Document Detail

Pregnancy outcome in the setting of extremely low first trimester PAPP-A levels.
MedLine Citation:
PMID:  19566556     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Serum pregnancy-associated plasma protein-A (PAPP-A) is part of first trimester Down syndrome screening. Low levels have been associated with adverse outcome as well as chromosomal abnormality. AIMS: To assess the incidence of adverse outcome when PAPP-A levels are at or below 0.2 multiples of the median (MoM). METHODS: Data on consecutive patients attending a first trimester screening program were collected. Those with PAPP-A levels < or = 0.2 MoM were divided into three groups: < or = 0.1 MoM; 0.11-0.15 MoM; and 0.16-0.2 MoM. RESULTS: Screening 44 535 patients resulted in 197 with PAPP-A levels < or = 0.2 MoM. The incidence of karyotypic abnormality increased with decreasing PAPP-A levels. In the absence of chromosome abnormality, pregnancy outcomes were defined as 'normal' in at least 30% and 'good' in at least 60%, with both percentages increasing as the PAPP-A level rose. The PAPP-A levels were significantly lower in the group with a poor outcome. The incidence of prematurity was similar in the three groups, but higher than the statewide average, while the incidence of extreme prematurity appeared to be related to reducing PAPP-A levels. The incidence of growth restriction in the three groups was similar, but was still double the incidence in the normal population. CONCLUSION: If the PAPP-A level is < or = 0.2 MoM and the karyotype is normal, there is an increased risk of adverse outcome. Even with PAPP-A below 0.1 MoM, a good outcome can be expected in 60% of cases. Careful morphological assessment is suggested and later monitoring of fetal growth and well-being.
Fergus Scott; Anne Coates; Andrew McLennan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Australian & New Zealand journal of obstetrics & gynaecology     Volume:  49     ISSN:  1479-828X     ISO Abbreviation:  Aust N Z J Obstet Gynaecol     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-07-01     Completed Date:  2009-10-05     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0001027     Medline TA:  Aust N Z J Obstet Gynaecol     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  258-62     Citation Subset:  IM    
Sydney Ultrasound for Women, Sydney, New South Wales, Australia.
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MeSH Terms
Abortion, Spontaneous
Chromosome Aberrations*
Congenital Abnormalities / blood*
Infant, Newborn
Infant, Premature
Infant, Small for Gestational Age
Pregnancy Trimester, First / blood*
Pregnancy-Associated Plasma Protein-A / metabolism*
Prenatal Diagnosis*
Retrospective Studies
Risk Factors
Reg. No./Substance:
EC 3.4.24.-/Pregnancy-Associated Plasma Protein-A

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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