Clinical value of serum pregnancy associated protein A combined with uterine artery Doppler ultrasound in predicting fetal growth restriction in early pregnancy

  Background   Fetal growth restriction (FGR) is one of the main complications in perinatal period. It not only affects the growth and development of fetus, but also increases the morbidity and mortality of perinatal fetus, which is an important cause of fetal intrauterine death or neonatal death. How to predict the occurrence of FGR in early pregnancy, and then effectively control the progress of the disease and complications, has become one of the research focuses in the field of obstetrics.

  Objective  To discuss the clinical value of serum pregnancy associated protein A (PAPP-A) combined with uterine artery Doppler ultrasound in predicting fetal growth restriction in early pregnancy.

  Methods  Clinical data about 1437 women with singleton pregnancy who received prenatal examination in Linyi Central Hospital from January 2016 to December 2018 were analyzed retrospectively. All the pregnant women received ultrasound Doppler examination of uterine artery and testing of PAPP-A at the early stage of pregnancy (11-13⁺⁶ weeks). According to the pregnancy results, they were divided into the fetal growth restriction group (FGR group) and the normal control group. The data of general information, ultrasonic Doppler of uterine artery and PAPP-A were compared between the two groups.

  Results  There were 1328 cases in the normal control group, and 109 cases in the FGR group. No significant difference in general conditions was found between the FGR group and the normal control group (all P＞0.05). The FGR group had higher levels of UtA-PI (1.92±0.41 vs 1.78±0.63) and UtA-RI (0.75±0.11 vs 0.71±0.14), and greater percentage of early uterine artery diastolic notch (62.4% vs 46.9%) compared to the control group (all P＜0.05). The concentration of PAPP-A (MoM) in the FGR group was significantly lower than that in the control group (0.86±0.17 vs 1.29±0.32, P＜0.05). In addition, the AUC and sensitivity of PAPP-A combined with UtA-PI in predicting FGR were 0.793 and 81.6% respectively, which were lower than those of PAPP-A+UtA-PI+diastolic early notch (AUC: 0.814, sensitivity: 82.1%) without significant differences (P＞0.05, respectively).

  Conclusion  Monitoring UtA-PI by Doppler ultrasound combined with PAPP-A testing in the early stage of pregnancy is an effective method in predicting fetal growth restriction. And the predicting ability can be slightly improved by combining with the index of early diastolic notch.