Objectives: The present study aims to evaluate the concentration and distribution of pregnancy-associated plasma protein a (PAPP-A), free ?-HCG and anti-mullerian hormone (AMH) in amniotic fluid, coelomic fluid and maternal serum in the first trimester of pregnancy. Materials and Methods: Coelocentesis was performed in 56 women with singleton pregnancy from 6 to 10 weeks of gestation. The concentrations of PAPP-A and free ?-HCG were measured in the coelomic fluid and maternal serum and additionally AMH was measured in 10 women to which amniocentesis was also performed. Results: The median concentration of PAPP-A in maternal serum was 624.75 mU/I, significantly higher than the concentration in coelomic fluid (median 45.06 mU/I; p < 0.001). There is a significant correlation between the levels of PAPP-A in coelomic fluid and maternal serum (r=-0.6945, n=56, p=0.003). The concentration of maternal serum PAPP-A increased significantly with gestation (r=0.837, n=56, p=0.001). In most of our amniotic fluid samples the concentration of this protein was undetectable. The median concentration of free ?-HCG in maternal serum was 86.35 ng/ml, significantly lower than the concentration in coelomic fluid (median 1535 ng/ml; p <0.001). The levels of free ?-HCG in the coelomic fluid did not vary with gestation. The amniotic fluid concentration (median 24.865 ng/ml) was significantly lower that the one in maternal serum (p=0.005). The median concentration of AMH in maternal serum was 2.54 ng/ml. In coelomic fluid the median levels were 7.55 ng/ml, significantly higher than serum concentration (p=0.006) and amniotic fluid concentration (median 1.25ng/ml, p=0.005). Conclusion: The distribution of AMH in the compartments of the gestational sac in the first trimester may suggest another source of anti-mullerian hormone apart from the ovary during pregnancy. The distribution of PAPP-A is in contrast with the one described in other placental-derived proteins. The levels of free ?-HCG are significantly higher in coelomic fluid than in amniotic fluid and maternal serum and are consistent with its syncytiotrophoblast origin.
Πανεπιστήμιο Ιωαννίνων Σχολή Ιατρικής Τμήμα Ιατρικής Τομέας Χειρουργικός. Κλινική Μαιευτική Γυναικολογική Πανεπιστημιακού Γενικού Νοσοκομείου Ιωαννίνων
University of Ioannina
