Low Papp-A?

may2806

I had the NT scan today - went fine, baby is ok, measuring on track and all measurements look good. But apparently my b/w results were not so good - I have really high HCG and really low Papp-A, which apparently puts me at a high risk for Downs (1 in 81).

 

Apparently this could have some connection to all the bleeding I've been having, because the other issue with the low Papp-A could be because my placenta is not functioning properly or attached well. But also, I guess placenta problems are more common for Downs babies so it's just hard to tell.

 

Next step is CVS or amnio. I can only do the CVS if I haven't had bleeding for a week prior, so I scheduled it but I'm not sure what to do. The m/c rate will be higher because of my bleeding episodes; however if I have to wait for the amnio...I just want to know as soon as possible.

 

I tend to think it's my crazy body not being able to create a good placenta rather than the baby having Downs, but who knows. Has anyone had low Papp-A? Any thoughts on CVS vs amnio?

jonsuz

I had similar but actually worse results from the NT scan. Personally, we chose not to do either test but rather to wait until the anatomy scan-we had one at 16 weeks and one at 18 weeks. It was a scary wait but the risk of miscarriage was higher than we were comfortable with accepting. The scans both looked perfect but if they had caught any real problems we would have gone ahead with the amnio then.

I have heard through colleagues(RN's and nurse midwives) that it is common to have low Papp A with bleeding. It is a very personal choice whether you want to do the invasive testing and whether you are comfortable waiting for the amnio to reduce your risk. I also know the risk of miscarriage varies greatly with CVS depending on the provider. Hopefully you have someone who does them routinely. Good luck in your decision!

justmeardle

I had my NT scan done today & found out I also have low PAPP-A.  The doctor wants me to come in every 4 weeks for growth scans.  My other blood work was fine & they did see the nasal bone.  Sorry I don't have any answers.  I'm interested in hearing what others have to say about this.

barefootbride2008

I had low PAPP-A and low HcG, which meant my risk of Trisomy 13/18 was elevated, not Downs.  I couldn't do the CVS bc my uterus was tipped and they couldn't get to the placenta.  Then I had a bleed (my placenta bled and caused a SCH) before they could do the amnio and the m/c risk seemed too high to proceed with the amnio, so we did the quad screening instead and my numbers came back much better.  I'm still pregnant and almost full term, and everything has looked great since (I've had an u/s every 2 weeks, including growth scans every 4).

As for the amnio v. the CVS, I've heard the CVS is more painful bc the needle is thicker, but probably not much more so.  I would have preferred the CVS personally bc I wanted answers sooner.  The risk of the CVS is slightly higher, but if you go to a very experienced MFM I personally still think it's generally reasonable (not sure where you are in NJ, but I go to Carnegie Imaging in NYC and I think they are wonderful).  That said, if you did end up miscarrying, it's not that you would ever know whether you caused the m/c by having the procedure or if it was the result of there being an inherent problem with the pg, and oddly enough I found that comforting when I decided I wanted to proceed with invasive testing.  I still wish I'd been able to go ahead with the testing - I have some residual fears even now - but obviously in these situations we are all faced with making the best choices we can make in a non-ideal world.  

I think it is worth speaking with a genetic counselor to get a handle on all these risks, if you haven't done so already.  Good luck!     

EllaSmella

I had low Papp-A that was flagged at my NT scan. I was told that it was linked to high blood pressure in the mom and poor growth in the baby due to placenta issues. My son was born at 40w2d at 7lbs 4oz and neither he nor I had any issues that stemmed from the low Papp-A. I did measure behind most of my pregnancy, but he always measured on track via ultrasound. Just wanted to let you know that in and of its self, Papp-A does not necessarily indicate issues, although it sounds like there are other factors at play.