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Elevated first trimester PAPP‐A is associated with increased risk of placenta accreta
Author(s) -
Desai N.,
Krantz D.,
Roman A.,
Fleischer A.,
Boulis S.,
Rochelson B.
Publication year - 2014
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.4277
Subject(s) - placenta accreta , medicine , placenta previa , obstetrics , confidence interval , pregnancy , gynecology , placenta , fetus , biology , genetics
Objectives The objective of this article is to determine whether there were differences in first trimester serum analytes between cases of placenta previa with and without accreta. Methods Cases of placenta previa in which the patient had first trimester aneuploidy screening were identified. Pregnancy‐associated plasma protein A (PAPP‐A) and free beta human chorionic gonadotropin (fbhCG) MoMs were compared with those with an accreta. Accreta cases were also compared with published distributions to determine significance and to develop likelihood ratios based on MoM values. Results Eighty‐two cases of previa were identified, including 16 with a histological diagnosis of placenta accreta. The median PAPP‐A MoM of 1.68 in accreta was significantly greater than that of 0.98 in non‐accreta ( P = 0.002). For fbhCG, the median MoM was 1.00 and 1.01 in accreta and non‐accreta, respectively. Of the 16 patients with accreta, 14 (87.5%, 95% confidence interval: [61.6%, 98.4%]) had PAPP‐A MoM above 1.0. Six of 16 (37.5%) accreta cases were above the 90th percentile of the unaffected distribution. The likelihood ratios for accreta were 0.5, 2.0, and 3.0. PAPP‐A MoMs were 0.19, 2.11, and 4.27, respectively. Conclusions First trimester PAPP‐A levels may be useful in identifying pregnancies at high risk for placenta accreta. Larger studies could incorporate both clinical and biochemical data into a risk algorithm. © 2013 John Wiley & Sons, Ltd.