Those who had/have low PAPP-A - tell me about your birth/plans

[Levithecat]

My 5yo son was small for gestational age (4lb10 born at 36w). I had low PAPP-A but at the time they had not linked it to low birth weight/prematurity.

I’m now 33 weeks pg wirh no2 and have low PAPP-A again. I’ve had growth scans roughly every 3 weeks since 26 weeks. Baby seems to be growing really well, estimate 75th centile at last scan, and everything else looking good.

The obstetrician is pushing for an induction at latest 39 weeks, but she’s always rushing in clinic (fair enough) and we don’t get a chance to discuss it. I just don’t see the clinical basis for this if he continues to grow well, and can’t find evidence for induction in cases of low PAPP-A.

I’d be really interested to know what has happened to others, or what they’re being recommended? Maybe I’ve missed something? Thanks so much.

I had very low PAPP-A with my first dc - I had a preterm PROM & ended up delivering by emcs at 36 weeks. I also had two second trimester miscarriages which were assumed to be caused by poor placental functional (one IUGR & one abruption).

My other three children were delivered between 37 & 38 weeks by elcs. They were a good weight for gestation (3-3.2kg) & each time the placenta looked healthy. I had regular scans throughout pregnancy (weekly after 30 weeks), doppler scans for placental function and heparin & aspirin right the way through each pregnancy.

I didn't have the PAPP-A levels tested in any of my later pregnancies but my obstetric history is bad enough that it was assumed I had a higher risk of stillbirth, hence the aggressive management.

Low PAPP A is associated with increased risk of the placenta deteriorating and still birth(still a very small risk), that's why they've started to aim for getting the babies out sooner rather than later.

I had it with my last and had a ELCS at 39 weeks and he was 9lb5, no problem with low birth weight.

Thank you both for sharing your stories. I’m so sorry for your losses, Laniakia. I had two (9 and 12 weeks) before this pregnancy.

I wonder whether I can just continue with/increase monitoring, rather than do what feels like a premptive strike. But maybe it’s the risk of stillbirth that’s prompting this approach.

I had low Papp-A with my DC who is now 14 weeks. The plan was always to induce at 38/39 weeks. He’s weight gain began slowing down during the third trimester (which is always the worry with low Papp A). During a routine 34 week scan, consultant decided it was best to induce baby within the week. He was born at 35 weeks weighing 4 pound 11.

I wouldn’t personally see a problem with inducing at 39 weeks as your full term! And I do believe at that point the risks of staying in the womb are greater then coming out.

If you do decide to continue then please have baby monitored constantly. I do not mean to scare you at all but a close friend of mine also had low Papp A. Her baby was measuring well throughout the pregnancy. Then at 38 weeks the doctors could not find a heartbeat. Whatever you do make sure you have a lengthy chat with the doctors.

Maybe it depends on the trust, but I have low Papp-a (0.27) and have been told it's not an indication for induction. I am having the extra scans and at 28 week baby was measuring just on the 10th centile. Next one is Thursday at 32 weeks. But everyone I have spoken to seem to be of the opinion that they will perform the extra checks but no huge cause for concern and certainly no cause for a particular birth plan.

As it is I am in discussions with them for an elcs following a traumatic first birth (She was born 28th centile at 40+10, so I don't produce big babies...), and my biggest fear is being induced.

I’m 30 weeks had a growth scan at 29 weeks and baby was measuring below 10th centile got told I had low Papp-a at 12 weeks. Just spent 5 days in hospital with threatened pre term labour now home and taking it easy. My first child was born at 32 weeks but never found out why. Unsure whether this one will get to term or still try and come early?!

I am being induced at 38/39 weeks but unrelated to the pappa (my baby has a condition that requires medical attention from birth in a hospital far away from my home). Hope all goes well for you!

Thank you, Spydie, Bumpandus and Mamathebest - so interesting to hear others’ experiences.

So my research has currently suggested that induction is not routinely recommended (and def not in any national guidelines) - in one document I found from Hampshire NHS trust is said explicitly that IOL is not necessary unless other indications. So it seems like my obstetrician’s preference. There is an independent association with increased stillbirth risk but it’s very small (not enough to change practice).
It is a hard choice, but I really want to avoid induction. I’d even rather have a section. Next scan is on the 26th, so I’ll go armed with info and see if we can have a proper discussion.

Thanks again, and all the best with your pregnancies and babies.