The use of maternal serum alpha-fetoprotein (MSAFP) in screening for open neural tube defects and other fetal abnormalities is discussed. The arguments for the introduction of this screening test in certain areas of Iceland are provided and its possible application. MSAFP could be used as part of the triple test used for the screening of chromosomal abnormalities at 15-18 weeks of pregnancy, or as a single marker for neural tube defects.