Uccella Stefano, Colombo Giacomo Filippo, Bulgheroni Carlo Maria, Serati Maurizio, Bogani Giorgio, Salvatore Stefano, Ghezzi Fabio, Bolis Pierfrancesco
Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Piazza Biroldi, 1, Varese, 21100,
Am J Obstet Gynecol. 2009 Aug;201(2):166.e1-6. doi: 10.1016/j.ajog.2009.05.009.
The purpose of this study was to assess whether low pregnancy-associated plasma protein-A (PAPP-A) levels in the first trimester are related to the risk of emergency cesarean section delivery (CS) for fetal distress during labor and fetal intrapartum acidemia.
We prospectively studied patients who requested first-trimester biochemical screening for Down syndrome.
Among the 1037 women who were enrolled, 152 women (14.7%) had a low first-trimester PAPP-A value, and 855 women (85.3%) had a normal first-trimester PAPP-A value. Excluding elective CS, 19 of 117 women (16.2%) with low PAPP-A values vs 59 of 749 women (7.9%) with normal PAPP-A values underwent CS for concerning fetal status during labor (P = .003; odds ratio, 2.27; 95% confidence interval, 1.30-3.97). This difference remained significant after correction for possible confounders (hypertension, preterm delivery, small for gestational age, labor induction). Among these 78 women, umbilical artery pH was significantly lower in fetuses from mothers with low vs normal PAPP-A values (pH = 7.19 [range, 6.95-7.39] vs pH = 7.26 [range, 7.02-7.39]; P = .022).
Low PAPP-A levels at first-trimester screening are associated independently with higher rates of emergency CS for nonreassuring fetal status during labor and lower pH.
本研究旨在评估孕早期妊娠相关血浆蛋白-A（PAPP-A）水平低是否与分娩期因胎儿窘迫行急诊剖宫产及胎儿产时酸血症的风险相关。
我们对要求进行孕早期唐氏综合征生化筛查的患者进行了前瞻性研究。
在纳入的1037名女性中，152名女性（14.7%）孕早期PAPP-A值低，855名女性（85.3%）孕早期PAPP-A值正常。排除选择性剖宫产，117名PAPP-A值低的女性中有19名（16.2%）因分娩时胎儿状况不佳行剖宫产，而749名PAPP-A值正常的女性中有59名（7.9%）因同样原因行剖宫产（P = 0.003；比值比，2.27；95%置信区间，1.30 - 3.97）。在对可能的混杂因素（高血压、早产、小于胎龄、引产）进行校正后，这种差异仍然显著。在这78名女性中，PAPP-A值低的母亲所生胎儿的脐动脉pH值显著低于PAPP-A值正常的母亲所生胎儿（pH = 7.19[范围，6.95 - 7.39] vs pH = 7.26[范围，7.02 - 7.39]；P = 0.022）。
孕早期筛查时PAPP-A水平低与分娩期因胎儿状况不佳行急诊剖宫产的较高发生率及较低pH值独立相关。
