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Dissertation zugänglich unter
URN: urn:nbn:de:gbv:18-44336
URL: http://ediss.sub.uni-hamburg.de/volltexte/2010/4433/


Uterine Blutflussgeschwindigkeitsmessung und maternale Serum PAPP-A-Bestimmung im ersten Trimenon zur Prädiktion eines gestörten Schwangerschaftsausgangs

Schneider, Eva Katharina

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Freie Schlagwörter (Deutsch): Uterine Dopplersonographie , PAPP-A-Bestimmung , erstes Trimenon , Präeklampsie
Basisklassifikation: 44.11 , 44.92
Institut: Medizin
DDC-Sachgruppe: Medizin, Gesundheit
Dokumentart: Dissertation
Hauptberichter: Hüneke, Bernd (Prof. Dr.)
Sprache: Deutsch
Tag der mündlichen Prüfung: 18.12.2009
Erstellungsjahr: 2009
Publikationsdatum: 21.01.2010
Kurzfassung auf Englisch: First trimester maternal serum PAPP-A and uterine flow velocity waveforms in the prediction
of adverse pregnancy outcome. - Preeclampsia, IUGR and preterm delivery represent main risk factors in today‘s
obstetrics.

This study investigates the early prediction of Preeclampsia (PIH), IUGR and prematurity using
first trimester uterine artery doppler waveform analysis (UAD) and maternal serum PAPP-A
analysis in a group of singleton pregnancies at 10- 16 weeks‘gestation.
A retrospective study was performed on two independent samples of singleton pregnancies
using Brahms Kryptor analysis and color coded doppler flow waveform analysis (GE Voluson
730E). The pregnancies undergoing PAPP-A analysis (n=66) were grouped respectively accor-
ding to normal and pathological birth results (IUGR < 10th centile, prematurity < 38 weeks,
APGAR 5’ < 7, umbilical artery pH < 7.2). PAPP-A levels from pregnancies with pathological
birth results were compared to those with normal birth results using the C hi2 - and Fisher‘s
exact-test. The cutoff level was MoM PAPP-A (10th centile). For the doppler cohort (n =
114) mean Pulsatility- and Resistance-Index of the uterine arteries were calculated using the
system built-in algorithm. The correlation of PI and RI with PIH and pathological birth result
was calculated using logistic regression.
Lower PAPP-A values were associated with pathological birth result, but the PAPP-A levels
within subgroups (normal/pathological birth result) differed without reaching statistical signifi-
cance (p=0.068). This difference reached statistical significance in the subgroup of primaparae
with a sensitivity of 67% (p = 0,01). Results for first trimester UAD did not correlate with
adverse pregnancy outcome.
PAPP-A levels below 10th centile are associated with preterm delivery and IUGR and seemed
to be a stronger first trimester predictor of adverse pregnancy outcome compared to first
trimester UAD.

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