Low Papp-a

[Babbbee]

Have been following threads on low papp-a for a while and genuinely looking for some thoughts / views experiences on this.

Had my combined nuchal scan at 11weeks. Result came back immediately with low papp-a (0.1 MoM) and head (BPD) abnormally large compared to the body (CRL). The head is 95th+ percentile and body 55th percentile. The risk for the trisomies were incredibly high, but NiPT came back low risk.

i’m not sure what to do. I understand i can do amnio to know for sure if the baby has any trisomy but I am concerned that even with those results coming back fine the risk of 2nd trimester miscarriage, still birth and pre term birth are incredibly high. Has anyone been in this situation before?

I have low papp a (0.24 mom) and am now nearly 37 weeks. It's a worrying time but as I understand it research is limited on this and many many people have no issues. I've taken aspirin as directed, had growth scans and so far no issues have come of it. Im planning to birth at home and no one has raised any concerns relating to papp a. How it's been explained to me is that it's a risk factor for growth/placenta issues and pre eclampsia so just need to keep an eye on those things. But if none of those happen then it's not an issue in itself.

Can't comment on the measurements but they can be quite inaccurate at that gestation and I would think you would have been referred to fetal medicine if they were concerned.

Thank you @Chasingbaby2. i’m so happy you’re so far ahead! From what i understand the papp-a is a growth concern during the pregnancy but you’ve already made it there!

the scans i’ve done them privately (twice) I’ve had a very bad experience with NHS in my previous pregnancy and I simply don’t trust them anymore. I’m not a trained doctor but even I could notice the disproportionate head. The consultant told me at best is a very high risk pregnancy and given my age (31) I could consider just trying again. However, i find this an impossible decision to make given it is in such a grey area.

Had lowpapp a baby who turns one next week! My pregnancy became complicated at 30 weeks and between that and emergency section at 37 weeks it was a very stressful time but I was looked after well and baby needed no help when born he was just small. Happy to talk more if you dm me but there ie also a really helpful facebook group you can join full of positive stories

My friend has low Papp an and was very concerned about having a prem baby/ MC etc. she's due tomorrow and hasn't had any complications at all so far xx

Based on the second part of your message it sounds like the consultant was indicating a more serious issue than papp a. Was this NHS or private? Was it explained to you what they suspect is wrong? I've never been through it myself but normally in these situations there are further conversations where the possible conditions, diagnostic pathway and your options are carefully laid out. This really shouldn't be a grey area.

Also was this consultant conversation before or after you had the NIPT results?

Was explained the risks of still birth, miscarriage and pre term are quite high but that at the same time things could potentially go well. (Hence the grey area)

Discussion happened post NIPT with a private consultant

To add my papp-a is actually 0.06 (0.1 only if you round up)..

In your case, I would have an amnio, yes. (I have had one previously following high risk nuchal scan). The amnio will check for a much greater range of things than the nipt.