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Dr.M.D.Mazumdar
Dr.M.D.Mazumdar, Doctor
Category: OB GYN
Satisfied Customers: 8656
Experience:  MD (Obst&Gynecology)
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I am 42 years old and pregnant with my 4th child (my date of

Customer Question

I am 42 years old and pregnant with my 4th child (my date of birth is 6th of November 1967) and I live in Perth, Australia.

My LMP was the 4/4/2010, I have a 23 day regular cycle and from many ovulation predictor kits I have used in the past I usually ovulate on day 11 or 12 of my cycle as I get positive opk on day 10 or 11 of cycle.

Friday the 18th of June 2010 I had my blood sample taken to determine PAPP-A and Free B HCG. Monday the 28th of June I had my ultrasound at 12 weeks and 1 day from LMP.
Ultrasound yielded NT=1.3 mm, CRL=70mm, BPD = 22mm, with nasal bone clearly visible. Ultra sound was very good & consistent with my other children. The ultrasound dated my pregnancy as 13 weeks and 1 day and stated that from LMP was 12 weeks instead of 12 weeks and 1 day? All my Children have constantly yielded greater CRL than normal at first trimester screening and they all are born long, above the 97th percentile. Yet every time they date my pregnancies 1 week in advance because of the large CRL. Annoying really!

Anyway my bloods yielded: FREE B-HCG = 28.33IU/L equivalent to 0.717MoM
PAPP-A = 0.62IU/L equivalent to 0.323 MoM.

I would like to know what my risks are for trisomy 21, 18 & 13 based on my background and the results I have provided you with as I would like a second opinion.

Note: I had 3 healthy pregnancies at age 34, 35 and 40. then I had 2 miscarriages at age 41 in the 11th week due to Trisomy 18 and a the second miscarriage a Blighted Ovum at week 10 at age 42 In January 2010.

Almost forgot at time of scan I weighed 76 kilograms and I am 167centimeters tall

Regards Lucia
Submitted: 4 years ago.
Category: OB GYN
Expert:  Dr.M.D.Mazumdar replied 4 years ago.

Hello,

 

The ultrasound at 12 weeks has an error margin of plus/minus 4 days.

 

The MoM for free Beta hCG should be 1.0 in women carrying normal fetuses. In women carrying fetuses with trisomy 21 (Down's syndrome), theMoM is usually more than 2.0 and in trisomy 18, it is very less - around 0.18. In trisomy 13, it is it is less than 0.5. On the whole a MoM more than 2.0 and less than 0.5 is considered abnormal and merits further investigations.

 

Where Papp-A is considered, it is significantly reduced in the blood of women carrying fetuses with Down syndrome and Trisomy 18: the median MoMs are 0.44 and 0.32, respectively (compared to 1.0 for unaffected fetuses).

 

The Nuchal thickness is the most important ultrasound marker and the most influential on risk calculation. The thicker the NT, the worse the foetal prognosis. Pathological values of NT usually range between 1.8 - 2 MoM or a measure greater than 3 mm (regardless of the MoM). At a CRL length of 70 mm, the normal NT should be between 0.9 to 2.5 with an average of 1.82.

 

Considering the above data, your NT is within normal range, but the PaPP-A is low. And your free Beta HCG , although not very low, is on the lower side.

 

Taken together with your age, and although the nasal bone is clearly visible, it would be advisable to go for further testing to confirm or rule out chromosomal abnormalities.

 

I hope this helps.

Let me know if you need more input. If not, please click on the green"Accept" button on this page. A positive rating and adding a bonus will be warmly appreciated.



Edited by Dr.M.D.Mazumdar on 7/1/2010 at 1:11 PM EST
Dr.M.D.Mazumdar, Doctor
Category: OB GYN
Satisfied Customers: 8656
Experience: MD (Obst&Gynecology)
Dr.M.D.Mazumdar and other OB GYN Specialists are ready to help you
Customer: replied 4 years ago.
Dear Dr Mazumdar

In my previous question I forgot to mention a very important point.
On the very day that I had my blood test that is the 18th of June 2010 at around 2:30am that morning I had a large vaginal bleed. I saw my gynacologist later that day in the afternoon, he did an ultrasound and found the baby was fine. After I left his office I went to the blood collection centre at around 3:00pm and had my blood taken to test for the Free beta HCG and PAPP-A as part of my First Trimester screen test.
Based in this new information do you think that the serum concentrations were affected and hence have given me incorrect concentrations?
Expert:  Dr.M.D.Mazumdar replied 4 years ago.
I am afraid not, the vaginal bleed will not affect your tests - the reports will still be accurate.
Customer: replied 3 years ago.
Dear Dr Mazumdar

Just to let you know I lost my baby back on the 10th of August 2010.
His heart stop beating and he was dead at 18 weeks and 2 days.
On the 22nd of July 2010 at 15 weeks and 4 days his heart was still beating.
So between the 22nd of July 2010 and the 10th of August he died.
We asked for a full pathology report and it was found that he had stopped growing at 13 weeks and only measured 110mm long. No chromsomal, no gentetic, no virsus, no bacteria was found, the baby boy was normal, the placenta was normal, in fact I had to go to theatre to have it removed because it would not come away. We are totally devasted and have no answers as to why our baby boy died. I guess the low level of PAPP-A of 0.323 MOM was the best predictor that poor pregnancy outcome was on the cards and this did eventuate into our worst nightmare.
Expert:  Dr.M.D.Mazumdar replied 3 years ago.

Hello,

 

I am very sorry to hear of your loss. Loss of a baby can always be heartbreaking, especially when the cause for the event cannot be identified.

 

Two important effects of low PAPP-A are placental dysfunction and restricted fetal growth.

 

PAPP-A is produced by the placental cells called trophoblasts and help in growth of the placenta into the uterine wall. A low level indicates that the placenta has failed to invade the uterine muscular wall properly leading to placental dysfunction and this is associated with miscarriage, intrauterine growth restriction (IUGR) of the baby, pregnancy-induced hypertensive disorders, fetal death in utero, premature delivery etc.

 

While this fact will not help now, it should help you in your next pregnancy should you plan to go for one. Medicines like low dose aspirin can help dilate the blood vessels of the uterus and stimulate placentation. They should be started as soon as you get pregnant (miss a period).

 

I hope this helps. Once again, I would like to express my sympathy at your loss.

 

With Regards,



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