First trimester PAPP-A MoM values predictive for breech presentation at term of pregnancy

Abstract

Introduction: Our aim was to state the role of first trimester pregnancy-associated plasma protein A (PAPP-A)-multiple of the median (MoM) value as a predictor for breech presentation at term of pregnancy.

Materials and methods: In this retrospective study, we present data for 1100 singleton full-term deliveries that took place in a third-level hospital setting in northeast Italy between January 2004 and July 2007. For each case, PAPP-A, free beta-human chorionic gonadotropin and nuchal translucency were measured during prenatal trisomies screening (between 11 weeks and 13 weeks and 6 d). A wide range of predictive factors for breech presentation at term of pregnancy and other confounding elements were considered.

Results: Of the 1100 singleton deliveries at term considered in our study, 40 babies were in breech presentation. Using bivariate analysis and multivariate logistic regression, a lower PAPP-A MoM than 0.63 (first quartile of our distribution) in the first trimester (OR 2.41, CI.95 1.25–4.67), and placental index at term higher than the median value (OR 2.04, CI.95 1.00–4.17) were proven to be associated with breech presentation at term.

Conclusions: A low PAPP-A during the first trimester was a predictive factor for breech presentation at term of pregnancy. Acknowledging and acting on this predictor could enable improved management of breech foetuses in the future.

• Breech presentation
• humans
• PAPP-A
• placenta
• term delivery
• uncomplicated pregnancies

Acknowledgements

We are grateful to Eilidh P.J. McIntosh for her suggestions on the style and grammatical correctness of our English.