low papp a levels

[tholeon]

hi

does anyone else have any experience of this? The rest of the nuchal scan was fine but apparently low papp a by itself raises the risk of all the bad stuff (including stillbirth.) Am currently 21 weeks and the 20 week scan was all good, but have moments of panic about the papp a results. My sister had a stillbirth so I've seen what its like. They have booked me in for extra growth scans, starting at 28 weeks.

How low was the Papp-A? Did they ever find out the reason for your sister's stillbirth? This is likely to make you feel more scared as you are sadly more aware than other pregnant people that things do go wrong with pregnancies.
However your sister's baby loss does not mean it is going to happen to you - unless she has a disorder that runs in the family.

Low PAPP-A can be indicative of later placental problems, but not necessarily. It's great that you are getting growth scans at 28 weeks, but I would also ask for a doppler scan of placental blood flow at 24 weeks as this is when problems can be identified. If they find notches at that point, you will need to be very closely monitored.

Sorry you are having this worry, there are plenty of people around who have had low papp-a and no problems. My consultant told me low papp-a can sometimes just be the result of bleeding in early pregnancy.

I had low Papp-a and was like you concerned about still birth, placenta problems, small baby, etc. My second son was born by planned c-section (unrelated reason) at 39 weeks weighing a very healthy 8lb 6oz (>75th centile) after no further complications.

I can totally understand why you're worried but I asked a senior sonographer about it at a private growth scan (me panicking!) and she said it was very rare for low Papp-a to cause any problems.

Push for growth scans to keep you reassured.

hi both,

thanks so much for the replies. I was 0.28 mom, so pretty low. My sister's stillbirth was due to acute fatty liver of pregnancy, she was also very ill herself and it was touch and go for a while, though she thankfully made a full recovery. It is such a rare condition I don't think they fully understand it, but I don't think there are strong genetic links, and she was fine in her subsequent pregnancy. Pre-eclampsia however does run in our family and I had this (fairly mildly) with my first child (this is my second pregnancy. )As far as I'm aware my papp a score was fine then though.

Combinearvester you sound like you have a lot of expertise - is it from personal experience or professionally? I'll look up doppler scans at 24 weeks so I know what to talk to the docs about at my next appointment. I didn't have any bleeding in early pregnancy so its not that.

Mummytoh thank you so much for the reassuring story.

From personal experience, have had low PAPP-A in one pregnancy.

It's good to know that your sister doesn't have an hereditary clotting disorder, that's what I was thinking of that could I was speculating could be connected to low PAPP-A. Terribly sad for her and glad to hear she has since had a healthy pregnancy.

I was doppler scanned at 20 weeks and 24 weeks in my most recent pregnancy. There is sometimes notching at 20 weeks that doesn't mean anything, if it is still there at 24 weeks they keep a close eye on you, looking for things like IUGR etc. Interesting that you had pre-eclampsia and normal PAPP-A in the first pregnancy.

In a way its good they are keeping a close eye on you - I always think of being high risk as getting me an adequate level of care to be honest, getting more scans instead of the useless measuring bump stuff, getting a doctor with some experience looking after me was very reassuring. I think it is crazy in this country that they don't usually scan you after 20 weeks.

hi,

thanks combinearvester. How was your low papp a pregnancy in the end?

I had an anc appointment yesterday and asked about the doppler scan at 24 weeks, they weren't keen as said that whatever the results of this were it wouldn't change the management: given my history, and the papp a results, they will still need to monitor growth from 28 weeks. I guess a good result at that stage might give me some peace of mind but then a bad one would just make me worry more, so probably no point in pushing it. Must stop Googling all this - it is driving me a bit crazy! I've also started baby aspirin, which I've found out I should have been told to do earlier on.

I had low PAPP-A with my DS. I was told there was a 1 in 5 risk of pre eclampsia/IUGR. I too was offered an extra growth scan at 28 weeks.

The 28 week scan wasn't that bad in terms of size but also at around 28 weeks my blood pressure started to go up and I was transferred to the care of the ante natal blood pressure clinic. I was scanned regularly - femur and abdo measurements started to fall behind head measurements (typical in IUGR). I had to start taking Beta Blockers for my blood pressure and it was decided that it was best to deliver at 35 weeks. I was admitted and given steroid injections to mature his lungs and he was delivered by elcs at 35 weeks exactly weighing 4lb 5oz.

I can't remember the exact figure for the PAPP-A but it was around 0.23 where the normal level is 1.

Oh and he is totally fine now - 19 months, average size - he caught up with his weight really fast and we only had to spend 2 weeks in hospital.

thanks bearcrumble, I'm glad your DS is doing well now x

I had my 20week scan yesterday and the consultant told me me Papp a was low when they did my screening at 12 weeks, everything else is fine and all measurements are spot on so they have booked me in to have a scan at 29 wreaks fm another at 32, I'm obviously worried and the consultant didn't really give me much information on what this means just it needs to be monitored, and reading things on the internet has me very stressed