# Papp-a/IUGR/small placenta/uterine artery notching - please help



## littlepea2012

Hello

I was wondering if anyone has/had experience of some of the issues Im experiencing with my pregnancy or can offer any pearls of wisdom?

Im currently 30 years old and 24+1 weeks my first baby. 

I had the nuchal translucency scan and blood test at 12 weeks and this came back with low risk for DS. A couple of weeks later I received a phone call saying that the blood test they ran at the time showed I had a very low papp-a level (0.27MoM) and I would need to go to for a growth and Doppler scans when I was 23+3 weeks.

Prior to the growth scan all my other scans have been positive, my little girl has always measured just under the 50th percentile but I was reassured at Trafford General Hospital (who have been great) that this is nothing to be concerned about at this stage.

Papp-a (pregnancy-associated plasma protein A) is a protein associated with the placenta and can be indicative of what is termed poor pregnancy outcomes such as late miscarriage, IUGR, PE, still birth that usually tend to occur during the 3rd trimester, it is also a marker for DS. 
From what I have heard the lower the papp-a level the more risk you have of a problem occurring but again this is just a risk and not a guarantee of a future problem. This outlook was what had kept me sane leading up to the growth scan.

Im fortunate that I was referred for the growth scans to a specialist placenta and preterm labour clinic at St Marys Hospital in Manchester and I attended there last Wednesday feeling really nervous but positive that all would be ok. 

At my appointment I was told that I have bilateral high resistance uterine arteries with notching on the left artery. This means that the blood isnt flowing to the baby properly and can cause growth issues or worse still birth, my risk is also increased as apparently I have a small placenta. 

My report says that my placenta also has an accessory lobe present  I had to Google this as it wasnt discussed at my consultation and apparently its an additional placenta  has anyone ever heard of this or had an accessory lobe? 

My baby is currently showing to be on the small side growth wise, particularly her AC measurement which is a lot less than the other readings. They have said that the results of the growth and Doppler scan combined with my papp-a score leads them to believe that I am going to have problems and will likely have to be induced early. 

They said that any issues resulting from the size of my placenta and high resistance arteries are unlikely to occur until I reach the third trimester when the baby needs more space and blood and nutrients to grow so I have to go back again when I am 27+3 weeks for a reassessment and then they will see me weekly or fortnightly to monitor how my baby is doing, they have also told me to start monitoring her movements and if she seems less active I have to go back in for a check-up.

Needless to say Im extremely concerned about all of this, especially the risk of still birth and also having her early before shes ready.

Has anyone got any experience in any of this? Or about being induced  if this happens how would they do it, induce labour naturally or c-section  does this depend on how many weeks gone I am?

Ive been so scared of losing my baby throughout this pregnancy I just cant relax. I have polycystic ovaries and although we were fortunate to conceive her naturally it has taken over 7 years of trying and miraculously I managed to conceive her last year just after getting out of hospital after a cancer scare. 

I have so far had two threatened miscarriages, the last one at 13 weeks in which I bled for over 3 weeks and Ive had so many scans and yet no-one knows what was causing the heavy bleeds. Im now wondering if it could be connected to the low papp-a?

Im also in a lot of discomfort from pelvic girdle pain and carpal tunnel syndrome and found out last week Im also anaemic :wacko: 

Im so sorry about the essay, I guess Im feeling a little overwhelmed by it all and its getting me quite down and although my partner and family have been great I dont really have anyone to talk to about all this and Im feeling lonely (I sound pathetic I know). 

A lot of my friends either have no interest in children/pregnancy at all, or the polar opposite  quite a few friends are having difficulty conceiving themselves and so I dont want to burden them with my pregnancy concerns as theyve taken me being pregnant quite bad. 

Sorry again and any replies would be greatly appreciated!


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## littlepea2012

Anyone? x


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## socitycourty

This is my first as well but I am also apparently at risk for IUGR due to a high Inhibin-A count on my 2nd tri bloodwork, ultrasounds showed she is ok and had been measuring on time, I'm still scared to death and so I know how you're feeling. Good luck and :hugs:


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## feb84

Hi I know how you must be feeling as we were told at our 20 week scan that our baby had an echogenic bowel, small AC measurements, small femur measurements, sandal gap toe and that baby's size is 2 weeks behind gestational age therefore this could be at risk of downs. My bloods results and neucal fold test listed us as low risk and I didnt want to have the amnio test. Due to this I am being closely monitored at Liverpools womens hospital. I am now 28 weeks and these things have slowly become less of a worry to the professor as the baby grows, so try and be positive as you will probably find that all the things they told you at the beginning become less of a worry as your baby grows. i know its so hard to think everything will be ok, but as the professor told me, these days the medical professionals are so over cautious with the top of the range scans and can cause unnecessary worry to most mothers to be. xxx


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## elfin2011

Hi Littlepea

I'm so sorry you find yourself in this situation. I had low Papp-a in my last pregnancy, 0.39 MoM, and was also worried about the problems you mention. Have you spoken to Antenatal Results and Choices, as they will be able to help you if you are feeling overwhelmed, and also offer an ear for you to talk to. https://www.arc-uk.org/

I can't help with the other issues you mention, as my hospital didn't give me much information. What did strike me, though, is how thorough your hospital is, which would give me some comfort in terms of them offering you and your baby excellent care.

Despite my concerns, my second son was born at 39 weeks (planned c-section, unrelated reason) at 8lb 6oz so hardly small. Also, the senior sonographer I saw privately for a growth scan said that while she was aware of the theoretical link between low Papp-a and issues as you describe, it wasn't something she'd ever seen happen in her vast experience. 

I hope that helps in some way.

Claire x


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## pachamama92

Hey, just noticed your post. I also have an extra lobe, I think it's sometimes called a placenta bipartita and isn't very sommon so there isn't much info. I've got one main placenta and one extra "lobe" thing..according to the docs it shouldn't make any difference, it's just a bit different. The problem is if it covers the cervix in which case it would be classed as a placenta praevia. Also you must make sure that it's all in your notes as when you are giving birth to the placenta they must get both parts out! Very important!! Hope this helps!


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