Okay thought I would add my 5 cents from my experience thus far for what its worth. we have a papp-a of .28 and a combined risk due to age etc of a 1 in 2 risk for downs and 1 in 16 for trisomy 18/13 so extremely high risk factors...needless to say many sleepless nights and turmoiled days ensued. We chose to have a CVS done last week and the early FISH result says no downs or trisomy 18/13...so yay for us on that score.

We have since met with our specialist obstetrician today and had a very long chat about all the possible implications of the low papp-a and what we can do to minimise the risk of issues later in the pregnancy. Now our specialist is the Head of Fetal Medicine at Monash Medical Centre so has dealt with these sorts of issues before and she came up with some interesting new research in this area that you may like to ponder.
Basically all this papp-a research has only been around for the last few years so research into the full implications is also quite new and not a lot is available, but what is coming to light is that a combined therapy of clexane (blood thinners) and low dose aspirin can be beneficial in helping to maximise the function of the placenta. After discussing this in great detail we have decided to to go down this track to give our baby the best possible odds.....we will be on 40mg of clexane a day and one low dose aspirin per day.

I feel so much better knowing there is something we can do to give our baby the best possible chance and just thought I'd share what we had learnt today. I think is also why flowerchild is recommending you see a fetal medicine specialist as really a normal obstetrician does not in all honesty have the training, knowledge or experience to deal with such complex issues.

Something she also mentioned which I found quite interesting is that the placenta has two main growths spurts, one has already occurred, one happens from 15-18 weeks and it is vital that you maximise the placenta's potential during these high growth phases to keep it going through the rest of the pregnancy.... that really cemented our decision to go the treatment route especially over the next few weeks of vital placental growth.

All food for thought....hope my experience adds to the discussion in some way.....