The value of PAPP-A to the prognosis of obstetrical complications

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PhD thesis (EN)

2008 (EN)
Η σημασία της ΡΑΡΡ-Α στην πρόγνωση των επιπλοκών της εγκυμοσύνης
The value of PAPP-A to the prognosis of obstetrical complications

Παπαδόπουλος, Μιχαήλ Σ.

Η μελέτη αυτή σχεδιάστηκε με σκοπό την εκτίμηση των επιπέδων της PAPP-A και της κινητικής των τιμών της κατά το διάστημα μεταξύ 18η και 28η εβδομάδας της εγκυμοσύνης και την πιθανή συσχέτισή τους με επιπλοκές της εγκυμοσύνης όπως την προεκλαμψία, την υπολειπόμενη ενδομήτρια ανάπτυξη, τον πρόωρο τοκετό και του ενδομήτριο θάνατο. Πρόκειται για προοπτική, τυχαιοποιημένη, συγκριτική μελέτη. Το υλικό της μελέτης αποτέλεσαν 117 έγκυες γυναίκες οι οποίες επισκέφθηκαν τα εξωτερικά ιατρεία της Β' Μαιευτικής-Γυναικολογικής κλινικής του Γ.Ν. "Παπαγεωργίου" κατά το διάστημα μεταξύ 18ης και 28ης εβδομάδας εγκυμοσύνης. Η ηλικία των γυναικών κυμαινόταν από 18 μέχρι 37 έτη(μέση τιμή 28,37 έτη). Η κλινική εξέταση και οι μετρήσεις της PAPP-A γινόταν ανά μήνα. Παρατηρήθηκε αύξηση των επιπέδων της PAPP-A από τις μικρότερες προς τις μεγαλύτερες εβδομάδες μέτρησης. Φάνηκε πως οι χαμηλές τιμές της PAPP-A σχετίζονται με επιπλοκές της εγκυμοσύνης. Βρέθηκε στατιστικά σημαντική σθυσχέτιση μεταξύ επιπέδων PAPP-A και πρόβλεψης πιθανής αυτόματης αποβολής. Δεν βρέθηκε στατιστικά σημαντική συσχέτιση μεταξύ επιπέδων PAPP-A και πρόβλεψης πρόωρου τοκετού, ενδομήτριας βραδύτητας της ανάπτυξης, προεκλαμψίας και ενδομητρίου θανάτου. Η ευαισθησία και η ειδικότητα της PAPP-A για το διάστημα μεταξύ 18ης και 28ης εβδομάδας της εγκυμοσύνης, φαίνεται πως είναι χαμηλές
OBJECTIVE Current bibliographic data support the prognostic value of PAPP-A during the first trimester of pregnancy, concretely 11th to 14th week of gestation. The aim of this study was to evaluate, firstly, a possible correlation between the values of PAPP-A during the 18th to 28th week of gestation, and pregnancy complications, such as preeclampsia, intrauterine growth restriction, premature labour and intrauterine death, and secondly, a continuing sensitivity and specificity of PAPP-A during the second trimester. METHODS Prospective, randomized comparative study carried out in the 1st and 2nd Department of Obstetrics and Gynaecology of the Aristotle University of Thessaloniki, Greece. 117 pregnant women between the 18th and 28th week who, either presented for a routine check in the antenatal clinic, or were inpatient because of a pregnancy complication, such as preeclampsia, intrauterine growth restriction, threatened premature labour, were evaluated. The mean age of women was 28.37 years, median age 29 years (range 18-37 years). The initial examination included a detailed medical and obstetric history, physical examination, body weight, ultrasound evaluation of the fetus, and finally blood sampling for PAPP-A levels. Consequently, women were re-examined every four weeks until the 28th week of pregnancy. Blood pressure, oedema evaluation and PAPP-A levels were performed. RESULTS Mean ΡΑΡΡ-Α levels and PAPP-A distribution increased with advancing gestational age. ΡΑΡΡ-Α levels were increased in women without pregnancy complications up until the 26th week, whereas no significant difference was observed in the 27th to 28th week subgroup. The ln(ΡΑΡΡ-Α) / week of gestation values were lower in women with pregnancy complications. No statistical correlation between PAPP-A values and the prognosis of preeclampsia, intrauterine growth restriction, premature labour and intrauterine death (>24 wks) was observed. A positive correlation between PAPP-A levels, especially during the 18th -20th week, and Large for Gestational Age (LGA) foetuses was observed. Low ΡΑΡΡ-Α values were correlated with increased risk of intrauterine loss before 24 weeks of gestation. We observed a rapid increase of PAPP-A values in women without complications during the initial weeks of the study and a slower increase later, whereas women with pregnancy complications exhibited a steady increase of PAPP-A. CONLUSIONS PAPP-A values during the 18th to 28th week of gestation tend to be lower in women with pregnancy complications. PAPP-A has a low sensitivity and specificity and therefore cannot be used as a prognostic factor of pregnancy complications. Larger studies are needed to confirm our results

PhD Thesis / Διδακτορική Διατριβή

Αυτόματη αποβολή
Υπολειπόμενη ενδομήτρια ανάπτυξη
Placental hormones
Pregnancy proteins
Πρόωρος τοκετός
Εγκυμοσύνη, Πρωτεϊνες της
Πλακουντικές ορμόνες
Εγκυμοσύνη, Επιπλοκές
Ενδομήτριος θάνατος
Pregnancy Assocoated Plasma Protein A
Pregnancy, Complications

Αριστοτέλειο Πανεπιστήμιο Θεσσαλονίκης (EL)
Aristotle University of Thessaloniki (EN)


Αριστοτέλειο Πανεπιστήμιο Θεσσαλονίκης, Σχολή Επιστημών Υγείας, Τμήμα Ιατρικής

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