Predictive value of first-trimester screening tests (PAPP-A and free βhCG) for placenta previa and placenta accreta spectrum disorders

INTRODUCTION: Placenta previa and the placenta accreta spectrum (PAS) represent critical conditions in pregnant women, carrying a life-threatening risk of bleeding and adverse obstetric outcomes. Timely diagnosis and intervention play a pivotal role in mitigating the potential risks associated with these conditions. Our study seeks to evaluate the significance of serum pregnancy-associated plasma protein-A (PAPP-A) and beta-human chorionic gonadotropin (βhCG) as early biomarkers for predicting placenta accreta spectrum disorders and placenta previa. This research is essential as further investigations are warranted to enhance our understanding of this significant medical condition
METHODS: A retrospective study was carried out on 254 pregnant individuals with placenta previa who underwent cesarean section delivery at our hospital. Excluding 187 pregnant women who had placenta previa with or without placenta accreta spectrum but lacked PAPP-A and βhCG test results in the second trimester, the study focused on 30 cases of placenta previa with PAS, 37 cases of placenta previa without PAS, and 30 cases of body mass index (BMI)-matched healthy pregnant controls with available second-trimester test results. The comparison of PAPP-A and βhCG MoMs (Multiples of the Median) between these groups was conducted to assess significant differences.
RESULTS: The ages of the individuals ranged from 22 to 41 years, with a mean of 32.29±4.14 years. BMI measurements ranged from 18 to 40 kg/m², with a mean of 26.22±4.48 kg/m². BMI, PAPP-A, and βhCG measurements did not show statistically significant differences between the groups (p>0.05). The mean age of the PAS group was significantly higher than that of the control group (p<0.05).
DISCUSSION AND CONCLUSION: Our study did not find significant predictive value for PAPP-A and βhCG in placenta accreta spectrum. However, conflicting results from previous studies suggest the need for further research. Larger prospective studies are necessary to clarify the role of these biomarkers.