Low PAPP-A Results after Nuchal Translucency Scan

I have been reading this thread word for word and reading and sharing with hubbie thank you for all the updates, it gives us some hope.

I am 12 weeks pregnant had my nt scan last week was put back 1 week here are my measurements

nt thickness 1.1mm
hcg 1.590 mom
papp-a 0.282 mom
1 in 140 chance trisomy 21

We decided not to have any extra tests as any risk is to high for us, so we are going into this blind and in faith:pray:

is anyone going through this now?

i will be getting a closer scan for the 18 week scan but im so scared and nervous and have not told family as i dont know what this could mean. What did you say to family did you tell them how did you tell them? My family are all VERY far away and we dont see them so we dont want them to worry too.

Hi Squidipa,

Your results sound simalar to mine. Please be positive although I know this is hard. There seem to be several people who had low PAPP-A and their children did not have Trisomy 21. I did tell my family as I am very close to them and had to get it off my chest, although I feel it did worry them.
All the best for your pregnancy, please feel free to ask any questions.
Emma

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All the best for your pregnancy, please feel free to ask any questions.
Emma

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i emma you might just regret saying that lol

does a low papp-a mean u could miscarry or deliver to early in other words mean loose ya baby?

How is your daughter now was there any long term effects of having a low papp-a? Has this changed your mind in having another baby? if so how and why if ya dont mind me asking.

SQuidipa - generally the problems with low papp-a don't commence until after 20wks and generally after that from about 24wks. Pre-term labour is one of the risk factors but most of the risk is with the baby being small and/or stopping growing and therefore the baby has to be delivered. This is what happened with my DD at 36wks they believed she hadn't grown in 2 weeks so was delivered at 37wks.

Like Emma said feel free to ask any questions.

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Like Emma said feel free to ask any questions.

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Thank you heaps,

with a risk of pre term labor was anyone or could you even be put on bed rest? if so what stage of pregnancy is that bed rest at home?

i should list my previous pregnancy problems hey and current
im anemic
negative blood group
varigous veins on uterus
i have had a ventro suspension and prostierior repair (uterus lifted)
and i get spd i pregnancy
1 vb
3 c sections
i have 4 children and are 29 years old.

Hi,
Like Bridee said, there is a risk of pre-term labour but that didn't present itself for me, thank goodness. Same for me as Bridee, our baby was quite small, 2.7kg so, fingers crossed, that seems to be the only thing that low PAPP-A has affected.:pray:. She loves her food now though and has put on 200grams in 2 weeks.
However, it is a waiting game, they cannot tell how growth is going until later in the pregnancy. Dr Kenneth Trofatter has some articles on the net (google them if you like) about low PAPP-A and the effects it can have on your pregnancy.
As for whether I will have another baby, I would say definately yes, in all hope, the low PAPP-A hasn't meant anything for our baby. The genetic counsellor i saw said that people who had a lot of eggs retreived on IVF (which was us) commonly had low PAPP-A scores. So we will try to fall pregnant naturally next time, hopefully we can avoid that.
All the best, will update you if I can find something more.
Emma

Hello guys

Just wanted to say that I had a low PAPP-A when preg with baby #2, I was 33 at the time, I had a risk of 1 in 270 I think it was.. I had a CVS which showed no chromosomal abnormalities... I went on to deliver a perfect baby at 38 and a half weeks, she was 3.3kg and I had a fabulous, normal pregnancy.

Now I'm 33 weeks with baby number 3 and this time at my nuchal I had a one in 5000 ratio, much better.

Best of luck to you all - it's scary but the outcome will most likely be fine. x x x

It has been great to read this thread and see the positive results!

I'm in a similar situation. Papp-a was around 0.15 MoM and we have since found out that we are also dealing with a single umbilical artery.

I'm just wondering if anyone has had issues with blood flow to the placenta? An ultrasound showed notching, but an OB said that it's probably normal at 15 weeks.

I met with a genetic counselor last week and she assured me that anything they do is a precaution and I should not worry. She said that a low Papp-a could be a flag but in her 19 years she had never seen any real correlation between the low score and major problems. It made me feel a little bit better. I have to go on Tuesday for 16 week blood work which adds to the nuchal for even more accuracy. It is so scary this time. I am so apprehensive to tell people that I'm even pregnant. I go back to work on Tuesday (I'm a teacher) and I don't even want to tell anyone there just in case. It's such a shame that such a happy thing should be so clouded!

Squidipa: A low PAPP-A alerts to placental function which when compromised affects the baby's growth. I have seen this frequently with low PAPP-A - however conversely I have seen babies with no growth issues with a maternal low Papp-A.

It is a waiting game and as another poster accurately said - the problems don't generally present themselves until after 20 weeks.

You do need monitoring and you do need it with a specialist. I would highly recommend you get some assessment at a fetal medicine unit. Knowledge is empowerment! :hug:

Holly,

This is so unusual! Bridee and I both had single umbilical artery's with our babies, and guess what we called them? Holly!! With my pregnancy, there was never any restriction in the blood flow from the placenta through the cord, so we assumed the artery was just larger to make up for the other one.

Emma

Holly - It is a little early to use notching as an alarm bell as it is sometimes just artifact at this early stage.
A single artery happens sometimes with no other problems - sometimes it is due to other issues with the baby (sometimes cardiac). All of this though is an unknown quantity right now.

Right now your litle one is growing and in another month or so a more detailed u/s will give a more accurate picture.

Wishing you lots of support along your journey - remember we are here to support you. :hug:

Holly - as you may have read in previous posts we did have restricted blood flow through the cord at times and then the next week it had corrected itself, this happened around the 28wk mark I think. It was a case of just regular monitoring. My ob said that with these issues (low papp-a and single umbilical artery) problems don't happen quickly so if something was picked up in an ultrasound it would be rechecked in 1-2 wks to see if it had got worse. In my case the repeat scans when issues had been detected, showed the problem had eased.

Just to let you know as well my DD is doing fabulous (could sleep better during the day but that is any baby). She put on a lot of weight early on - going from barely on the growth charts to know being in the 25th%, so in my experience they do catch up in there own time.

Hi Emma, Flowerchild and Bridee,

The similarities between our situations and names is pretty interesting.

The blood flow problem is actually between me and the placenta, not along the cord. Good to know that problems with this don't happen quickly though.

Flowerchild, your response is reassuring that it is too early to see notching as a problem.

The blood flow issue I would suggest it's a bit too early to say that definitively at 15 weeks honey...:hug:

I will be thinking of you on Friday - know we are here holding your hand... :hug:

HollyC wishing you all the best for friday:pray::hug:

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..... :)

Mel I am glad you came & shared your experience - thankyou... :hug:

As you probably know I was on the regime you mentioned but for an autoimmune condition that caused multiple deaths for my unborn babies. I too have read this research and found it interesting. My fetal medicine obstetrician also uses a similar regime on some high risk women.

It makes sense doesn't it? When placental function is not optimal it has to work harder - thinning both the maternal supply and the placental supply (asprin crosses the placenta) aims to make the placental job easier.

Know Mel that the regime you are on is used frequently by high risk women - you will become adept at injecting yourself and your tummy will be battered for a few months - but in the end it will be worth it all!

I just cant reiterate more loudly what Mel said about a specialist. It is imperative. I have had lots of personal and professional experience with this and I have to say this is a time you need the big guns! Some obstetricians are quite unsure about this type of issue and only those very studied in the area are truly helpful (of course some will happily call in the big guns!)...

Good luck Mel - if you need any "pointers" let me know... (scuse the pun :lol:)