First-trimester maternal serum screening and the risk for fetal distress during labor.
OBJECTIVE
The purpose of this study was to assess whether low pregnancy-associated plasma protein-A (PAPP-A) levels in the first trimester are related to the risk of emergency cesarean section delivery (CS) for fetal distress during labor and fetal intrapartum acidemia.


METHODS
We prospectively studied patients who requested first-trimester biochemical screening for Down syndrome.


RESULTS
Among the 1037 women who were enrolled, 152 women (14.7%) had a low first-trimester PAPP-A value, and 855 women (85.3%) had a normal first-trimester PAPP-A value. Excluding elective CS, 19 of 117 women (16.2%) with low PAPP-A values vs 59 of 749 women (7.9%) with normal PAPP-A values underwent CS for concerning fetal status during labor (P = .003; odds ratio, 2.27; 95% confidence interval, 1.30-3.97). This difference remained significant after correction for possible confounders (hypertension, preterm delivery, small for gestational age, labor induction). Among these 78 women, umbilical artery pH was significantly lower in fetuses from mothers with low vs normal PAPP-A values (pH = 7.19 [range, 6.95-7.39] vs pH = 7.26 [range, 7.02-7.39]; P = .022).


CONCLUSIONS
Low PAPP-A levels at first-trimester screening are associated independently with higher rates of emergency CS for nonreassuring fetal status during labor and lower pH.
Uccella
Stefano
S
Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Piazza Biroldi, 1, Varese, 21100, Italy.stefucc@libero.it.
Colombo
Giacomo Filippo
GF
Bulgheroni
Carlo Maria
CM
Serati
Maurizio
M
Bogani
Giorgio
G
Salvatore
Stefano
S
Ghezzi
Fabio
F
Bolis
Pierfrancesco
P
D000138:Acidosis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D004630:Emergencies; D005260:Female; D005316:Fetal Distress / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007743:Labor, Obstetric; D016015:Logistic Models; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D011261:Pregnancy Trimester, First / Q000097:blood; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D012307:Risk Factors; D055815:Young Adult
D011266:Pregnancy-Associated Plasma Protein-A