Μελέτη βιοχημικών παραγόντων στο εξωεμβρυϊκό υγρό

Abstract

Objectives: The present study aims to evaluate the concentration and distribution of pregnancy-associated plasma protein a (PAPP-A), free ?-HCG and anti-mullerian hormone (AMH) in amniotic fluid, coelomic fluid and maternal serum in the first trimester of pregnancy. Materials and Methods: Coelocentesis was performed in 56 women with singleton pregnancy from 6 to 10 weeks of gestation. The concentrations of PAPP-A and free ?-HCG were measured in the coelomic fluid and maternal serum and additionally AMH was measured in 10 women to which amniocentesis was also performed. Results: The median concentration of PAPP-A in maternal serum was 624.75 mU/I, significantly higher than the concentration in coelomic fluid (median 45.06 mU/I; p < 0.001). There is a significant correlation between the levels of PAPP-A in coelomic fluid and maternal serum (r=-0.6945, n=56, p=0.003). The concentration of maternal serum PAPP-A increased significantly with gestation (r=0.837, n=56, p=0.001). In most of our amniotic fluid samples the concentration of this protein was undetectable. The median concentration of free ?-HCG in maternal serum was 86.35 ng/ml, significantly lower than the concentration in coelomic fluid (median 1535 ng/ml; p <0.001). The levels of free ?-HCG in the coelomic fluid did not vary with gestation. The amniotic fluid concentration (median 24.865 ng/ml) was significantly lower that the one in maternal serum (p=0.005). The median concentration of AMH in maternal serum was 2.54 ng/ml. In coelomic fluid the median levels were 7.55 ng/ml, significantly higher than serum concentration (p=0.006) and amniotic fluid concentration (median 1.25ng/ml, p=0.005). Conclusion: The distribution of AMH in the compartments of the gestational sac in the first trimester may suggest another source of anti-mullerian hormone apart from the ovary during pregnancy. The distribution of PAPP-A is in contrast with the one described in other placental-derived proteins. The levels of free ?-HCG are significantly higher in coelomic fluid than in amniotic fluid and maternal serum and are consistent with its syncytiotrophoblast origin.