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Low PAPP-A

(29 Posts)
confusedat23 Fri 05-May-17 14:54:15

Hi I wondered if anyone had any advise relating to low PAPP-A. Mine is 0.31 MOM which is well below the minimum of 0.5 MOM

I am still low risk for Chromosomal Stuff so not worried about that but just really worried about what i have read regarding Preterm Labour and high risk of Still birth.

ADuckNamedSplash Fri 05-May-17 19:56:27

Hi - I'm currently 23 weeks pregnant and was told I had low PAPP-A (0.37) at my 12 week scan. I was quite anxious about it at first, but less so now - my obstetrician (who I'm seeing for other reasons - nothing to do with that) told me that the risks associated with it are similar to the risks associated with smoking. I also read that 9 in 10 pregnancies with low PAPP-A end up being totally normal, i.e. the risks only present themselves 1 in 10 times. Whether there's any truth in that, I don't know, but it seems to align to what the obstetrician said.

As part of my research, I also came across a thread elsewhere on Mumsnet for women who had given birth pre-term as a result of the risks associated with low PAPP-A. Their stories were overwhelmingly positive, which was reassuring in terms of the outcomes if it does happen - though I think I'll still worry about it to some extent at least as far as the 32 week point! But so far, everything seems to be going normally for me in spite of my low level. If I can find the thread again, I'll share the link.

marthastew Fri 05-May-17 20:04:24

I did with DC1. Everything was fine but I had regular scans to keep an eye on his growth. . He is now a strapping 6 yo.

marthastew Fri 05-May-17 20:05:04

And was born at 41+6.

ADuckNamedSplash Fri 05-May-17 20:13:35

Ah, here's the thread I was referring to:

www.mumsnet.com/Talk/premature_birth/1174335-Any-much-needed-advice-from-mums-of-babies-born-early-due-to-placental-insufficiency

Hobbes8 Fri 05-May-17 20:53:45

I had low Papp-a (0.34 I think) and had extra growth scans as a result. My 28 and 32 weeks scans were fine, but at my 36 week scan they weren't happy with the baby's growth or blood flow, so they sent me straight to the regional specialist for another opinion. He recommended I was induced that weekend, and my son was born 2 days later. He was 4lb 11oz and in SCBU for 8 days as his blood sugar was dropping between feeds and they wanted to keep an eye on that. He also had jaundice a couple of days after the birth and needed some treatment with a UV lamp. He was a bit too sleepy to feed (both prematurity and jaundice can make babies sleepier than usual) so he had a nose tube for feeding for a few days too.

So not the easiest start, but basically throughout my pregnancy, birth, and first couple of weeks I felt very looked after and at no point did I feel like my son was in any danger. He needed a bit of help but he was always going to be fine. Once he was discharged he put on weight really quickly. He's almost 6 now and has no ill effects.

confusedat23 Fri 05-May-17 21:13:32

Thanks so much all for your advise!

I'm glad to hear everyone has been really well looked after and that Martha you carried to term... i just panicked because they send a letter showing you its very low but not providing any explanation apart from loads of extra appointments!

I understand baby might be early and the risk is higher the closer to 0.29 MOM you are so thanks for your experience Hobbes as I think my story may end up similar to yours!

Duck it's nice to see a name who i know is going through the same as me! I also have a blood disorder so i am seeing the Obstertrician for this seperately so i'm sure they will be sick of me by the end! Lol

Anyway me and DH have had a very good chat with the baby and told it that it is not allowed to come early lol we might both be going insane grin

Notsure1234 Sat 06-May-17 07:28:55

Have you been told to take baby aspirin? I had low Papp-a and was advised to take it to help placental function and reduce some of the risks

Neverpeelmushrooms Sat 06-May-17 07:38:15

I had low papp-a with my third. My obstetrician told me the same as ADuckNamedSplash's. The (horrible) consultant who I saw later on told me that the risks were greater from dc3 having a different dad than from the low papp-a so I shouldn't worry about that as I had caused a higher risk myself hmm

Dc3 was born ten days late in the end, placental function had been fine at scans so they didn't even want to induce me at term which I had initially been told they would.

confusedat23 Sat 06-May-17 10:08:35

Notsure I have read a lot about people being given baby asprin for it so will ask at Midwife appt on Tuesday

Never I'm not sure what your doctor meant by the dad thing! Did you not want to push for the induction at term anyway?

I guess the main thing is i read there are no NHS guidlines about what to do if there is Low PAPP-A and clearly there are some risks involved so don't want to be palmed off with a it means nothing

PrincipalCelestia Tue 09-May-17 10:37:28

Hi, I'm following this thread as my bloods have flagged up low Papp-a 0.27 with normal hcg 0.64
Considered low risk so trying not to focus on it too much.
Good to see some positive outcomes upthread^^
I am having an extra scan at 23 weeks, an uterine artery Doppler scan, and if it comes back normal I'll be back to normal care, or if abnormal I'll get extra growth scans.
This is my third and never had anything to worry about with the first two! but I'm low risk so trying to keep things in perspective smile

OVO1410 Wed 10-May-17 05:40:26

I had low PAPP-A with DC2 (0.33). Other hormone levels normal and low risk of chromosomal abnormalities. I had a Doppler scan at 22+4 and blood flow was good. Had a growth scan at 32+4 and was told baby was small (under 4lb). Then had another one at 35+4 and was told baby was big (over 6lb). Baby was born at 41 weeks weighing 7lb 5oz - the average weight of a baby at birth! Later discovered I had fairly low PAPP-A with DC1 (0.43) but it was over the threshold (0.40) so I wasn't even aware of it. DC1 was born at 41+2 weighing 6lb 12oz.

confusedat23 Wed 10-May-17 07:49:21

Hey everyone,

Thanks for your replies!

I had my 16 week appointment yesterday with the Consutlant and it did not go particularly well. However that is just in my opinion as I could not ask the questions I wanted to ask as the woman kept shooting me down as it was not the lowest level she had seen before.

What I would suggest to anyone with low PAPP-A is not to get too stressed (Like I have) about the earlier appointments and to wait until 20 week scan. You will be provided with much more information which you can use to make sure you get the care that you want.

It is lovely hearing everyones positive stories on here though, I know I will literally fight tooth and nail if there is anything at my 20 week scan to show that Placenta Fuction is not as good as it should be (unfortuantly I do not have great faith in doctors as I almost died of a blood disorder as well due to being young and overlooked). But there are oodles of positive stories on here and please provide updates as your pregnancies continue! I know I will be updating so that others can find some comfort in this thread smile

DizzyNorthernBird Wed 10-May-17 09:20:33

I had low papp-a.....I've just checked and mine was only 0.15 mom! I had this combined with low b-hcg too, we paid for a private screening and our results were 1 in 1 million chance of baby having any of the trisonomies.

I was just told that the risks were associated to reduced growth and pre term labour, and to take baby aspirin to increase blood flow to the placenta. I've had scans at 28, and 32 weeks so far and baby is bang on target with his growth. I have my 36 week scan next week so I guess this is where I'll find out how he's really getting on as I was told that growth sometimes plateaus at 36 weeks.

Anyway I suppose my point is that, according to the figure given above, my papp-a was very low and my pregnancy is still progressing well at 35 weeks. I hope this reassures anyone reading this with similar concerns!

PrincipalCelestia Wed 10-May-17 14:42:42

Was everyone else with low Papp-a referred to a consultant as a matter of routine? I have been told to just see my midwife at 16 weeks, then have the 20 week anomaly scan and artery Doppler scan at 23...

PrincipalCelestia Wed 10-May-17 14:44:06

Also, I asked one the midwives if this low Papp-a was unusual and she said it's 'not uncommon' so it's slightly reassuring that I'm not completely abnormal!!grin

OVO1410 Wed 10-May-17 15:20:46

I saw my consultant for the first time immediately after my Doppler scan to discuss the results.

confusedat23 Wed 10-May-17 19:02:36

Dizzy although it sounds like you were given little information it's more than I was given!... she very briefly touched on the possibility of delivering early following Scans. I'm so glad everything is going well with your pregnancy so far and i hope it stays on course!

Principal I had a consultant anyway due to a blood disorder so i'm not sure at what point you should be referred... also in regards to what your midwife said I would see that as reassuring. The only thing that troubles me is the major inconsistencies between what advice/information has been given to different people.

Also just to add to that my scans are Growth Scans not doppler ones as my consultant refused to talk about the correlation in low PAPP-A and Placental function. Has anyone had similar?

DizzyNorthernBird Thu 11-May-17 10:03:22

principal I was referred to the consultant but the decision was made that I would remain mw lead unless anything flagged up with the growth scans. So after each scan I see a consultant, as things have been ok so far it's usually just a couple of minutes where they discuss where baby is on the charts and remind me to keep taking my aspirin. (I've also had other issues with low lying placenta and raised blood pressure which they've monitored too but that's a separate issue!)
I first saw the consultant after my 20 week scan. I was told that if everything looks ok at 36 weeks then I'll just see the mw for the remainder of the pregnancy.

DizzyNorthernBird Thu 11-May-17 10:05:27

Oh not sure if the above makes sense lol. So I'm midwife lead and I still see mw for the usual appointments but my care is overseen by the consultant with the short appointment after the scans if that makes sense.

PrincipalCelestia Fri 12-May-17 09:59:27

Ah yes I remembered that my scan is actually being carried out by the consultant rather than a sonographer.

Just can't wait to have it, my anxiety is through the roof even with me trying so hard to remain rational and positive sad I suppose I'm just a natural worrier... oh god, I'm actually turning into my Mother!!!

Bisquick Mon 22-May-17 14:05:16

Does anyone know the likelihood of low PAPP-A recurring? I had low PAPP-A in my first pregnancy, now waiting on blood results from the second to see if it'll recur.

I wish all of you the very best of luck with your pregnancies. Just wanted to share my experience in case it helps. I had a loss at term so please don't read on if you'd rather not. Low PAPP-A appears to be relatively unknown and misunderstood. I had low (<0.4MoM) in my first pregnancy and serial growth scans. The baby was always just above their minimum threshold for consultant referral so they kept classing me as low-risk. I had multiple visits to emergency maternity for reduced movement. At last visit after waters broke, MW didn't communicate clearly to consultant about repeated reduced movement and they missed clear opportunity to intervene and save him. Sadly as labour progressed his heart stopped before anything else could be done.

My consultant said lessons for next time (which may be useful if you're in this situation) is to clearly advocate if your baby is very small and push for continuous monitoring + CS if needed to reduce stress on an already tiny baby. Definitely keep an eye out for movement and more important than ever to go in whenever there is reduced movement so they can check.

Sorry to be a downer - just if this even helps one other person will be worth it I suppose.
flowers

confusedat23 Mon 22-May-17 15:10:16

Thank you so much Bisquick I am so incredibly sorry for your loss flowers

Low PAPP-A is supposedly related to the placenta and it attaching to the womb lining meaning it is on a case by case basis and it would not be expected to repeat itself. However thats not saying it wont.

It is very obvious on this thread and others that everyone seems to be fed different information about Low PAPP-A and the risks. They seem to get played down as it all being scare mongering online... however it is stories like yours that keep me strong enough thinking when I make it to my growth scans with my little boy I will fight tooth and nail to ensure he is delivered as early as they will possibly let me have him.

My consultant is also flippant about the risks... yet another consultant is happy to deliver DSis at 36 weeks if baby is big? It's so silly...

Anyways thank you so much for telling your story and please stay with us throughout your pregnancy!

Bisquick Mon 22-May-17 15:29:19

That's useful to know confusedat23. Will keep my fingers crossed for a healthy result now then.

It's frustrating to see the conflicting info given. The risks were really downplayed for us throughout (except for one suggestion being made at 12 w that I start 75mg aspirin). After exhaustive investigation showed no other issues at all they've now said the it was the PAPP-A that led to it. Although many many women have even lower levels and perfectly healthy babies.

Anyway, we can just be as vocal as we need to be, and hope for the best I suppose. Good luck with your pregnancy!

confusedat23 Thu 07-Sep-17 14:31:59

Hey everyone, I just wanted to provide a mini-update and check how other people have gotten on!

I am currently 33 weeks and so far baby has measured 3 weeks over at the last 2 scans. Hoping they will induce at 40 weeks although my consultant has been absolutely rubbish throughout my whole pregnancy (to the point where she even forgot about my 28 week bloods), so not holding out much hope!

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