PAPP-A is a glycoprotein released from the placenta, and was first obtained from the plasma of pregnant women in 1974 by Lin et al. 21 Its level in the maternal bloodstream increases as pregnancy advances, 8 reflecting the placental activity. 7 It is produced by the syncytiotrophoblast and is also expressed in ovarian granulose cells as well as in the nonreproductive tissues, like fibroblasts, osteoblasts and vascular smooth muscle cells. Every patient visiting the antenatal OPD with a period of gestation of 11-14 weeks was counselled for the testing of first trimester screening to assess fetal well-being. An informed consent was taken from all the participants. In all cases, the mothers were followed up for the duration of their pregnancies. Majority of the patients (62.4%) had a normal CTG at the time of delivery, with only 30 patients (32.3%) showing fetal distress. There is a significant association between CTG and levels of PAPP-A.