Low PAPPA-A Results?

KaliChick · September 2011

My NT Scan went fine ... the fold looked great and a nasal bone was detected. My risk though is 1:120 for downs. Apparently this is because my PAPP-A is coming back low (how low I'm not sure yet). My OB called me today and said low PAPP-A can be an indicator of placental or growth issues in the 3rd tri. I could be a pretty high candidate for pre-e, IUGR or worse. And it could mean absolutely nothing.

She is scheduling me to see a peri at 28 weeks (I'm wondering if I should push for this to be sooner) and then start growth scans at 34 weeks. Nothing until then as she said these issues don't typically present until 3rd tri.

My a/s is scheduled for 17 weeks, so I think I'll ask them then to check for any abnormalities in the cord, placenta or growth.

Anyone else have this? Any stories you want to share?????

Mrs. Mo · September 2011

My PAPP-A levels came back at 2.5% with the lowest they like to see being 5%. All they did was just moniter me closer once I hit the 3rd Tri ( with a growth u/s) because they were also worried about the placenta failing. Thankfully, it is working as it should & my LO is in the 45th growth percentile ( just about average).

KYRN · September 2011

I would ask for the a/s to be moved from your OB office to the MFM (peri). It won't hurt to establish a relationship early and it's helpful for all your u/s to be in one place, and since they are already planning to refer you it makes sense.

KaliChick · September 2011

KYRN ... we have Kaiser (managed healthcare basically). The A/S is actually done by radiology. If any concerns are shown then I get referred for a Level II. The results are all available to both the peri and the OB. The peri is actually in the same location as my OB. So I'm not so worried about that part.

A peri actually did my NT scan, but I didn't care for him so I'm hoping I get someone different or will request someone different.

Thanks!

And Mrs. Mo ... thanks for the info!! That makes me feel better!!

bbakersgirl75 · September 2011

My Papp-A levels came back low as well. My perinatologists recommendation was to do a second level u/s for the anatomy scan between 18-20 weeks (I had it at 19 weeks). The peri was in the anatomy scan and said everything is looking well (even measuring a little ahead) so he didn't need to see more for another 6 weeks. Originally I was told I would go over 4 weeks from 19 weeks on, then once a week from the 32nd week for scans.

I don't have a lot of advice, as I'm not horribly far along, but good luck hun!

I was told that most of the time IVF patients give a false positive for low papp-a.

DonsWife · September 2011

I mostly lurk and cheer on "itsbabytime", but wanted to share my experience. During my 1st trimester screening, the measurements were fine as well as my HCG, but I was given a 1:50 chance of DS due to an extremely low PAPPA-A. I want to say it was maybe 1%. I opted for an amnio because MH and I figured if our baby had DS, I wanted the best care once it was born. Amnio came back normal. I spoke with my OB about the results and she said the test is so new and not very reliable. Also, the ratio is based off of all results as well as your age, race, and weight. Well it didn't help that I was pushing 35 and a little overweight.

I did not have any issues with my placenta and I delivered a healthy baby boy. I read somewhere that a low PAPPA-A can sometimes indicate a boy (not sure how true this is) I hope everything works out for you. GL!

lyse2143 · September 2011

No advice, just wanted to say that I hope its nothing!

tosh24 · September 2011

I also had a low PAPP-A score.

I was sent for a doppler of the placenta and umbilical cord between 22 and 24 weeks. Everything mostly came back fine, with the flow being a little low on one side, but nothing they are really worried about.

My OB is sending me for growth ultrasounds and NSTs starting at 34 weeks to be on the safe side.

They can't really do anything for you until you're into 3rd tri, so I don't think you'll be able to "push" for much until then. They just can't get the info they need until you're farther along.

Depending on what your score actually was, I may ask for a consult with the peri just to be prepared and to meet him/her in case you need his/her services later.

KaliChick · September 2011

Thanks, ladies. I just got my score it's .34 MoM. So it's low but it's not on the lowest end (although not far off).

I will meet with the peri at 28 weeks. I asked my OB about it and she says they are one of the only practices in the region even following the guidelines because this is so new and the connection is still being researched. So I guess I feel like at least they are being proactive.

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