title: Low PAPP-A: the impact of ultrasound to evaluate fetal growth.
abstract: OBJECTIVE
  Our objective was to describe utilization and impact of sonographic growth assessment in pregnancies with low pregnancy-associated plasma protein-A (PAPP-A).
  
  
  METHODS
  Singleton pregnancies with PAPP-A ≤5th percentile and no other risk factors for fetal growth restriction from January 2011-June 2013 were included. Antepartum and delivery data were obtained by reviewing medical records. Outcomes of pregnancies referred for sonographic growth assessment were compared with those not referred for ultrasound. Fisher's exact test, chi-square analysis, and Mann-Whitney U were used for statistical comparison.
  
  
  RESULTS
  Two hundred ninety-five patients were included. Of 285 pregnancies reaching the third trimester, 77.5% were referred for ultrasound, with the initial scan at a median gestational age of 28 weeks [26-29]. Referral for growth scans was associated with earlier gestational age at delivery and higher rates of delivery for fetal indications. Those who did not undergo growth scans were more likely to deliver a small for gestational age infant at term, 20.7% versus 35.0% (p = 0.04). There was one third-trimester fetal demise, occurring in a patient who had been undergoing growth scans.
  
  
  CONCLUSIONS
  Growth scans in those with low PAPP-A were associated with delivery at earlier gestational age, with higher rates of delivery for fetal indications and lower rates of small for gestational age newborns at term. No significant differences in neonatal outcomes were observed.
authors.affiliation: Department of Obstetrics and Gynecology, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Armin S
authors.initials: AS
authors.lastname: Razavi
authors.affiliation: Department of Obstetrics and Gynecology, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Chasen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000097:blood* / Q000000981:diagnostic imaging; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D009774:Obstetrics; D010500:Perinatology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D047928:Premature Birth / Q000453:epidemiology*; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data*
chemical_list: D011266:Pregnancy-Associated Plasma Protein-A