Low papp-a in pregnancy

Hi all,

Sorry for the long one.

I am 23 weeks pregnant with my 3rd child and have been told I have low papp-a. I had no idea what papp-a was until yesterday when I was told this by the obstetrician. I admit, I feel very stupid for not asking more questions whilst in there, for thinking I understood at the time and walking away and realising I still don't know much at all. Neither midwives or the obstetrician really gave me much, they seemed to assume I knew more than I did and as I said, I didn't really give them reason to think otherwise.

So quick background - the NT scan brought down my trisomy scoring, I assumed this was due to the measurements during the scan. I was borderline high risk for DS so had the harmony test. This came back negative for DS so I thought everything was all good - all dealings at this point had been through a gp only. I was due to have my first appointment with the midwife team at 18 weeks at a birthing center when they called right before(literally as I was pulling in to the car park) to say they were no longer able to accept me as I needed extra monitoring due to my scoring from the NT scan and needed to see an obstetrician. I assumed this meant they were still concerned about chances of DS and so had a few weeks of waiting for my OB appointment until I could find out more. I met with doctors and midwives yesterday and now the information I have is that whilst the DS results are borderline high risk, they are still considered to be in the low risk category and so they are not really concerned about this(plus results from harmony test are very reliable) and it was the papp-a result that had brought this down anyway. They are concerned about the papp-a only. From memory my reading is about .36. I will need extra monitoring and scans throughout the pregnancy to keep an eye on the placenta/blood flow and extra monitoring through labour. There is a chance I will go into labour early and he will be born small(although at the moment he is actually measuring a week ahead and due to my others being born so big, they will not let me go over 39 weeks due to this and the low papp-a) but they seemed pretty casual about it all. I came home and googled and now I have a million more questions and 2 weeks until I see the obstetrician again and have my next scan. It seems the risks are more than just the ones mentioned - it seems there's a higher chance of still birth and pre eclampsia for a start, as well as placenta issues and therefore problems with the baby being able to continue to grow and blood flow to the baby. I know Google can sometimes be the worst thing to do but I just can't stop kicking myself for not finding out more at the appointment and now I'm driving myself mad with the more I keep thinking and wondering.

I don't know how low this reading is. I don't know how high the risks are. I don't know how concerned I need to be. I don't know how early I need to prepare for my baby being born. I never and very luckily, had a single issue(besides regular aches and pains) with my previous 2 pregnancies. This is all new to me and this pregnancy has just been so hard already with HG, the DS tests and worries, him already being big and needing to be induced at 39 weeks(although now it seems he could possibly go the other way and end up small) and now this.

I'm normally a real stress head but I'm dealing with this well but just want to prepare and arm myself so I can do all I can to make sure I have a healthy baby, to know what I need to be on the lookout out for and to fully understand what's happening. Anyone who has experienced this or can shed some light, it would be really gratefully appreciated.