Desai N, Krantz D, Roman A, Fleischer A, Boulis S, Rochelson B
Division of Maternal-Fetal Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA.
Prenat Diagn. 2014 Feb;34(2):159-62. doi: 10.1002/pd.4277. Epub 2013 Dec 9.
The objective of this article is to determine whether there were differences in first trimester serum analytes between cases of placenta previa with and without accreta.
Cases of placenta previa in which the patient had first trimester aneuploidy screening were identified. Pregnancy-associated plasma protein A (PAPP-A) and free beta human chorionic gonadotropin (fbhCG) MoMs were compared with those with an accreta. Accreta cases were also compared with published distributions to determine significance and to develop likelihood ratios based on MoM values.
Eighty-two cases of previa were identified, including 16 with a histological diagnosis of placenta accreta. The median PAPP-A MoM of 1.68 in accreta was significantly greater than that of 0.98 in non-accreta (P = 0.002). For fbhCG, the median MoM was 1.00 and 1.01 in accreta and non-accreta, respectively. Of the 16 patients with accreta, 14 (87.5%, 95% confidence interval: [61.6%, 98.4%]) had PAPP-A MoM above 1.0. Six of 16 (37.5%) accreta cases were above the 90th percentile of the unaffected distribution. The likelihood ratios for accreta were 0.5, 2.0, and 3.0. PAPP-A MoMs were 0.19, 2.11, and 4.27, respectively.
First trimester PAPP-A levels may be useful in identifying pregnancies at high risk for placenta accreta. Larger studies could incorporate both clinical and biochemical data into a risk algorithm.
本文旨在确定有植入性胎盘和无植入性胎盘的前置胎盘病例在孕早期血清分析物方面是否存在差异。
识别出进行过孕早期非整倍体筛查的前置胎盘病例。将妊娠相关血浆蛋白A（PAPP-A）和游离β人绒毛膜促性腺激素（fbhCG）的中位数倍数（MoM）与有植入性胎盘的病例进行比较。还将植入性胎盘病例与已发表的分布情况进行比较，以确定其显著性，并根据MoM值制定似然比。
共识别出82例前置胎盘病例，其中16例经组织学诊断为植入性胎盘。植入性胎盘组的PAPP-A中位数MoM为1.68，显著高于非植入性胎盘组的0.98（P = 0.002）。对于fbhCG，植入性胎盘组和非植入性胎盘组的中位数MoM分别为1.00和1.01。在16例植入性胎盘患者中，14例（87.5%，95%置信区间：[61.6%，98.4%]）的PAPP-A MoM高于1.0。16例植入性胎盘病例中有6例（37.5%）高于未受影响分布的第90百分位数。植入性胎盘的似然比分别为0.5、2.0和3.0。PAPP-A MoM分别为0.19、2.11和4.27。
孕早期PAPP-A水平可能有助于识别有植入性胎盘高风险的妊娠。更大规模的研究可将临床和生化数据纳入风险算法。
