellitus that is controlled with insulin.  She smokes a pack of cigarettes daily.  As part of her prenatal laboratory screening, a second-trimester maternal serum quadruple screen is performed and reveals an elevated alpha-fetoprotein level.  Which of the following is the most likely etiology of this patient's abnormal screening result?

A) Dating error
B) Down syndrome
C) Edwards syndrome
D) Fetal growth restriction
E) Fetal heart defect
F) Hydatidiform mole

Correct Answer:

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