Low PAPP-A Results after Nuchal Translucency Scan

[Stella'sMum]

Hi,

Last week i had my Nuchal Translucency Scan. The ultrasound showed that the skin fold was within normal limits. Results were as follows:

NT: 1.5
freeBhcg: 1.22 MoM
PAPP-A: 0.25 MoM

The risk for me of Downs Syndrome was 1:153. Yesterday I had CVS and will get the results back today or tomorrow.

My question is: Has anyone had a positive pregnancy outcome after having low PAPP-A scores?

This is an IVF pregnancy, which I have been told, increases the likelihood of having low PAPP-A scores.

I have read a bit about those without chromosomal abnormalities, such as Downs Syndrome, that still have problems throughout the pregnancy with poor fetal growth, and premature birth.

I would really love to hear from anyone who has low PAPP-A and how their pregnancy progressed.

Thanks very much,
Stella'sMum

[LSK]

hi stell,

sorry you are going thru this.... you might want to explain a little more what is low ppp-a?

you might get more responses then.

[Stella'sMum]

Thanks,

PAPP-A is Pregnancy-associated plasma protein A, and when the score is low, it is a marker for Trisomy 21, interuterine growth restriction, premature delivery and basically is a placenta problem. It cannot really be monitored until after 20 weeks to see if the baby is growing sufficiently.

Stella'sMum

[Janie71]

Stellas Mum - I've never heard of this before... just wanted to wish you the best of luck with your pregnancy.

Janie xxx

[Inanna]

Big hugs Stellas Mum... This is a scary time and I do understand...

Your PAPP-A is low - and yes it's an indicator. Just like a temperature is an indicator to pneumonia - but you could just get a cold... KWIM???

The ratio between the PappA and HCG is not too bad.

To put it into perspective. My PAPP-A was 3 times yours and my baby was born at 28 weeks with a shot placenta... It is just an indicator. In the absence of any other indicator the likelihood is good that your baby is healthy.

I wish I could give you a hug in person. I feel your pain - please let us know when your CVS comes thru.

My thoughts and prayers are with you...

[LSK]

ohh okay- have you tried a google seach?? all the best and i really hope you find the anwers on here you are looking for.

[Stella'sMum]

Thanks for your reply Flowerchild.

When you say your PAPP-A was 3 times mine, do you mean 3 times higher or 3 times lower?

[bridee]

Hi Stellas Mum, I certainly know exactly what you are going through as I have recently just gone through the same thing. I'm currently 21 weeks and got very similar results to you at 12 weeks. My results were:

NT: 1.28
freeBHCG: 1.1 MOM
Papp-a: .28MOM

We also elected to have the CSV which came back with everything being good. Given there are no other markers you should be ok as well. My OB has said he has had patients reach 39weeks but other only reaching 28 so it is very individual. I'm having additional growth scans at this stage at 28 and 32 weeks but really all depends of the results.

My 19 week scan showed bubs was growing right on target but OB has said it really isn't until 28 weeks where we can start to tell what might happen as that is when bubs will start to have growth spurts. My 19 weeks did show that bubs has only a single umibilical artery (SUA) (instead of 2), this is linked to kidney problems (but scan showed bubs does have 2 kidneys) and small babies. Given we were already expecting a small baby from the papp-a that is not a big shock. Anyway I don't think the SUA is linked in anyway to the papp-a just lucky (hahah) to get the 2 issues in the one pregnancy.

Anyway can't really help you with the outcome of pregnancy but it is great to hear someone else going through the same thing coz I don't think it is really common.

[Stella'sMum]

Thanks for your reply Bridee. I am so glad to hear your baby is growing well at 19 weeks.
Our doctor said this to us too, that the baby doesn't really start growing independently until about the 20th week, so fingers crossed it keeps growing like a champion for the next 20 weeks!
Please keep me updated on how everything goes. I wish there was something we could do to 'fix' this!

Originally Posted by bridee

Hi Stellas Mum, I certainly know exactly what you are going through as I have recently just gone through the same thing. I'm currently 21 weeks and got very similar results to you at 12 weeks. My results were:

NT: 1.28
freeBHCG: 1.1 MOM
Papp-a: .28MOM

We also elected to have the CSV which came back with everything being good. Given there are no other markers you should be ok as well. My OB has said he has had patients reach 39weeks but other only reaching 28 so it is very individual. I'm having additional growth scans at this stage at 28 and 32 weeks but really all depends of the results.

My 19 week scan showed bubs was growing right on target but OB has said it really isn't until 28 weeks where we can start to tell what might happen as that is when bubs will start to have growth spurts. My 19 weeks did show that bubs has only a single umibilical artery (SUA) (instead of 2), this is linked to kidney problems (but scan showed bubs does have 2 kidneys) and small babies. Given we were already expecting a small baby from the papp-a that is not a big shock. Anyway I don't think the SUA is linked in anyway to the papp-a just lucky (hahah) to get the 2 issues in the one pregnancy.

Anyway can't really help you with the outcome of pregnancy but it is great to hear someone else going through the same thing coz I don't think it is really common.

[Inanna]

You are right Bridee it's not uncommon - especially now since the Nuchal Translucency Test has become a "usual" prenatal test for most women.

My PappA was 3 times greater than yours Stellas Mum. What I am trying to illustrate is that it's an indicator. It's not a diagnosis. Your level could be what it is and you have your baby at +40 weeks! My bby was born early due to my own illness - we just don't know what's around the corner.

In a way these tests are trying to tell us "what may be around the corner".

You will be monitored a little more closely - wishing you all the best my love...

[Stella'sMum]

Hi all,

Sydney genetics rang this afternoon, and thank God, the results were clear of trisomy abnormailities.

Fingers crossed our little baby keeps growing for the next 25 weeks and comes out healthy in every way.

Please keep responding as I will check back often and keep you updated with all the good news (fingers crossed)!

Stella'sMum

[bridee]

Great news Stellasmum. Look forward to sharing our stories over the coming months.

[LSK]

that is so so so great- i cant imagine the relief you'll be feeling!!

all the best for a happy and healthy pregnancy!1

[Inanna]

YIPPPPPEEEEEEEE YEEEEHAW!!!!!!!!!!!!

I am so so happy my love! It's such a relief.

Did you find out if you have a little girl or a little boy on board?

You could join one of our other chat threads to get much needed support. Thankyou for letting us know...

[bridee]

Just an update on what is happening. A month ago at routine OB appointment the scan done at OB office said baby was about 1 week behind in growth. I had a growth scan done today which found the baby has fallen further behind about 2 weeks behind or in the 10th% of gestation, also there is low fluid and blood flow is restricted through the cord. So not a glowing report. The only positive is that it is not conclusive whether the small growth is directly related to the placenta. My DD was only 5lb 14oz (born at 37wks) so I have small babies anyway. The 1 reason why it may not be a placenta issue is babies that have restricted growth due to placenta issues generally have a large head (out of proportion with the body) but my baby is in proportion so this can suggest the placenta is not restricting growth but the cord blood flow is a concern. We also found out the baby is breech (as was my first) but I already suspected that.

So I have another growth scan in 2 weeks to see what changes have occurred. From there there are a few options - steroid injections to help baby along with view of delivering shortly after, further monitoring (OB talked about going in every second day to have monitoring) and just continue on as growth is continuing.

But OB has said once we get to 34 weeks he will deliver baby as the baby will be fine out and it is safer than risking going any further. So it seems I will have a baby within 6 weeks. Oh the things I have to do.

[Stella'sMum]

Hi Bridee,

I had my 19 week ultrasound on Monday which showed I also have single umbilical artery, but everything else looked good and size was on target. I have been a little worried about the prospect of SUA but most stories I have read seem to be positive, so fingers are tightly crossed that things are positive for our babies too.

Thanks for the update. Im hoping and praying that our babies grow healthy and strong. The best of luck to you in your upcoming appointments.

Stella'sMum

[sezza]

My PAPP-A was 0.07 MoM, which I was warned was very low.

Our baby has interuterine growth restriction which was found at the 20 week scan. The specialist believes it was caused by an early placental problem that has since rectified itself. As long as our little girl keeps meeting her expected growth curve from now on, he is hopeful that I will get to term and the baby will be small but otherwise okay.

Unfortunately for us however our baby may also have a heart condition, which will require surgery.

The team of doctors dealing with me say that they will take are better in or out approach and continually weigh up which option is better as I progress. But the interuterine growth restriction specialist has told me he has had cases as bad or worse than my little girl make it to term without any need for early induction.

So heres to hoping we keep meeting growth curve expectations.

[bridee]

Stellasmum - wow our pregnancies appear to be very similar, hopefully your bub grows a bit better than mine seems to be. My OB really didn't see the SUA as being an issue, he said once they know the kidneys are ok it doesn't really matter. But what I didn't ask yesterday was whether the restricted blood flow through the cord was related to SUA or it would be like that regardless. Will have to ask him in 2 weeks time.