DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20184956

Prediction of pre-eclampsia in early pregnancy using PAPP-A and uterine artery pulsatility index

Charu Pratap, Srishti Thakur

Abstract


Background: The aim is to study the role of first trimester pregnancy associated plasma protein A (PAPP A) and second trimester uterine artery pulsatility index (PI) in prediction of pre-eclampsia in early pregnancy.

Methods: This prospective study conducted at GSVM Medical College, Kanpur from May 2011 to May 2012 included 100 pregnant women. Serum PAPP-A level was determined in the first trimester (8-14 weeks) and uterine artery Doppler was done at 20-25 weeks of gestation.

Results: Out of 100 patients 7 developed pre-eclampsia. Mean PAPP-A level in pre eclamptic and normotensive patients were 1.25±1.4 and 2.5±0.5ng/ml respectively. Mean PI level in pre eclamptic and normotensive patients were 1.77±0.28 and 0.96±0.25 respectively. The sensitivity and specificity of PAPP-A at cut off <1.7ng/ml was 71%, 71% respectively. The sensitivity and specificity of pulsatility index at cut off >1.4 was 100% ,94% respectively.

Conclusions: Low level of maternal serum PAPP-A at 8-14weeks and high level of uterine artery PI at 22-25 weeks of pregnancy can predict subsequent development of pre-eclampsia.


Keywords


Early pregnancy, PAPP-A, Pre-eclampsia, Uterine artery pulsatility index

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References


Roberts JM, Cooper DW.Pathogenesis and genetics of preeclampsia. Lancet 2001;357(9249):53-6.

N.A. Bersinger, A.K. Smarason, S. Muttukrishna, N.P. Groome, and C.W. Redman. Women with pre-eclampsia have increased serum levels of pregnancy associated plasma protein A (PAPP-A), inhibin A, activin A and Soluble E-selectin. Hyperten Preg. 2003;22(1):45-55.

Poon LC, Maiz N, Valencia C, Plasencia W, Nicolaides KH. First-trimester maternal serum pregnancy-associated plasma protein-A and pre-eclampsia. Ultrasound Obstet Gynecol.2009;33(1):23-33.

Audibert F, Boucoiran I, An N, Aleksandrov N, Delvin E, Bujold E et al. Screening for preeclampsia using first-trimester serum markers and uterine artery Doppler in nulliparous women. Am J Obstet Gynecol. 2010;203(4):383-e1.

Papageorghiou AT, Yu CK, Erasmus IE, Cuckle HS, Nicolaides KH. Assessment of risk for the development of pre-eclampsia by maternal characteristics and uterine artery Doppler. BJOG. 2005;112(6):703-9.

Pilalis A, Souka AP, Antsaklis P, Daskalakis G, Papantoniou N, Mesogitis S et al.Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler and PAPP-A at 11-14 weeks' gestation.Ultrasound Obstet Gynecol. 2007;29(2):135-40.

Cnossen JS, Morris RK, ter Riet G, Mol BW, van der Post JA, Coomarasamy A et al. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis. Canadian Med Associat J. 2008;178(6):701-11.

Spencer K, Yu CK, Cowans NJ, Otigbah C, Nicolaides KH. Prediction of pregnancy complications by first-trimester maternal serum PAPP-A and free beta-hCG and with second-trimester uterine artery Doppler. Prenat Diagn. 2005;25(10):949-53

Spencer K, Cowans NJ, Chefetz I, Tal J, Meiri H. First‐trimester maternal serum PP‐13, PAPP‐A and second‐trimester uterine artery Doppler pulsatility index as markers of pre‐eclampsia. Ultrasound in Obstetrics and Gynecology. 2007;29(2):128-34.

Odibo AO, Zhong Y, Goetzinger KR, Odibo L, Bick JL, Bower CR et al. First-trimester placental protein 13, PAPP-A, uterine artery Doppler and maternal characteristics in the prediction of pre-eclampsia. Placenta. 2011;32(8):598-602.