Role of pregnancy associated plasma protein-A and doppler velocimetry in the assessment of fetomaternal outcome in high risk pregnancy

Asmita Kaundal, Usha Gupta, Jayashree Bhattcharjee


Background: The study aimed at defining the role of Pregnancy associated plasma protein-A (PAPP-A) and uterine artery doppler (Ut.A.PI) in the development of adverse pregnancy outcome (APO) in high risk pregnancies.

Methods: This was an observational study where 100 singleton pregnancies at high risk of development of APO, between 11 to 13 + 6 weeks POG were enrolled. PAPP-A levels were measured at 11 to 13 + 6 weeks POG and uterine artery doppler PI was measured at 20 weeks. Women were followed till delivery. Pregnancy outcome were seen and a cut off at which APO developed was derived.

Results: In this study women with lower mean PAPP-A (0.75±0.19 MOM versus 1.23±0.31MOM) (p<0.001) values and higher Ut.A.PI (1.43±0.35MOM versus 0.99±0.25MOM) (p<0.001) developed APO. Cut off value for PAPP-A and Ut.A.PI was determined and was found to be ≤11.65 µg/ml (≤0.79MoM) and   >1.42 (>1.19MoM) respectively which was higher than what is determined in other studies done on low risks populations thereby suggesting for an intervention or more meticulous observations at a higher cut offs.

Conclusions: PAPP-A and uterine artery doppler are already being used for the screening of preeclampsia in most of the countries but not for other adverse pregnancy outcomes. PAPP-A levels along with the uterine artery PI in predicting APO in high risk women has high negative predictive value. Hence can be uses as a screening method in high risk population whether they should be used for low risk population also needs further evaluation.


Adverse pregnancy outcome, High risk pregnancy, PAPP-A, Uterine artery PI

Full Text:



Hajo IJ. Wildschut, Constitutional and environmental factors leading to a high-risk pregnancy. Chapter 1 in David K. James book of high risk pregnancy: management options, Saunders company 3rd edition, page no.11.

Sciscione AC, Hayes EJ. Uterine artery Doppler flow studies in obstetric practice. A Journal of Obst and Gynecol. 2009;121-5.

Mcleod L. How useful is uterine artery Doppler ultrasonography in predicting pre-eclampsia and intrauterine growth restriction? CMAJ. 2008;178(6):727-9

Irwin JC, Suen L-F, Martina NA, Mark SP and Guidice LC. Role of the IGF system in the trophoblast invasion and pre-eclamsia. Human Reproduction. 1999;14(2):90-6.

Fialova L, Malbohan IM. Pregnancy-associated plasma protein A (PAPP-A): theoretical and clinical aspects. BratislLekListy. 2002;103(6):194-205.

Pilalis A, Souka AP, Antsaklis P, Daskalaki 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 wks’ gestation. Ultrasound Obstet Gynecol. 2007;29:135-40.

Spencer K, Cowans NJ, Chefetz I, Tal J and Meiri H. First-trimester maternal serum PP-13,PAPP-A and second-trimester uterine artery Doppler pulsatility index as markers of preeclampsia. Ultrasound and Gyanecol. 2007;29:128-34.

Aardema MW, Saro MCS, Lander M, De Wolf BTHM, Oosterhof H and Aarnoudse JG. Second trimester Doppler ultrasound screening of the uterine arteries differentiates between subsequent normal and poor outcomes of hypertensive pregnancy: two different pathophysiological entities? Clinical Science. 2004;106:377-82.

Poon LCY, Stratieva V, Piras S, Piri S and Nicolaides KH. Hypertensive disorders in pregnancy: combined screening by uterine artery Doppler, blood pressures and serum PAPP-A at 11-13 weeks. Prenatal Diagnosis. 2010;30:216-23.

Albaiges G, Missflder-Lobos H, Lees C, Parra M and Nicolaides. One Stage Screening for Pregnancy Complications by Color Doppler Assessment of the Uterine Arteries at 23 Weeks’ Gestation. Obstet and Gynecol. 2000;96:559-64.

Albaiges G, Missfelder-Lobos H, Parra M, Lees C, Cooper D and Nicolaides KH. Comparison of color Doppler uterine artery indices in a population at high risk for adverse outcome at 24 weeks’ gestation. Ultrasound Obstet Gynecol. 2003;21:170-3.

Lees C, Parra M, Missfelder-Lobos H, Morgans A, Fletcher O and Nicolaides KH. Individualized Risk Assessment for Adverse Pregnancy Outcome by Uterine Artery Doppler at 23 Weeks. Obst and Gynecol. 2001;98(3):369-73.

Yu CK, Khouri, O, Onwudiwe N. Spilliopoulos Y and Nicolaides KH. Prediction of the preeclampsia by uterine artery Doppler imaging: relationship to the gestational age at delivery and small for gestational age. Ultrasound Obstet gyanecol. 2008;31:310-3.

Spencer K, Cowans NJ, Nicolaides KH. Low levels of maternal serum PAPP-A in the first trimester and the risk of pre-eclampsia. Prenatal Diagnosis. 2008;28:7-10.

Kumar M, Sharma K, Singh R, Singh S. Role of maternal factors, PAPP-A and Doppler in screening for early-and late-onset pregnancy hypertension in Asian population. Hypertension in pregnancy. 2016;35(3):382-93.