Abstract

Objective: Low values of pregnancy-associated plasma protein-A (PAPP-A) routinely observed during the first trimester testing may be a preliminary indicator of developmental delay. Doppler flow measurements and fetal biometric measurements (FBMs) that would be performed in the second trimester together with low PAPP-A values may be useful in predicting poor pregnancy outcomes.

Methods: The pregnant women were followed until delivery. PAPP-A values measured during the first trimester test of pregnant women participating in the study were recorded. Later on, color pulsed Doppler ultrasound examination of umblical artery was performed on the 20th-24th and 28th-32th weeks of pregnancy.

Results: In the present study, we achieved a sensitivity of 70.6% and a specificity of 48.9% for poor pregnancy outcomes, when the cut-off value for umbilical artery pulsatility index (PI) was 1.135 during the 20th-24th weeks of pregnancy. On the 28th-32nd weeks of pregnancy; when the cut-off value of umbilical artery PI was taken as 0.85, a sensitivity of 82.4% and a specificity of 22.7% were achieved for poor pregnancy outcomes. In the present study, the pregnant women of whom estimated gestational age that was calculated based on ultrasonographic. FBMs performed on the 20th-24th and 28th-32nd weeks of pregnancy was more than 1 week behind the gestational age that was calculated according to the last menstrual period and the pregnant women with head circumference/abdominal circumference (HC/AC) ratio over 1.15 and 1.10 on the 20th-24th and 28th-32nd weeks of pregnancy, respectively were considered as risky group in terms of early-onset fetal growth retardation.The group of risky pregnant women was compared with the other group of pregnant women and significant difference was determined in terms of pregnancy outcomes.

Conclusion: We found that early prediction of unfavorable maternal and fetal outcomes of placental insufficiency might be possible using some test results, such as FBMs or assessment of HC/AC ratio,even though there is no method that can be used alone as a screening test.