Obstetric Outcome in Pregnant Patients with Low Level of Pregnancy-Associated Plasma Protein A in First Trimester

Authors

  • Vesna Livrinova University Clinic for Obstetrics and Gynecology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
  • Igor Petrov Universtity Clinic for Neurology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
  • Igor Samardziski University Clinic for Obstetrics and Gynecology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
  • Viktorija Jovanovska University Clinic for Obstetrics and Gynecology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
  • Slagjana Simeonova-Krstevska University Clinic for Obstetrics and Gynecology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
  • Irena Todorovska University Clinic for Obstetrics and Gynecology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
  • Aleksandra Atanasova-Boshku University Clinic for Obstetrics and Gynecology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
  • Milena Gjorgjievska University Clinic for Obstetrics and Gynecology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje

DOI:

https://doi.org/10.3889/oamjms.2018.238

Keywords:

Factor screening, First trimester, Pregnancy-associated plasma protein A, the Perinatal outcome

Abstract

BACKGROUND: Pregnancy-associated plasma protein A (PAPP-A), is a protease which releases Insulin-like growth factor. The role of this factor is stimulation of cell mitosis, differentiation and trophoblastic invasion of deciduas. Identification of patients with low PAPP-A (under 0.4 MoM in the first trimester has an influence on birth weight, attenuation of fetal growth, preeclampsia, birth and fetal demise.

AIM: The main issue in the study is evaluating an influence of PAPP-A, calculated in the first trimester on the unfavourable outcome of pregnancy.

MATERIAL AND METHODS: Seventy pregnant women with singleton pregnancy underwent first-trimester biochemical screening. The target group were women with PAPP-A below 0.4 MoM, and in control group, PAPP-A were оver 0.4 MoM. There was an assessment of the influence on the mode of delivery, gestational week, the presence of intrauterine growth restriction, preeclampsia, temporary birth, intrauterine fetal demise and newborn condition.

RESULTS: In target group, consisted of 35 patients, 16 were delivered at term. From 28 to 37 g.w.- were 7 patient, 22-28 g.w.- 4 and 8 patients were under the 22 g.w (all with fetal demise) there were 19 pretemporary deliveries - 9 with Cesarean Section (SC). In the target group: 5 newborn wеre with IUGR, 6 women had preeclampsia, 1 had placental abruption. In control group were 35 patients: 28 delivered at term, 9 with SC, 26 vaginal deliveries; with IUGR were 4 newborns. Two newborns were hypertrophic.

CONCLUSION: There is a significant difference in unfavourable outcome in the cases with PAPP-A under 0.4 Mom, particular in the group, with a PAPP-A value under 0.2 MoM. The patients delivered with SC with the main indications in utero hypoxia, growth restriction and elevated blood pressure had PAPP-A between 0.3-0.4 MoM. The patients with intrauterine fetal death and placental abruption in the most of the cases have PAPP-A value under 0.2 MoM. There is a need to be aware in these pregnancies to achieve the preventions of adverse outcome, to decrease perinatal morbidity and mortality.

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References

Nikolaides KH. Nuchal translucensy and other first trimeter sonographic markers of chromosomal abnormalities. Am J Obstet Gynecol. 2004; 191(1):45-67. https://doi.org/10.1016/j.ajog.2004.03.090

Hynhh L, Kingdom J, Akhtar S. Low pregnancy–associated plasma protein A level in the first trimester. Can Fam Physician. 2014; 60:899-903.

Smith GC, Shah I, Crossley JA, Aitken DA, Pell JP, Nelson SM, et al. Pregnancy associated plasma protein A and alpha-fetoprotein and prediction of adverse perinatal outcome. Obstet Gynecol. 2006; 107(1);161-6. https://doi.org/10.1097/01.AOG.0000191302.79560.d8 PMid:16394054

Tornehave D, Chemnitz J, Teisner B, Folkersen J, Westergaard JG. Immunohistochemical demonstration of pregnancy associated plasma protein-A (PAPP-A) in the syncytiotrophoblast of the normal placenta at different gestational ages. Placenta. 1984; 5:427–431. https://doi.org/10.1016/S0143-4004(84)80023-5

Lin TM, Halbert SP, Spellacy WN. Measurment of Pregnancy Associated Plasma proteins during Human Gestation. J Clin Invest. 1974; 53(3):576-582. https://doi.org/10.1172/JCI107794 PMid:4853116 PMCid:PMC301590

Abdel Moety GAF, Almohamady M, Sherif NA, Raslana AN, Mohamed TF, Abd El Moneam HM, Mohy AM, Youssef MAFM. Could first-trimestar assessment of placental functions predict preeclamsia and intrauterine growth restriction? A prospective cohort study. Journal of Maternal-Fetal and Neonatal Medicine. 2015; 29(3):1-5.

Marttala Ј, Peuhkurinen С, Laitinen P, Gissler M, Nieminen P, Ryynanem M. Low maternal PAPP-A is associated with small-for gestational age newborns and stillbirths. Acta Obstet gynecol Scand. 2010; 89(9):1226-8. https://doi.org/10.3109/00016349.2010.493195 PMid:20590503

Hanita O, Roslina O, et al. Maternal level of of PAPP-A as a predictor og pregnancy failure in threatened abortion. Malys J Pathol. 2012; 34(2);145-51. PMid:23424777

Tul N, Pušenjak S, Osredkar J, Spencer K, Novak Ž. Predicting complications of pregnancy with first-trimester maternal serum free-βhCG, PAPP-A and inhibin-A. Prenat Diagn. 2003; 23: 990–996. https://doi.org/10.1002/pd.735 PMid:14663836

Van Ravenswaaij R, Tesselaar-van dervGoot M, Visser GH, et al. Firѕt-trimester serum PAPP-A and fβ-hCG concentration and other maternal characteristics to establish logistic regression based predictive rules for adverse pregnancy outcome. Prenat Diagn. 2011; 31(1):50-7. https://doi.org/10.1002/pd.2610 PMid:20827668

Krantz D, Goetzl L, Simpson JL, Thom E, Zachary J, Hallahan TW, Silver R, Pergament E, Platt LD, Filkins K, et al. Association of extreme first trimester free human chorionic gonadotropin-beta, pregnancy-associated plasma protein A and nuchal translucency with intrauterine growth restriction and other adverse pregnancy outcomes. Am J Obstet Gynecol. 2004; 191:1452–1458. https://doi.org/10.1016/j.ajog.2004.05.068 PMid:15507982

Saruhan Z, Ozekinci M, Simsek M, Mendilicioglu I. Association of first trimester low PAPP-A with adverse pregnancy outcomes. Clin Exp Obstet Gynecol. 2012; 39(2):225-8. PMid:22905470

Policy developed by: SA Maternal & Neonatal Community of Practice Approved SA Health Safety & Quality Strategic Governance Committee on: 19 April 2016 Management of women with a low PAPP-A and normal chromosomes. South Australian Perinatal Practice Guidelines, 2016.

Published

2018-06-06

How to Cite

1.
Livrinova V, Petrov I, Samardziski I, Jovanovska V, Simeonova-Krstevska S, Todorovska I, Atanasova-Boshku A, Gjorgjievska M. Obstetric Outcome in Pregnant Patients with Low Level of Pregnancy-Associated Plasma Protein A in First Trimester. Open Access Maced J Med Sci [Internet]. 2018 Jun. 6 [cited 2021 Dec. 7];6(6):1028-31. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2018.238

Issue

Section

B - Clinical Sciences

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