Low Papp-A, hospital error meant I found out at 21 weeks.

[SpecialStains]

Due to an admin error, I only found out yesterday that I have low Papp-A levels (unsure of absolute values). My combined risk for downs was low at 1:1952. 8, 12 and 20 week scans all perfectly normal. I am 25yrs old, healthy normal bmi, never smoked/taken drugs, light drinker (when not pregnant, no alcohol in pregnancy). I have no other medical conditions other than hyperemesis in pregnancy.

I found out about my Papp-A levels, because I had a letter asking me for a 30 week scan and so I called up to query why I was having an extra scan. I apparently should have had a consultant appointment at 16 weeks. Midwife couldn't tell me anything over the phone, just repeated that I needed to talk to a consultant.

They have now scheduled me an appointment with a consultant on Friday. I presume my risk is more for placenta issues than chromosomal. Can anyone tell me what to expect in this appointment? What does this mean in terms of baby's health?

Just scared and Friday's appointment seems a long way off!

[bayswatersophie]

Poor you, stress full
The low Papp A can be due to issues with the placenta which will involve more monitoring to make sure all stays well. What was your other hormone level like?

[SpecialStains]

Thanks for replying, I'm going a bit mad with uncertainty. I have no idea what my other hormone level is like. I have only been told over the phone that I have a low Papp-A, midwife couldn't discuss further as I need to talk to a consultant. As only Papp-A was mentioned I presume everything else is normal, and my combined screening risk is low. I can't find any clear NHS/NICE/WHO guidelines on the management of pregnant women with low Papp-A, so I have no idea what to expect.

Very scared and stressed. Just want baby to be OK.

[SpecialStains]

Just going through all my notes/letters and the only letter I had was one saying that I am low risk for carrying a baby with downs syndrome and they do not recommend any further action.

No mention of Papp-A or hcg etc whatsoever.

[bayswatersophie]

Firstly, I am no expert but I am sure there is no cause for concern. If the only thing is the low Papp A, my under standing is that this can be linked to an issue with the placenta and the way it nourishes the baby. From reading other threads the risk is slower growth for the baby and they seem sometimes to recommend daily aspirin. And more frequent scans to monitor growth.
But I don't think it is a big deal.
The reason I asked about the hcg is because I had extremely low levels for both. That combined with a very small baby for dates at 18 weeks, my age (40) and a small cyst on the brain that they picked up on the scan meant there was much more cause for concern and unfortunately I did have a serious chromosomal problem with my baby diagnosed by amnio. It sounds like there is far less cause for concern as far as your results go. Why don't you ring ARC antenatal results helpline today? They really know what they are talking about and will help put in perspective. I know far easier said than done but please don't panic, I am sure all is fine. Thinking of you

[KittyandTeal]

Low papp a can be an indicator of either chromosomal issues of placental issues.

If your 20 week scan was fine I'd say that you can rule out chromosomal issues.

In terms of inter uterine growth restriction there is mixed evidence. My hospital recently did research on low Papp a and found that out of 70 with low Papp a and no chromosomal issues 2 gave birth to babies slightly under the weight they were happy with.

[Pagetta]

Hi
I had v similar experience - had low papp a but not mentioned until after 20 week scan due to being overlookEd.
My midwife reassured me that low papp a alone is purely a flag for potential SFG (small for gestational age) baby but they keep an eye just to be safe.
Like you I am healthy, normal blood pressure BMI etc and low downs.
At my scan turns out I have poor blood flow to placenta which has made me high risk for SFG - I will have scans every 3 week to check baby's growth ok and if it slows they deliver earlier.
I'm now 30 weeks and scan today showed baby is growing just fine in fact if he goes full term he's tracking to be much bigger than DS1 and is at top of growth curve! Just need placenta to hold out til then!
I know easier said than done (having been there recently ) but try not to worry.
In the absence of any other issue low papp a is purely linked to growth and the fact they are keeping an eye is a good thing - plus you get to see baby lots more which is a definite silver lining
They will do a full growth scan, check fluid levels and blood flow to baby and in baby.
It's always scary when they say you need extra tests but try to stay positive hun as other said low papp a is not a cause for concern - just they like to monitor closer xx

[daluze]

As previous posters already said - most likely they will suggest monitoring baby's growth, so you are likely to have extra scans towards the end of pregnancy.
It has already been taken into account to calculate the chromosomal abnormalities risk, i.e. the risk that you got would have included it into calculations, so you should not worry about chromosomal defects, especially after a clear 20 weeks scan.
Good luck and try to relax - easier said than done, I know!

[SpecialStains]

Hi, thanks for the replies, they are really reassuring. I've got my consultant appointment in a few hours so hopefully the consultant will just reiterate what you've all said.

I've been on the small for gestational age pathway since very early on in pregnancy anyway, due to me having lost lots of weight because of constant morning sickness. I need to ask the consultant more about this today as well.

I just want my healthy baby! Suddenly feeling very vulnerable.

Thanks again for the advice. I really have appreciated it.

[bayswatersophie]

Good luck for today and let us know how you get on
Xxx

[SpecialStains]

Hello,

My appointment was 2.5hrs late, but when I finally saw the midwife who took my obs before the consultant appointment (blood pressure, pulse, doppler for baby's heartbeat) she was absolutely fantastic. Really reassuring, and reiterated a lot of what has been said on this thread. I think she clocked quite quickly how anxious I was and she was so nice and sympathetic with me. The consultant was also very nice, and confirmed that baby is the correct size for dates on all my scans.

So in case anyone is in a similar position in future and comes across this thread on google, Papp-A can be linked to chromosomal or placenta issues. As my combined score was low (even including the low Papp-A) and I've had 3 scans clear of any soft markers it's very unlikely to be linked to chromosomal abnormalities. It can possibly be linked to babies growing a bit slower, but also it can be completely normal for some women who have perfectly ordinary babies. I'll have three extra scans in the third trimester, and a 36 week consultant appointment. The consultant at 36 weeks will decide if I need to be consultant led and induced at 37 weeks (if baby is a bit small), as if baby isn't growing well inside me, it's better to get him out and fed. If everything is completely normal, the consultant will discharge me back to midwife led care and I can have a midwife led delivery (which is what I want).

Either way, I think the NHS is wonderful (despite the admin error) and I feel very well looked after. Thanks to everyone on this thread for your support. It has been appreciated. :-)

[bayswatersophie]

Very happy to hear all is well x

[KittyandTeal]

Brilliant.

I figured this is probably what they'd tell you (because I was told the same stuff only before soft markers were picked up for trisomy)

Did they say anything about baby dose aspirin? I was on that before we got our T18 diagnosis, there is some evidence that it can help blood flow to the placenta which might help counteract any low Papp a side effects for iugr.

I agree, the nhs is wonderful. Especially in times of distress.

[SpecialStains]

Kitty Sorry to hear about your T18 diagnosis.

I asked the consultant about aspirin, and she said that as I don't have any problems currently and baby is the right size, she reckons there's not enough evidence to recommend it to me at the moment. I have read online that some people are told to take it, but tbh I'm happy enough with everything the consultant said. I've been bad with pregnancy sickness (constant nausea and vomiting) so glad I don't need to try to take any more tablets at the moment!

Thanks again everyone. :-)

[KittyandTeal]

That's great, as long as they went over it with you.

It's always best to follow consultants advice. Sounds like you will probably be one of the Mia y women with low Papp a and a perfectly good sized, healthy baby.