20 week scan measuring very small, low PAPP-A

[LDoug]

Hello everyone

Just looking for some reassurance really as I've been really upset and worried following my 20 week scan today.

I actually had my 20 week scan on Monday (20+3). The sonographer took lots of measurements and said that she was happy with everything, other than being unable to see the heart and lip clearly enough due to baby's posiiton. The scan report only actually listed one measurement for abdominal circumference which was small but around the 20th centile mark. The report did say though that kidneys, bladder, spine etc were examined and appeared normal - including chest, extremities and nasal bone.

The sonographer booked me in for a rescan today to double check the heart and lip. I arrived today and this was with a different sonographer who commented that 'we have a lot to look at today, it looks like baby wasn't cooperating and you couldn't get much done on Monday', which I thought was strange after what I was told on Monday and that there were only a couple of things left to look at.

Anyway.. I had lots more measurements taken. Again brain stomach kidneys etc all seemed fine but a few things were flagged up and I was told on the report 'globally small measurements with chest and profile concerns', in addition the femur length was measured to be short, well below the fifth centile marker. Which all seemed very different to the scan a few days earlier.

All measurements are either only just on the fifth centile mark or slightly below, with the femur much lower. So all seems very small.

I now have an appointment on Monday with a consultant to rescan and I'm just so worried.

I would add that my PAPP-A is very low (0.15 at my 10 week bloods) so I was warned of potential growth problems and was due growth scans anyway.

The organs all seem to be formed as they should and baby has been very active.

I guess I'm looking for reassurance from anybody that has experienced discrepancies between scans, has experienced very low papp-a and very small measurements during pregnancy and whether there are any positive stories?

Thank you
Lauren

I also forgot to add that I had a NIPT test following a 1 in 78 DS risk, this test came back low risk.

Hi

Hi. I can't offer any specific advice and I didn't face quite as many difficulties. But I did have low Papp-A and measured along the 7th centile until week 37 and the growth dropped off and I had an emergency induction. He was born at 6lb 8! I know this isn't the case for everyone- but positive things can happen.

It's very good they're rescanning you- and keeping an eye on you. Best of luck x

Hi OP.

At 28 weeks I had a scan and they said femur was short. Very short.

she was born healthy and proportionate. If that makes any sense. A little underweight but managed to put the weight on.

I was so worried. I know it’s easier said then done but please try not to worry too much.

friend got told her baby on the small. But baby was born big.

Both my pregnancies had low PAPP-A 0.09. I had fortnightly scans so the doctors could keep an eye on their growth.

My boys were both born on the small size at full term. Both c sections.

Both my husband and I are quite small people, the consultant did say it makes sense for our baby to be small. He wasn't too worried as long as the growth scans showed the baby was growing steadily.

I remember feeling very anxious that first pregnancy too but all thankfully was ok.

@LocoInLockdown thanks that is really helpful. I've not come across many people with PAPP-A levels which were as low as mine so its great to hear a good outcome. Do you remember what centiles your boys measured at around the 20 week mark?

Hi, I have low Papp a too but not sure how low. I found my 20 week scan to be quite inaccurate. We were measuring just under 10th on that, whereas we've been 25th-40th on all the other scans so try not to panic.

Our femur length has also come out consistently smaller (under 10th) than head and body. No one is worried at all about this. Apparently they become more concerned with a smaller abdominal measurement than head as that can be the first to reduce if growth is being restricted.

There is a low Papp a Facebook support group that is fantastic. Lots of positive results and loads of knowledge from others who have been in similar situations. Well worth joining!

My eldest was on the 9th centile throughout. He weighed 6lbs 9oz at almost 42 weeks. He was an emergency csection. He's still small now!

My youngest was 25th centile. He's more average now.

Hopefully at your rescan with the consultant they can provide some reassurance.

Hi

Would you remember how small it was, as Im in similar position and really worried.

Appreciate your response

I've had Papp-A as low as yours too (5 years ago) and the reason was that my placenta wasn't growing (found out after birth only though), had reverse blood flow, and at one point they just kept me in hospital to deliver. the positive outcome was that my son was and is absolutely fine, but he was born on the 0.4th centile and had to be delivered by c-section in week 33. tbh it was really scary to go through because there seems to be something worse new each week but now having been through it, my son has caught up and has no other health problems from it!

Thank you for this reply, I’ve actually had my baby girl now. She arrived 14 weeks early when I was 26 weeks pregnant due to severe pre-eclampsia. I had no symptoms so it was a bit of a shock at a routine midwife appointment where my blood pressure was extremely high, I was sent straight to triage and once they managed to stabilise me I had Darcy by c-section 36 hours later. We are currently on week 9 of our NICU stay, but she is doing well 🤍 Hopefully she will be home by my due date of 9th December. In terms of her measurements all of the nurses comment on how long her legs are! She was born between 0.4 and 2nd centile, and was just a proportionally small baby. We think that the preeclampsia caused the placenta to not work properly which caused the small growth, and could be a result of the low PAPP-A

I can attach a copy of my measurements if this is of any use. Baby arrived very early, but the growth restriction was most likely from preeclampsia and she is proportionally small