Polyacrylamide gel electrophoresis of amniotic fluid cholinesterases: a good prenatal test for neural tube defects.

The qualitative assay of the cholinesterases (ChE) in amniotic fluid on polyacrylamide gel gave a single major band (cholinesterase) in all samples from normal pregnancies, and two major bands (cholinesterase and acetylcholinesterase) in all cases from fetuses with open neural tube defects. Five fluids which were true false positive on alpha-fetoprotein (AFP) assay (elevated AFP in a clear fluid but normal fetus) had a single band, and two fluids which were false negative on AFP testing (normal AFP but spina bifida fetus) had two bands. The second 'diagnostic' ChE band sometimes occurred, together with other extra bands, in some fluids which were very severely contaminated by maternal or fetal blood, but in four of six fluids from normal fetuses where fetal blood staining was sufficient to cause the AFP to be elevated, there was only one ChE band. It is suggested that the qualitative assay of ChE should be performed in addition to AFP in the prenatal diagnosis of neural tube defects.