Low PAPP-A Results after Nuchal Translucency Scan

[Stella'sMum]

Hi Karen,

What a crappy week you've had! Is this your first baby? Fingers crossed for you that everything goes as planned.
Keep your hopes up, my low papp-a baby is healthy and happy (and quite fat now!) so hopefully it is just a number to you, as it was to us.

Emma

[KarenW]

Hi Emma--yes this is my first at age 33.

[BloominRoses]

Hi all -

Just thought I'd reiterate to those who stumble across this thread the importance of speaking with your care provider about the potential complications of a Low Papp-A score just so you can be prepared.

I too was told I had a low score at my 12 week scan and the only information that I was provided with was that it could be a marker for Downs. At my 20 week scan, conducted by the same Specialist, nothing out of the ordinary was mentioned nor was I told to be potentially concerned about anything.

My son arrived at 32+6, weighing 1.33 kg and I endured the first 2 1/2 hours of my 4 hour labour at home as I had no clue as to what was going since I was unaware of the possibility of my delivering early.

I am lucky, in many ways, that both of us came out of the process relatively okay, but it was through no help from any special precautions or monitoring throughout my pregnancy. Just a sheer miracle I think.

So my advice would be to be arm yourself with as much information as possible and ensure your care provider(s) take you seriously. And are aware of your score - as once it was determined that my son didn't have any discernible genetic abnormalities, the score was never mentioned again.

Not to freak anyone out, but I felt I had to say something in this thread as I would be devastated if anyone went through what I went through because someone in the medical community dropped the ball like they did with me.

S xo

[KarenW]

BloominRoses: How scary! I was referred to a high-risk specialist due to the low papp-a, and he did cover all the other potential risks. Thank you for bringing it up!

[bridee]

Emma - so pleased to here your Holly is doing well. Mine is also doing very well. She's a very active girl, was a continuous roller (1 side of room to the other very quickly) but sitting is now taking preference over that or trying to get her sisters toys (DD1 not too impressed with this new skill). She also has 3 teeth which she has finally decided can be used for good not evil (ie biting me when feeding). I get her weighed next week but she is definitely over 7kg and seems to be long (all her pants are short but fit her around her waist).

Holly is another example of a small birth weight (2.4kg) doesn't mean a small baby in the long run. They all catch up.

I do however, reiterate BlooinRoses post about taking the results seriously. While my OB did take the results seriously I was monitored very closely but if I wasn't who knows what would have happened because towards the end they did think she had stopped growing.

[alexsandra]

hi everyone

bloominroses: thanks for the advice. i am now in my 20th week and have just had my scan. all looked good on the scan (baby size was spot on) and as you said no mention of my initial score.
i may keep this in mind and bring it up with the OB in my next appointments just so it isnt 'forgotten' about.

At your 20 week scan was everything fine? it is a bit concerning that they didnt mention the low results i got at the 12 week scan.

thanks for the advice i will def remember to keep it in mind.

My papp-a was low and risk of downs was 'high risk' for my age group but low risk overall, i hope i have a good outcome like some of you and all goes well.

thanks again for the advice

[kaib]

Hi all,

I've just been reading this thread and wish how I had have come across all this information when I was pregnant with my little girl two years ago. I had a very similar experience to many of you, but only learnt about the real effects of low PAPP-A until it was thrown upon us. We were told at our 12/13 wk nuchal that I had very low PAPP-A, and we were given an overview of the potential complications of having low PAPP-A by the sonographer and specialist. My OB downplayed the low PAPP-A reading when we brought it up with him after the 12/13 wk scan, saying there was only an association and not a causal link between low PAPP-A and growth restriction etc etc. At our 12/13 wk scan, our little girl was measuring exactly to dates, so no alarm bells were ringing at the time. My sister also had similar low PAPP-A in both her pregnancies, and she carried both her girls to past full-term and very healthy weights. At our 19/20 wk scan, we found our little girl had started to slow in growth, but only by a week. It was then again the sonographer/specialist pointed out in their report of the links and risks with low PAPP-A, and its association with growth restriction etc. The sonographer/specialist recommended in their report that I have a growth scan done at 28-30 wks. I had to ask my OB whether he thought it necessary to go for this scan, and again he 'seemed to' downplay the seriousness of it all, recommending we go ahead with a later growth scan to provide us with reassurance. At 28&1/2 wks, I had my first growth scan and it was identified our little girl's growth had slowed down significantly, with her head and limbs ranging from 1-3 weeks behind and her abdominal circumference 3+ wks behind - she was under the 3rd percentile. My amniotic fluid was low and the blood flow through the cord was restricted. I was having regular uterine tightenings around that time too. I was told to give up work overnight, as it was likely I would be delivering our little girl before 32 weeks. I gave up work, was placed on home bed rest, was told to drink gallons of water, and to wait until a further growth scan a week later. The following growth scan showed an improvement in the cord flow, amniotic fluid, and improvement in bub's growth, so I continued in that fashion (having fortnightly growth scans and dopplers) until I reached 37 wks. At 37&1/2 wks our little girl's growth slowed down again, so they decided to arrange for a caeser. I was caesered at 38+4wks, with our little girl being born at 45cm and 2520g. She was placed in special care due to difficulty breathing and having low blood glucose. She was supplementally fed until my milk came in (because of her low blood glucose) and I took her home 4 days after her birth. She is now 17 months old, and weighs 8.84kg (still on 3rd percentile). She has had times of great catch-up growth along the way (getting past the 10th percentile), but then has plateaued again down on the 3rd percentile. She had terrible reflux (which we have only just weaned her off her reflux meds), and has been unable to tolerate cow's milk/dairy after numerous attempts of trying to introduce it into her diet. But other than her being a petite little thing, she is an energizer bunny - full of life, happy and reaching all other milestones. My OB was/is still unconvinced that our little girl had "growth restriction" secondary to low PAPP-A, or whether she was just always going to be a "small baby". However, he has acknowledged that we are at risk of having another growth restricted baby.

We are 12 wks pregnant and a week away from having our nuchal scan. I know a lot more about low PAPP-A now and feel 'ok' about going into the scan even with the history we've got. I am on low dose Aspirin due to my history of early miscarriage (3), and to help improve the blood flow to the placenta. I was interested to read in a recent post about the newest research on PAPP-A and the role of clexane, and will raise this with my OB if my PAPP-A is low this time around. I really hope that for you who are going through the experience of having low PAPP-A for the first time, that you seek out as much information as you can about it. Sometimes having too much information is not a good thing, but the opposite is also true. We were 'aware' of the links but kept on being reassured by well-meaning people "to stop worrying because it will all be ok"; however I don't think burying your head in the sand is the answer either. It did turn out ok for us in the end, but if I didn't have the ability to 'drop everything' by giving up work literally overnight, I don't think the outcome would have been the same.

Again, I have gained a lot from reading through your posts and thank you for being willing to share your experiences with others. I found it difficult finding information on the web on low PAPP-A when I was going through it two years ago, so your thread will be filling a need in this area. I will let you all know how my nuchal goes next week. I would be interested to hear if anybody has experienced more than one pregnancy with low PAPP-A.

Kaib

[BloominRoses]

bloominroses: thanks for the advice. i am now in my 20th week and have just had my scan. all looked good on the scan (baby size was spot on) and as you said no mention of my initial score.
i may keep this in mind and bring it up with the OB in my next appointments just so it isnt 'forgotten' about.

At your 20 week scan was everything fine? it is a bit concerning that they didnt mention the low results i got at the 12 week scan.

At my 20 week scan, the only things that were mentioned was that the Dr/Ultrasound Specialist noticed a teeny white dot on DS' heart and that he was measuring small. She then went on to emphasise though that she wouldn't have mentioned either of these issues in a normal situation but because I was so concerned about the possibility of a genetic abnormality after my Low Papp-A score, she thought it best to tell me since the little dot could have been another marker although the chances were slight.

No mention of my Low Papp-A score or the fact that my baby was measuring small BECAUSE of that. Instead I ended up with a lot of blood loss during my 4 hour labour/birth experience and a son who had to remain in SCN for 6 weeks until he reached 2kgs and could suck feed on his own.

Sorry if I sound a bit bitter/harsh etc... I just found out the link between Low Papp-A and DS' premature birth and low birthweight after 2 other BB members who are much more knowledgeable than me with all of this stuff, explained what my birth report actually meant. There was some really scary, not-so-pleasant stuff on there that could all be traced back to the low score which I won't get into in this thread as it may be disturbing to some so again: Please just ensure that you are comfortable that you are receiving the best preventative care possible throughout your pregnancy and that your care providers take any of your concerns seriously.

S xo

[alexsandra]

bloominroses: thanks for the reply. My OB was the one who mentioned the chance that i will have a low birth weight baby, but again he didnt seem to be concerned about this, it wasnt until i looked this up on BB that i found more people with the same thing all saying that their little ones were born smaller than average.

i am now, after reading the threads, going to ask my OB for a growth scan (as he hasnt mentioned this is something that will be done) and hopefully he takes my concerns seriously and not brush them off. He has been a great OB so far and i have no doubt he will be ok with me going for the scan.
I would rather be prepared and ready for anything that may happen if i have the knowledge up front.

kaib: thank you for your post im sorry to hear about your difficult pregnancy but happy to hear that your little one is doing fine. Your post has encouraged me to get a growth scan done to make sure my little one is growing on track. I just wish Ob's and midwifes were more proactive about things like this and not brush them off.

i will post back to let everyone know how i go with the growth scan

thanks again to all who have posted on this thread

[ozlem]

Thank you all, especially Bridee and StellasMum.

I am now 30 weeks and 4 days pregnant. My papp-a level was 0.30 at the 12th week. In the detailed ultrasonography at the 20th week, I was told that my little girl also had SUA. At that time, her growth was OK though I concerned about her AC which was 1 week behind. At the 24th scan, the AC was almost 2 weeks behind, but FL was 2 weeks ahead and HC is in accordance with the gestational age. At the 28th week, AC fell 2 weeks and 4 days behind, that's why my OB asked me to come every two weeks for US and every week for NST. But, still FL was 2 weeks ahead. At the 30th week, AC fell 3 weeks and 1 days behind! But FL is still 2 weeks ahead and HC is in accordance with the gestational age. My OB says that, the growth is still in acceptable ranges.

Bridee, my little girl is also in breech position as her brother who is 4,5 years old now. It seems that I will have a c-sect, too.

I hope that my little daughter and all our children will be OK.

Cheers

Ozlem

[Emma01]

Hi all,

I am looking for Bridee, I used to be under the name 'Stella's Mum', but I can't remember my password etc, so here I am as Emma01!

Just wanting to see how your little Holly is going? I hope it has all been smooth sailing for you!

Just an update on my Holly's progress, she is now 2 years old.

She is so cute and clever, I am just loving her to bits. Besides that, we found out a few months ago that Holly has congenital scoliosis caused by a misshapen vertebrae in her lower spine. Lots of other investigations were done because heart and kidneys can also have probelms because they are all format the same time, but luckily for her they are both ok. She will likely have surgery to correct the scoliosis as she gets older, but for now, it is not causing her any problems. Anyway, I just wanted to make sure all was good at your end. I am on the congenital scoliosis support group and it turns out that a lot of the children with congenital scoliosis also had a single umbilical artery, which was something I was not aware of in our pregnancy.

Anyway, i hope all is well, just thought i'd touch base with you all again. Other than that, Holly is a smart, healthy and adorable little girl and we have been very blessed.

Emma