Low PAPP-A Results after Nuchal Translucency Scan

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

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.

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

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

Janie xxx

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

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... :hug:

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.

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?

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.

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!

:

---

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.

---

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... :hug:

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

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

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

:leap: YIPPPPPEEEEEEEE YEEEEHAW!!!!!!!!!!!! :leap:

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... :hug:

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.

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

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.

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.

Another update from me, had a scan last Wedneday which resulted in some great news - looks like this bub is just small and the low papp-a isn't playing a part as first thought. The amonic fluid levels have returned to normal and the blood flow through the cord is no longer restricted. Bubs had good growth, put on about 200gms and stayed within the 10th% so the Dr was happy to say at this point just a small bub. So she won't need to be delivered at 34wks. We go back in a fortnight to see OB, he will do a scan in his office and in 1 months time I will go for a detailed growth scan again so still being closely monitored but OB is happy with everything at the moment. Now I just need bub to turn head down so we can try for a VBAC.

Bridee,

That is such great news! I'm so glad everything is going according to plan. Keep me updated with news, im sure it will all be smooth sailing from here on in!
Nothing to report from my side, last scan in the doctors office showed its a few days behind size in femur length but nothing to be concerned about by the looks of things. Hopefully SUA and low PAPP-A will mean nothing for us!

Stella'sMum

Hi there

Ive been reading this thread with much interest

I got a call on tues of this week to come in a see the dr. I assumed it would be about the combines tests

Im 33 yo and 1 st child

My scores where as follows
NT 1.1 MOM
Papp-a .44MOM
hcg 2.2MOM

And the sheet says im in the increased risked catergory of 1 in 186

Im rather nervous and have busily been researching what I can on the internet (god bless google)

My Oh wants to have a Amnio done. less risk of miscarriage and I do too, but Im very scared and emotional about it

Ive always been one with realistic goals and ambitions, but im dreaded the fact that if this baby has Downs then we will terminate. Im absolutly petrified and am hoping with all my might that he will be fine

It was an assited pregnancy thru ovulation induction (i have PCOS) so i suppose they also take this into account

It was nice reading those who unfortunatey had lower scores than I have got healthy babies.

I have an appointment with my OB next thrus so from there I will book in to get the amnio done

Has anyone had one of these done before. Can u tell me what u felt etc etc

Im rather nervous, Ive got no idea why, just I hate this waiting

Im currently nearly 14 weeks pregnant

I know I cant do this test for a min of another 2 weeks, but ohh the waiting game

thanks for listening

cheers :pray:

hey..... at my 12 weeks scan for the nuchal translucency the folds on the back of my babys neck showed that i was in a 1:94 chance of bubs having any abnormalities!!!!
i had to undergo amniocentesis at 16 weeks and got the results back 3 weeks later that everything was completly normal!! and that my bub was a girl.. mind u im only 20 yrs old and having an amnio at that age is very risky... but i thought i have to do what i have to do right??? well im glad i made the perfect decision because i would of gone through hell not knowing whether bub had any abnormalities!!!
i say take the chance..........

I had an amnio due to an increased risk of both edwards syndrome and downs syndrome (around 1:200). I was completely petrified of having it done, it was the worst week of my life waiting for the appointment. But I had a great OB doing the amnio, she explained exactly what she was doing, what it would feel like and didn't mind at all that I basically sobbed through the whole thing. I was too much of a chicken to watch the actual amnio being done, but managed to dry my tears up when they were finished to catch a good look at my bubs, who seemed oblivious to all the action going on around her. The only thing I felt was the injection for the local, and some slight pressure when they were doing the amnio. I didnt have any cramping or anything afterwards. I just enjoyed spending the rest of the day on the couch watching my fav DVDs as a reward for a job well done and because you are supposed to rest afterwards. In the end, after the two week wait, our results came back all clear.

Sezza, glad to hear that the amnio went well, it is truly stressful!

Bridee, I went for a growth scan today (I am 23w 1d) which was performed by my OB which was good. The baby is measuring just about on target so size is looking good. He measured the flow in the umbilical artery (SUA), however this was difficult because the baby was moving so much! Anyway he said everything looked okay. Well when i got home I looked at the report and it said that the umbilical artery PI and RI were way below average, but just above the 5th percentile. Do you know what this means? Im worried this means there is some sort of restriction in cord flow? Can you let me know how you found out you had a restriction?

Stella'sMum:pray:

Further update - had a detailed growth scan yesterday and the baby is growing well, still small but consistent growth, we actually shot up to the 18th% from the 15th a fortnight ago. She is still breech and now I have had 3 people tell me she won't turn. Been seeing a Chiro and she said everything is now positioned well there is no reason from her perspective why the baby can't turn, she says the cord must be short or wrapped around the neck preventing her turning, the Dr doing the ultrasound said she won't turn coz of not enough fluid (fluid levels are ok but he said not enough to help her turn) and my OB said last week he didn't think she would turn.

So c-sect is definitely on the cards however, OB now doesn't know when to do it, last week he said 37wks just to play it safe but now since she is doing so well inside he doesn't want to deliver her too early. He normally does c-sec at 39wks but its still a wait and see game. The longer she stays inside the better.

The weight estimate was 2kg which is great, we actually think she is going to be about the same weight as DD1, she was born at 37wks weighing 2.6kg. We also think this is just a small baby and the SUA and low papp-a is playing no part but it better to be closely monitored and be sure than the other options.

Stellasmum - hope everything is still going well for you.

Bridee,
I must say, I breathe a sigh of relief when I read these good emails! So glad she is doing well, 2kg is great. How did your ceasar go last time? I'm just starting to think about the birth now, the way I look at it, the ceasar seems to be pretty much risk free for the baby? What are your thoughts on the matter?
Well my little bub must be growing I suppose, my stomach has ballooned over the past 4 days! She has been lying transverse, but on the weekend I felt this huge movement and she must have gone feet down, but has since moved back to transverse. I cant wait to have the scan next week, fingers very tightly crossed that everything is going well.
Keep me updated on the progress, its getting so close for you now!
Emma

To answer the original Q my mum had a risk of 1:50 with my brother who is here and perfectly healthy and "normal"... Well, as normal as 18 year old boys can be! So although the numbers may be low sometimes they are just that, low numbers and nothing more.

Ryders Mum, it's all very well to say take the chance, but I think these things need to be looked into and research carefully, and Mummy of bub needs to be comlpetely 100% sure of her choice and comfortable with it. At the end of the day it is possible to misscarry a perfectly healthy baby from an amnio, and it's not a "chance" that should be taken lightly.

Stellasmum- c-section isn't risk free for the baby complications can occur but if bub is breech the majority of Dr will do a c-sect. I would prefer to have a natural birth but I think my body has decided breech is the way to go. My c-sect went really well last time I recovered really quickly - the midwives in hosp were insisting on take pain meds when I really didn't need them. So hopefully the same occurs this time. But the major downfall with c-sect is the recovery time, you really aren't meant to do much for 6 wks which is difficult with a baby, particularly when I have another as well. My DH is great and takes at least a month off work to help but with a natural birth the recovery just isn't that long.

Good luck for scan next week, I'll be looking forward to hear how it goes.

Stellas mum - how are you, how did you scan go? Well my news the baby will be arriving on Monday. Had a growth scan yesterday and the results suggest the baby hasn't grown in the 2 weeks since the prior growth scan and signs the placenta isn't functioning as it should, then went for monitoring which we have been doing weeks for the past month and it took 1.5 hours to get her to move around and her heart beat was on the low side so with all this combined it was decided baby needs to be delivered. At one stage it could have been today but thankfully she moved a bit and that was enough for Dr to say Monday is ok. I have to go in on Saturday for further monitoring so hoping that is ok for us to last till Monday.

I did actually make a midnight trip into the hospital last night coz I hadn't felt movements for nearly 12hours, they were so lovely at the hospital. Turns out everything was fine and in fact the monitoring was far better than in the afternoon, the hearbeat had returned to around 150-160 and apparently I was having some 'tighenings'.

So anyway looks like low papp-a has caught up with us, it was only last week we were saying it looks like this is just a small baby but now there seems to be evidence it is the low papp-a that is causing the smallness. The weight estimate is 2kg so hopefully she does surpass this estimate. On Monday I will be 37weeks so technically she will be full term but the size of about a 34weeker. But maturity wise she should be fine.

Hope all is going well for you Stellasmum.

Oh my goodness! When I hadn't heard from you for a while I was starting to think you'd had the baby already! Well, that is exciting, Monday it is! A new addition to the family. 37 weeks is fantastic, I hope I get that far! Make sure you take it easy over the weekend. Is the baby still breech? Will you be having the c-section? I will be thinking of you on Monday, and Im sure everything will go well.
Did the doctor comment on the flow in the artery? Just wondering if that is playing a part. Bloody low PAPP-A, wish that would disappear!
Well my scan last friday went well, growth is on target, still a little behind the 50th percentile, but growth is keeping up. He measured the cord flow for a while, and didn't mention anything was wrong so Im assuming thats ok. Will be seeing him again on Monday for a visit and then on the 16th for another scan. Im really wishing everything keeps going well.

The flow through the cord is at thevery upper end of acceptable which was one of the signs the baby has to come out.

Baby is still very much breech so will be a c-sect.

Really hope you can maintain around the 50th%, this bub has slipped to the 2nd%

Well I'm home from hosp, we have a beautiful baby girl Holly Matilda she weighed 2.4kg which was a pleasant surprise given we thought she was going to be smaller.

Everything at birth went well and she performed wonderfully, however, over the coming days she got weaker and weaker, she just didn't have the energy to feed, so while I am home Holly has remained in special care to working on her feeding. The problem has been her size and Dr say some 37weekers do start well then just start to fall in a heap. We abandom BF (for the moment) because it was taking too much effort but even bottle feeding EBM was taking over an hour to get the required or less into her. So that is when she went into special care.

Anyway she will be fine just needs to the strength to endure feeds but obviously a vicious cycle needs food to gain strength but it is the feeding that makes her so weak, all she does is sleep. It wasn't until day 5 we heard her cry for food before that she just slept and had to be woken for feeds of which she never opened her eyes.

Anyway they think a week in care and she will be ready to come home.

Stellasmum hope everything is going well with you, look forward to continuing hear your story.

I have been anxiously awaiting to hear how things went!

Congratulations! She sounds beautiful! Can't believe her name is Holly - we have pretty much decided to call our daughter that!

2.4kgs sounds like a great weight. I hope she eats well and continues to grow over the next week and beyond.

Did you end up having the cesarean? How are you feeling now?

I am still plugging along, feeling a bit of breathlessness now which I hate! Am glad I'm on the 10 week countdown now.

Keep me updated with how she goes this week. Congratulations again to you and your family.

Emma

Yes I did have c-sect which I am recovering well from still have a little pain but nothing too bad. It is just annoying I can't drive it would make it so much easier if I was able to drive myself to hospital to see Holly.

I can't believe you have decided on Holly as a name, great minds think a like.

I called the hospital this morning and she had a really good night, feeding really well, they are going to let me try breastfeeding her today which I am very excited by. The nurse said she thought she might have turned the corner so hopefully we will have her home within the next couple of days.

I hope the last 10 weeks goes well for you, I know they went really quickly for me but that was largely because it always seemed she might be coming in a few weeks, at one stage she was going to be arriving at around 30wks then 34wks, then 36wks so it always seemed close.

Just letting you know Holly arrived home on Monday. She is doing well with weight gain and at this stage just sleeps and eats. I have to wake her for all her feeds but I'm assured she will wake up to the world in the next couple of weeks. She is acting like a typical 37wk baby that is small.

It must be great to have her home! I'm so glad she is doing well. Maybe a good thing she is sleeping often, so you can recover from the operation too!

Hi bridee,

How is Holly doing? Hope you are all well.

Just an update from my side. I had another ultrasound today to check on the growth. I am 31 weeks now. The baby's head is measuring at 32 weeks and tbe legs and abdomen are measuring small at 29 weeks! What does this mean? I hope they catch up. The doctor wasn't concerned and is not scanning me for another 4 weeks. The cord flow is still good so hopefully that continues. He estimated the weight to be a little over 1.5kg. Did you ever have a discrepancy like this? The head seems to measure in the 80th percentile and the rest measures in the 30th percentile.

Emma

Big Hugs! I went through all this during my pregnancy to dd. As my obstetrician explained it, a low PAPP-A is associated of slow growth but this doesn't always happen. I ended up getting an amnio, and in the counseling prior to the procedure the nurse said some women get a low papp-a for no identifiable reason. Everything ended up being fine and dd was delivered a week early (her choice not mine) weighing in at 2.956kg. Its hard not to worry, but a low papp-a sometimes means nothing.

Stellasmum - We are all doing very well. Holly is putting on some good weight now which is a great relief. I'm now fully breast feeding her - with the help of a nipple shield coz she still won't open her mouth for feeds but the nipple shield means I can get the nipple into her mouth and then she will suck. She is still very sleepy so I'm waking her every 4hrs for feeds - she would just continue to sleep. So at the moment it is all quite cruisey - I feed her put her back in her bassinette where she falls asleep herself and then I don't hear from her until I wake her for the next feed. I'm sure things will change at some point and she will get demanding.

Pleased to hear you are now at 31 wks. From what my OB told me a larger head measurement than the body meant it was a sign the placenta was not functioning as it should. If growth is being restricted in any way the body will direct growth to the brain (very untechnical but something like that, brain gets priority over all other body parts), hence the head being bigger. But if you are not having another scan for 4wks everything else must be looking good. Are you seeing your Dr before 4wks? My Dr sometimes didn't order a scan but I saw him and then if he had concerns would order another scan.

It wasn't until the last week where we had a discrepency with the measurements - generally she was just small all over. She sat at the 10th% most of pregnancy (from 24wks). The last scan she was in the 2nd%.

Hi and thanks for your replies.

Bridee, how is Holly going now? Hope she is feeding well and you are both happy.

I'm having another scan tomorrow so I'm really hoping that the baby has made some good growth. The doctor has bought the scan a week early, only because he is going away for a week in the school holidays. I'll be glad to see her again anyway! I will post an update tomorrow. I looked into the problem of growth restriction that is 'head sparing'. It sounded very familiar to me, but the doctor hasn't mentioned it so I guess i will have to trust him! I'll be 34 weeks on Wednesday so it's certainly getting closer!