China
Africa
Explore chapters and articles related to this topic
Obstetrics: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
The combined test for Down syndrome is a combination of blood tests, maternal age and an ultrasound scan (1). The blood tests performed are pregnancy-associated plasma protein A (PAPP-A) and free beta-human chorionic gonadotrophin (1). The ultrasound determines fetal nuchal translucency, which is a measure of the fluid-filled space at the back of the fetal neck (1). The test is performed between 10 and 14 weeks’ gestation and has a detection rate of 85% for a 5% false positive rate (1).
Cardiac biomarkers in acute coronary syndrome
Published in K Sarat Chandra, AJ Swamy, Acute Coronary Syndromes, 2020
Pregnancy-associated plasma protein (PAPP-A) is a high molecular mass (∼200 kDa) glycoprotein typically measured during pregnancy for screening of Down syndrome. PAPP-A has also been implicated in coronary plaque disruption [36]. It is released during atherosclerotic plaque disruption in a homodimeric active form, uncomplexed with the inhibitor proform of eosinophil major basic protein (proMBP) contrary to the form present during pregnancy. Bayes-Genis et al. found abundant PAPP-A expression in unstable plaques but not in stable plaques from patients who died of sudden cardiac death, mostly in the inflammatory shoulder region. They also described increased PAPP-A concentrations in the serum of patients with both UA and AMI, with PAPP-A levels >10 mIU/L identifying ACS patients with a sensitivity of 89% and a specificity of 81%. Lund J et al. found that PAPP-A plasma levels >2.9 mUI/L were associated with a risk of MI, death, or revascularisation 4.6-fold higher versus PAPP-A plasma levels <2.9 mUI/L. Similar results were obtained by Heeschen et al. They demonstrated the role of PAPP-A as an independent marker of future cardiac events in ACS patients [37–39].
Pregnancy-Related Proteins Detected by Immunochemical or Physicochemical Methods
Published in Gábor N. Than, Hans Bohn, Dénes G. Szabó, Advances in Pregnancy-Related Protein Research, 2020
In addition to PP12 and PP14, several other soluble placental proteins were found to be synthesized or localized in the endometrial/decidual tissue: PP5, a serine protease inhibitor, was shown to occur in menstrual fluid and to be produced by endometrial stromal cells.71,78 PP10 (plasminogen activator inhibitor 2), which is mainly synthesized by the syncytiotrophoblast, was found to occur also in human endometrium and menstrual fluid.98 PAPP-A (pregnancy-associated plasma protein A) was shown to be present in the uterine fluid and to be significantly elevated during the secretory phase of the menstrual cycle as compared to the proliferative phase. This indicates that PAPP-A may be synthesized by the secretory endometrium.22 Other soluble placental proteins which could be localized immunohistochemically in decidual cells are PP16, PP17, PP19, PP20, and PP21.126
The predictive value of maternal serum AFP to PAPP-A or b-hCG ratios in spontaneous preterm birth
Published in Journal of Obstetrics and Gynaecology, 2022
Ebru Celik, Rauf Melekoğlu, Arzu Baygül, Uzeyir Kalkan, Yavuz Şimşek
Preterm birth is related to perinatal morbidity and mortality, mostly occurring in children born before 34 weeks (Saigal and Doyle 2008). It remains a major health problem that needs to be solved. Neonates born early account for approximately 75% of neonatal mortality and up to 50% of all long-term neurological sequelae (McCormick 1985). Therefore, the development of a reliable screening method for spontaneous preterm birth (sPTB) is essential for establishing a relevant management plan. Biochemical markers for screening chromosomal abnormalities have been found to be associated with obstetric complications (Dugoff et al. 2004; Huang et al. 2010). Low pregnancy-associated plasma protein-A (PAPP-A) levels at 11–13 weeks of gestation lead to preterm birth (Spencer et al. 2008). An algorithm in which a composite of serum biochemical markers in the first trimester was linked with maternal characteristics was identified to determine the individual-risk calculation for spontaneous sPTB ≤34 weeks (Beta et al. 2011). However, such a performance test as a screening tool has been found to have a detection rate of 20% and 38% in nulliparous and multiparous women, respectively (Beta et al. 2011).
Effect of adenomyosis on adverse obstetrical outcomes in twin pregnancies achieved with assisted reproductive technology
Published in Journal of Obstetrics and Gynaecology, 2021
Mi Sun Kim, Ji Hyon Jang, Seulgee Park, Eun Hee Ahn, Sang Hee Jung
The criteria for the diagnosis of AD with TVUS included the presence of one or more of the following: (1) globally enlarged uterus; (2) heterogeneous myometrium, seen as irregular myometrial echotexture with either increased or decreased echogenicity; (3) asymmetrical myometrial thickening of the uterine walls, defined as a thicker posterior or anterior uterine wall; (4) hypoechoic striations in the myometrium (parallel shadowing) (Bazot et al. 2001; Exacoustos et al. 2014). Patients with a coexisting uterine myoma (less than 5 cm in largest diameter) or endometriosis were included if they satisfied the above diagnostic criteria for AD. Baseline characteristics including history of miscarriage (<24 weeks of gestation), or preterm delivery (<34 weeks of gestation) and history of loop electrosurgical excision procedure or myomectomy were analysed. Pregnancy-associated plasma protein-A (PAPP-A), human chorionic gonadotropin (hCG), inhibin A, unconjugated oestriol or maternal serum alpha-fetoprotein (MSAFP) levels were measured at the first and second trimester for Down syndrome screening. Nuchal translucency and the cervical length at mid-second trimester were also analysed.
The effects of progesterone treatment on nuchal translucency in women with threatened miscarriage
Published in Journal of Obstetrics and Gynaecology, 2021
Cihan Karadağ, Tevfik Yoldemir, Sinem Demircan, Eray Çalışkan
Nuchal translucency (NT) is a hypoechoic region located between the skin and soft tissues behind the cervical spine. This hypoechoic area is presumed to represent mesenchymal edoema and is frequently associated with distended jugular lymphatics (Haak and Van Vugt 2003; Bekker et al. 2005). NT should be measured when the crown-rump length (CRL) is between 45 and 84 mm, which corresponds to gestational weeks between eleven to fourteen (Malone et al. 2005). Increased NT has been related to higher risk for aneuploidy, structural abnormalities (specifically congenital cardiac abnormalities), developmental and genetic syndromes (Ghi et al. 2001; Mangione et al. 2001; Souka et al. 2001; Tekesin 2020). The first-trimester screening test consists of three markers; namely maternal serum beta human chorionic gonadotropin (beta-hCG), maternal serum pregnancy-associated plasma protein-A (PAPP-A) and NT (Canick and Kellner 1999). These three parameters together with maternal age gives a calculated risk for that individual pregnant woman (Haddow et al. 1998).