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First trimester prenatal screening in multiple pregnancies. Part II: serum proteins PAPP-A and β-hCG as markers of adverse pregnancy outcomes

https://doi.org/10.17749/2313-7347.2020.14.1.34-43

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Abstract

Aim: to evaluate the ability of serum biochemical markers in pregnant woman - PAPP-A (pregnancy-associated plasma protein-A) and β-hCG (the в-subunit of human chorionic gonadotropin) studied in the first trimester (11+0-13+6) during combined prenatal screening to predict adverse perinatal outcomes of multiple pregnancy that occurred spontaneously and as a result of in vitro fertilization (IVF).

Materials and methods. The main group consisted from 65 women with pregnancy occurred as a result of IVF; comparison group included 56 women with spontaneous pregnancy. All pregnancies were multiple and their outcomes were known. Serum PAPP-A and β-hCG levels were measured in the first trimester. The results were expressed in absolute values and in MoM (multiples of median). Subgroups were compared with mono- and dichorionic pregnancies, complicated and uncomplicated pregnancies, distributed according to MoM index: within the reference values (0.5-2.0), below or above the reference values.

Results. PAPP-A MoM values in the spontaneous pregnancy group were 1.12 [0.8; 1.57], in the IVF group - 1.35 [1.11; 1.72] (p = 0.01). In subgroup of low PAPP-A MoM antenatal fetal death occurred in 50 %, in subgroup of normal PAPP-A MoM - in 14.58 %, in subgroup of high PAPP-A MoM - in 5.88 % (p = 0.011). In addition, a positive correlation was found between serum PAPP-A level and time of fetal death (rs = 0.564; p = 0.036). Low PAPP-A MoM values were associated with 50 % fetal mortality, 75 % of them were attributable to pregnancy as a result of IVF.

Conclusion. Identification of adverse outcomes in multiple pregnancies is still a difficult task, but evaluation of serum biochemical markers during the first trimester screening can help in early diagnosis of necessity and extent of timely prophylaxis.

About the Authors

V. I. Tsibizova
Almazov National Medical Research Centre, Health Ministry of Russian Federation
Russian Federation

Valentina I. Tsibizova - MD, Departments of Functional and Ultrasound Diagnostics.

2 Akkuratova St., Saint Petersburg 197341



I. E. Govorov
Almazov National Medical Research Centre, Health Ministry of Russian Federation
Russian Federation

Igor E. Govorov - MD, PhD, Obstetrician-Gynecologist, Research Laboratory of Operative Gynecology, Institute of Perinatology and Pediatrics, Scopus Author ID: 57188586021, Researcher ID: P-1257-2015.

2 Akkuratova St., Saint Petersburg 197341



T. M. Pervunina
Almazov National Medical Research Centre, Health Ministry of Russian Federation
Russian Federation

Tatiana М. Pervunina - MD, PhD, Director of the Institute of Perinatology and Pediatrics.

2 Akkuratova St., Saint Petersburg 197341



E. V. Komlichenko
Almazov National Medical Research Centre, Health Ministry of Russian Federation
Russian Federation

Eduard V. Komlichenko - MD, Dr Sci Med, Deputy Director of the Institute of Perinatology and Pediatrics, Researcher ID: N-5315-2015.

2 Akkuratova St., Saint Petersburg 197341



E. K. Kudryashova
Leningrad Regional Clinical Hospital
Russian Federation

Elena K. Kudryashova - Head of the Department of Medical Genetic Counseling, Leningrad Regional CH.

45-49 Lunacharsky Ave., Saint Petersburg 194291



D. V. Blinov
Institute for Preventive and Social Medicine; Lapino Clinical Hospital, GC «Mother and Child»
Russian Federation

Dmitry V. Blinov - MD, PhD, MBA, Head of Medical and Scientific Affairs, IPand SM; Neurologist, Lapino Clinic Hospital, GC Mother and Child, Researcher ID: E-8906-2017. RSCI: 9779-8290.

45-49 Lunacharsky Ave., Saint Petersburg 194291



A. D. Makatsariya
Sechenov University
Russian Federation

Alexander D. Makatsariya - MD, Dr Sci Med, Academician of RAS, Professor, Head of the Department of Obstetrics and Gynecology, Scopus Author ID: 6602363216, Researcher ID: M-5660-2016.

62 St. Zemlyanoi Val, Moscow 109004



G. C. Di Renzo
Sechenov University; Center for Prenatal and Reproductive Medicine, University of Perugia
Italy

Gian Carlo Di Renzo - MD, Professor, Department of Obstetrics and Gynecology, SU; Director of the Center for Prenatal and Reproductive Medicine, University of Perugia,; Honorary Secretary General of the International Federation of Gynecology and Obstetrics (FIGO), Scopus Author ID: 7103191096, Researcher ID: P-3819-2017.

62 St. Zemlyanoi Val, Moscow 109004; Umbria, Perugia, Piazza Italia



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For citation:


Tsibizova V.I., Govorov I.E., Pervunina T.M., Komlichenko E.V., Kudryashova E.K., Blinov D.V., Makatsariya A.D., Di Renzo G.C. First trimester prenatal screening in multiple pregnancies. Part II: serum proteins PAPP-A and β-hCG as markers of adverse pregnancy outcomes. Obstetrics, Gynecology and Reproduction. 2020;14(1):34-43. (In Russ.) https://doi.org/10.17749/2313-7347.2020.14.1.34-43

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