Continuation of my low PAPP-A story

In my last post, I vaguely mentioned that on my 12-week combined test, they found out that I have low PAPP-A. Mind you at that time, I had no idea what it was or what it means for my pregnancy. It was a new medical term/ acronym for me.

But since we were focusing on determining my chances for Downs syndrome, the midwife did not put much emphasis on it. She told us to not worry about it too much as it can signify nothing. There are pregnant women with the same result as mine who had no issues with their pregnancy and delivery.

If there is one thing I have learned so far, that is that every pregnancy is different. So there is no use comparing mine to others. I can only dream and hope for the best but still, a lot of things can happen before, now, and even after. You can only ride your own pregnancy, enjoy the ups, and bravely overcome the downs.

What is PAPP-A?

The first I did after the appointment with the midwife was google PAPP-A. It stands for Pregnancy Associated Plasma Protein- A which is a protein produced by the placenta. It is needed to facilitate the implantation process and to maintain healthy vascularisation of the placenta and the placental bed.

Low levels of PAPP-A may cause placental dysfunction and lead to the following adverse outcomes:

  • Mid-trimester miscarriage,
  • Fetal growth restriction,
  • intrauterine fetal death,
  • Preterm birth,
  • Preeclampsia.

All that information was taken from here. But it is not really hard to find information though because there are a lot of websites and studies that have mentioned PAPP-A. The majority of them, however, point out an unfavorable outcome of the pregnancy.

In short, I did not enjoy reading them. That I had to stop googling about it because it only added to my worry and anxiety.

20-week scan

Fast forward to our 20-week anatomy check scan in the local hospital which we were very excited about. This is when the gender will be checked together with the other organs of the baby. The sonographer first checked the baby’s heartbeat which looked strong, Then she went further with measuring the baby’s head circumference, bones, etc. 

She asked if we wanted her to tell us about the gender of the baby and we told her that we were planning on a gender reveal with a few friends. We also wanted to be surprised. So she wrote the gender on a piece of paper and kept it in an envelope.

After the ultrasound though, she told us to wait in a private room as a midwife will talk to us. We were not really paying much attention to what the problem at the time was. We were more excited about the baby’s gender and how or when to do our gender reveal. 

Small baby

Inside the room, the midwife came with a written report of the scan. She told us that our baby was small, a week or two behind. We were confused at the beginning because everything seems so well during the scan. We saw our baby move and according to the sonographer, all organs seems alright except the spine. Due to the position of the baby, she was not able to get a good look at it so she advised that we come back for another scan at a later date. 

The midwife was very gentle with us as she explained that it can be because we were small babies as well. Or it can be caused by infection or other genetic abnormalities. She offered to have amniocentesis as an option for us if we decide to go with it to rule out genetic problems. 

In addition, as a protocol, she would need to refer me for another scan and consultation with a Fetal Medicine doctor at a bigger hospital in another city. That brought up another wave of worry for us. But we decided to be positive because there is no good in thinking about all the wrong that could happen. 

Anatomy Scan Result- Small baby
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Anatomy Scan Result- Our small baby

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