Background: Placenta previa is a major cause of maternal and fetal morbidity. Early prediction could improve management. Maternal serum alpha-fetoprotein (MSAFP), mainly produced by the fetal liver, may be elevated in abnormal placentation. This study examined the association between MSAFP levels and placenta previa.

Objectives: Estimation of maternal serum AFP in maternal serum presenting with or without placenta previa and to find the correlation between the maternal serum AFP and placenta previa.

Methods: A prospective case–control study was conducted at Gauhati Medical College and Hospital among 120 pregnant women (>28 weeks): 60 with placenta previa and 60 controls. MSAFP was measured; >150 IU/mL was considered elevated. Placenta previa was graded by ultrasound. Data were analyzed using chi-square tests; p<0.05 was significant.

Results: Elevated MSAFP was found in 75% of placenta previa cases vs. 3% of controls (p<0.0001). Higher MSAFP levels correlated with more severe grades (IIIA–IV). The previa group also had higher rates of emergency caesarean, maternal complications, and adverse neonatal outcomes.

Discussion: MSAFP levels were significantly higher in women with placenta previa, especially severe forms. MSAFP may serve as a simple, non-invasive marker to identify high-risk pregnancies and guide management. Larger studies are needed to validate these findings.