Lubainabanu, A (2022) Maternal Serum PAPP-A Levels in Early Pregnancy as a Screening Test for Prediction of Preeclampsia. Masters thesis, Madurai Medical College, Madurai.
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Abstract
The findings of our study demonstrate that the maternal serum PAPP-A concentration at 11 - 14 weeks of gestation in normal pregnancies increased, whereas in preeclamptic women there was slight decrease with the cutoff value of < 1.235 with sensitivity of 90% and specificity of 23.4%. • Consequently, as in the case of Preeclampsia the measured concentration of PAPP-A must be adjusted for these variables before comparing results with pathological pregnancies. • Previous studies comparing PE with controls either have made no corrections for the measured PAPP-A or they corrected only for gestation. • These results are in agreement with most previous studies, which reported reduced serum PAPP-A not only during the clinical phase of the disease but also during the second and first trimesters of pregnancy. • Our study comparing values between patients who developed early PE and late PE was not significant since there was only Nine patient who developed early PE and was difficult to draw conclusion. • In our study there is significant independent contribution from maternal serum PAPP-A which was found to be decreased in screening of PE women compared to normotensive pregnant women. With the AUC showing 0.144 and P value being <0.001 which was statistically significant serum levels of PAPP-A showed significant decrease in pre eclamptic women (0.920) when compared to normal women (1.252). in ROC analysis • In our study we found a higher sensitivity rate (91.9%) and specificity was 95.6% and it will have a limited role in the clinical practise due to low PPV. • In our study showed no single maternal serum biomarker as a satisfactory predictive value of clinical importance in pre eclampsia when investigated in early first trimester; however they are more beneficial when multiple parameters are combined like maternal serum PlGF, PAPP-A and uterine artery Doppler study. • Our study is in agreement with the above study which had 91% predictive value when the parameters like maternal serum PlGF, PAPP-A and uterine artery Doppler study are combined during pregnancy as early as 11-14 weeks of gestation. • The above parameters failed in significant contribution individually in predicting PE at early first trimester which may be due to hetrogenicity and complexity of pre eclampsia syndrome, difficult identification of at risk patients from among low risk population and of defining an enriched population for pre eclampsia study. CONCLUSION: 1. The combined measurement of maternal serum PlGF, PAPP-A concentrations and mean PI of uterine arteries at 11-14 weeks of gestation has very high predictive value for pre-eclampsia in pregnancy when other co-morbidities are excluded. 2. In our study maternal serum PAPP-A levels evaluation at 11-14 weeks of pregnancy alone significantly play role in prediction. 3. However we need more studies on larger variable populations to evaluate the use of these individual parameters in predicting PE. 4. Early prediction of PE could potentially improve the outcome by close surveillance of the patient and would be the basis of the prophylactic medications, starting from the first trimester to improve placental invasion, uteroplacental circulation and so decreasing the prevalence of the disease. multiple parameters are combined like maternal serum PlGF, PAPP-A and uterine artery Doppler study. The above parameters failed in significant contribution individually in predicting PE at early first trimester which may be due to hetrogenicity and complexity of pre eclampsia syndrome, difficult identification of at risk patients from among low risk population and of defining an enriched population for pre eclampsia study.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221916108 |
| Uncontrolled Keywords: | Maternal Serum PAPP-A Levels, Early Pregnancy, Screening Test, Prediction, Preeclampsia. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology > MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 07 May 2021 13:27 |
| Last Modified: | 03 Dec 2023 08:55 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/16082 |
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