Patil Mithil, Panchanadikar T M, Wagh Girija
Bharati Vidyapeeth University Medical College, Pune, India ; Bharati Hospital & Research Centre, Katraj, Pune, 411043 Maharashtra India.
Bharati Vidyapeeth University Medical College, Pune, India.
J Obstet Gynaecol India. 2014 Apr;64(2):116-9. doi: 10.1007/s13224-013-0481-4. Epub 2013 Dec 1.
Abnormalities in maternal serum marker levels and fetal measurements obtained during the first trimester screening can be a marker not only for certain chromosomal disorders and anomalies in the fetus but also for specific pregnancy complications. In particular, low maternal serum pregnancy-associated plasma protein-A (PAPP-A), at 11-13 weeks of gestation, is associated with stillbirth, infant death, intrauterine growth restriction, preterm birth, and pre-eclampsia in chromosomally normal fetuses, while a raised nuchal translucency is associated with specific structural abnormalities and genetic syndromes. We have studied the serum Papp-A level in 560 pregnant patients (11-13 weeks gestation) registered at Bharati Hospital and Research Centre, Pune. All patients undergoing testing were followed till the delivery and their neonatal outcome was also taken into consideration.
Our aim is to study the pregnancy outcome in relation to the variations of Papp-A level in the first trimester of pregnancy.
Every patient visiting the antenatal OPD was counseled for testing of First Trimester Screening to assess fetal well-being. Patients who were registered for delivery at our hospital were taken into the trial. Blood samples were taken at 11-13 weeks of pregnancy and sent to the PerkinElmer lab for analysis. Results were expressed in Multiple of Median and patients having MOM value less than 0.5 were carefully observed till the delivery, and a thorough neonatal examination was done by a pediatrician.
524 patients were included in the trial out of which 452 patients were found to have a normal Papp-A level of >0.5 MOM. All these patients were followed further during the antenatal period where 18 patients developed preterm labor and few patients developed pregnancy-induced hypertension. The obstetric outcome of patients with a normal Papp-A level was fairly uneventful as compared to others with a low Papp-A level.
Though Papp-A level in the first trimester of pregnancy (11-13 weeks) is an important predictor of future obstetric outcome, it has poor positive predictive value. Patients having a Papp-A level less than 0.5 MOM have a high risk for preterm delivery, fetal growth restriction, and stillbirths along with increased incidence of hypertensive disorders of pregnancy. A low Papp-A level is a useful indicator of risk of preterm delivery and future chance of development of pregnancy-induced hypertension.
孕早期筛查时获得的母体血清标志物水平及胎儿测量值异常，不仅可能是胎儿某些染色体疾病和畸形的标志物，也是特定妊娠并发症的标志物。特别是，妊娠11 - 13周时母体血清妊娠相关血浆蛋白A（PAPP - A）水平低，与染色体正常胎儿的死产、婴儿死亡、宫内生长受限、早产和先兆子痫有关，而颈项透明层增厚与特定结构异常和遗传综合征有关。我们研究了在浦那巴拉蒂医院和研究中心登记的560例妊娠患者（妊娠11 - 13周）的血清Papp - A水平。所有接受检测的患者均随访至分娩，并考虑其新生儿结局。
我们的目的是研究妊娠早期Papp - A水平变化与妊娠结局的关系。
对每位到产前门诊就诊的患者进行咨询，建议其进行孕早期筛查以评估胎儿健康状况。在我院登记分娩的患者纳入试验。在妊娠11 - 13周采集血样，送至珀金埃尔默实验室进行分析。结果以中位数倍数表示，MOM值小于0.5的患者在分娩前进行密切观察，由儿科医生进行全面的新生儿检查。
524例患者纳入试验，其中452例患者的Papp - A水平正常，>0.5 MOM。所有这些患者在孕期进一步随访，其中18例患者出现早产，少数患者出现妊娠高血压。与Papp - A水平低的患者相比，Papp - A水平正常患者的产科结局相当平稳。
虽然妊娠早期（11 - 13周）的Papp - A水平是未来产科结局的重要预测指标，但其阳性预测价值较低。Papp - A水平低于0.5 MOM的患者早产、胎儿生长受限和死产风险高，同时妊娠高血压疾病的发生率增加。低Papp - A水平是早产风险及未来发生妊娠高血压可能性的有用指标。
