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

Abstract

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.