European Journal of Molecular & Clinical Medicine

Introduction: Preeclampsia is a multisystem disorder and is a major contributor of maternal and perinatal morbidity and mortality. Identifying women, who are at risk is important to prompt gestational management. Uterine artery waveform and biomarkers like pregnancy-associated plasma protein-A (PAPP-A) may reflect the pathophysiology of preeclampsia.
Aim: We aim to find out whether abnormal uterine artery pulsatility index (PI) and low serum PAPP-A in the first trimester can be used to predict preeclampsia.
Material And Methods: Antenatal women at 11-13⁺⁶ weeks of gestation visiting Sri Guru Ram Das Universty Of Health And science, Amritsar were enrolled after informed consent. Uterine artery Doppler was done with the early anomaly scan at 11-13⁺⁶ weeks. Serum levels of PAPP-A were analyzed. The women were followed up at intervals up to delivery. Incidence of preeclampsia was noted.
RESULTS: The incidence of preeclampsia was 26%. The mean uterine artery PI among those who developed preeclampsia was 2.03, which was significantly higher than the unaffected group (p=0.001). The first-trimester uterine artery PI as a screening tool showed a sensitivity of 84.67% and specificity of 75.68 % .The mean PAPP-A MoM of the affected group was 0.91 which was lower than the unaffected group (p=0.028). The first trimester PAPP-A as a screening tool showed a sensitivity of 15.38%, specificity of 91.89%.
Conclusion: Both the tests were concluded to be good predictors of preeclampsia. Identification of high-risk factors, screening, and surveillance are  important for timely  prediction of  preeclampsia and initiation of preventive therapy.

Low maternal serum level of pregnancy associated plasma protein A (PAPP-A) is known to be associated with the development of pregnancy-related complications like small for gestational age infants, intrauterine fetal demise, gestational diabetes and pre-eclampsia. Assessing the level of PAPP-A at 11-13 weeks of gestation can be helpful to predict pregnancy complications and fetal distress at the time of delivery, as well as chromosomal disorders like Down syndrome. This was a prospective study, conducted for a period of one year in the Department of Obstetrics and Gynaecology. 93 females with singleton pregnancies were divided into 2 groups based on their first trimester PAPP-A MoM values as <0.5MoM or >0.5MoM. A significant association was seen between PAPP-A levels and mother’s BMI. PAPP-A level in maternal serum in first trimester can indicate fetal distress and other pregnancy complications at the time of delivery, but it has a poor positive predictive value. Hence, further studies are required to confirm its significance to predict pregnancy outcome.