Department of Gynecology and Obstetrics, Haseki Training and Research Hospital, Istanbul, Turkey.
Gynecol Obstet Invest. 2010;70(2):126-31. doi: 10.1159/000303260. Epub 2010 Apr 2.
The aim of this study was to assess the correlation between first trimester maternal serum free beta-human chorionic gonadotropin (fBHCG), pregnancy-associated plasma protein A (PAPPA), second-trimester uterine artery (UA) Doppler measurements and adverse pregnancy outcomes.
Serum levels of PAPPA and fBHCG were determined at the first trimester, and patients underwent bilateral UA Doppler assessments at 20-25 weeks of gestation. A serum PAPPA level <0.4 MoM was termed as low and the abnormal Doppler findings were the presence of bilateral notches and RI >0.52 (mean) or unilateral notch and RI >0.66 (90th percentile).
Mean PAPPA level was significantly lower in cases with unilateral or bilateral notches (1.09; 0.79 and 0.80 MoM for 0, 1 and 2 notches, p < 0.001). Fifty-two cases (12.8%) had a low PAPPA level; in this group the incidence of abnormal Doppler was significantly higher (34.6 vs. 18.4%, p = 0.011). In the presence of abnormal Doppler in a case with a low serum PAPPA the risk of pregnancy-induced hypertension (OR = 4.56, p = 0.0067), low birth weight (OR = 6.8, p = 0.0002) and the risk of at least one complication (OR = 7.6, p = 0.00001) were significantly high.
Combination of first- and second-trimester findings might improve the efficiency of screening for pregnancy complications.
本研究旨在评估早孕期母血清游离β-人绒毛膜促性腺激素（fBHCG）、妊娠相关血浆蛋白 A（PAPPA）、中孕期子宫动脉（UA）多普勒测量值与不良妊娠结局之间的相关性。
在早孕期测定 PAPPA 和 fBHCG 血清水平，在 20-25 孕周对患者进行双侧 UA 多普勒评估。PAPPA 血清水平<0.4MoM 称为低水平，异常多普勒表现为双侧切迹和 RI>0.52（平均值）或单侧切迹和 RI>0.66（90 百分位）。
单侧或双侧切迹患者的平均 PAPPA 水平显著降低（0、1 和 2 个切迹的 PAPPA 水平分别为 1.09、0.79 和 0.80MoM，p<0.001）。52 例（12.8%）PAPPA 水平较低，在该组中异常多普勒的发生率显著更高（34.6%与 18.4%，p=0.011）。在低血清 PAPPA 存在异常多普勒的情况下，妊娠高血压（OR=4.56，p=0.0067）、低出生体重（OR=6.8，p=0.0002）和至少一种并发症的风险（OR=7.6，p=0.00001）显著升高。
结合早、中孕期发现可提高妊娠并发症筛查的效率。
