The aim: To assess the sensitivity of second trimester prenatal screening and its value in predicting pregnancy complications and genetic abnormalities.Methods: 300 pregnant females were subjected to MSAFP testing at 15 -18Wks and ultrasound scan at 16-18 Wks for soft markers, major anomaly. AC was offered to high risk cases, and cases were followed till term to assess the outcome.Results: 12/300cases had low MSAFP with high risk for chromosomal abnormalities, one case of them had trisomy 21 fetus with soft markers, another case the fetus developed generalized edema and IUFD, 3/300 cases had high MSAFP with adverse pregnancy outcome,one of them had NTD and multiple anomalies. Ultrasound abnormalities with adverse pregnancy outcome were detected in 11/293 cases while soft markers were detected in 18 cases, only 5/18 had structural anomalies with two chromosomally abnormal fetuses. Soft markers were detected in normal unaffected fetuses. Amniocentesis was offered to 20 cases, The AC acceptance rate was 55 %, and no post procedure complications were detected.Conclusion: Combining genetic ultrasound to the MSAFP screening increases the efficiency and accuracy of prenatal screening as ultrasound can detect most structural abnormalities with less AC numbers. Soft marker improves the detection rate of fetal abnormalitiesand anaeupliodies, so soft markers should be considered carefully when detected especially at high risk cases.