Original research article produced in increasing concentrations with a peak at delivery (2). Maternal serum PAPP-A has prognostic value in first trimester screening test for aneuploidies in combination with maternal age, free beta-human chorionic gonadotropin (free beta-hCG) and fetal nuchal translucency (NT) measurements (3-5). Several studies indicate an association between abnormal PAPP-A levels and some adverse perinatal and birth outcomes. In fact, low first trimester PAPP-A relates to preterm birth, early onset preeclampsia, intrauterine growth retardation and threatened abortion (6-12); high first trimester PAPP-A relates to placenta accreta (13). PAPP-A has been considered as a marker of oxidative stress that could be responsible in the pathogenesis of several important adverse perinatal outcomes due to placental insufficiency like preeclampsia and intrauterine growth retardation (14-25). As marker of preeclampsia, PAPP-A in combination with other biomarkers and maternal characteristics was considered a more reliable prognosticator than PAPP-A alone (26). Serum PAPP-A concentration can be influenced by several factors such as method of conception, ethnicity, maternal weight, gestational age, smoking status.
In 2018 a 30-year-old, second gravida, was referred to the Department of Obstetrics, Ospedale San Giovanni Calibita, Fatebenefratelli, tertiary care Centre of Rome, for fetal AV block at 35 weeks of gestation.Autoimmune screening was performed and it revealed positivity to anti La/SS-A, anti-ANA, anti-RNP, anti-SM. She was not assuming corticosteroids.Previous ultrasounds revealed at the first trimester screening an increased Nuchal Translucency and in the second trimester a IIdegree AV block.
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