In a 35-year-old primigravida expecting twins, what would you anticipate her alpha fetoprotein (AFP) levels to be?

In a 35-year-old primigravida expecting twins, it is anticipated that her alpha-fetoprotein (AFP) levels would be higher than normal. AFP is a protein produced by the fetal liver, and its levels can provide important information about the health of the pregnancy.

In twin pregnancies, the amount of fetal tissue present is greater than that in single gestations, leading to increased production of AFP. This elevation is due to the contribution from each fetus, and it is expected that the levels would reflect this increased fetal mass. Therefore, measuring AFP levels can often provide insights into conditions like neural tube defects or other fetal anomalies, but in the case of twin pregnancies, a higher level is a normal physiological response due to the increased production of this protein.

In contrast, a normal level would be expected in a singleton pregnancy, while lower than normal levels are more associated with specific conditions or high-risk scenarios that do not relate to twins. Therefore, for a pregnant woman expecting twins, higher than normal AFP levels are to be expected as a standard physiological occurrence.