Screening for Low Papp-A: Inconsistencies and Incongruities

Summary When women and birthing people are found to have low PAPP-A at the combined test for chromosomal abnormalities (Down’s syndrome, Edwards’ syndrome and Patau’s syndrome) it has major implications for their pregnancy, labour and delivery. However, neither women nor their midwives are informed that PAPP-A results will be looked at independently, or that recommendations of care will be based on these results, and neither is consent gained for this. In addition, the question arises of why screening for low PAPP-A is not offered to all women (regardless of their decision to have screening for chromosomal abnormalities) given its potentially serious implications.