The role of vascular and angiogenic factors in the development of selective fetal growth restriction in monochorionic multiple pregnancy

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Abstract

Background: Selective fetal growth restriction (sFGR) affects 10-25% of all monochorionic twin pregnancies. If not detected and treated, sFGR is associated with high perinatal mortality and a wide range of neonatal complications. However, currently, due to the introduction of the dynamic fetal monitoring and intrauterine treatments, including fetoscopic laser coagulation of placental vascular anastomoses and the determination of optimal delivery time, it is possible to achieve high survival rates for both fetuses. The main etiological factor of sFGR is placental dysfunction, including morphological and functional changes associated with reduced placental volume, impaired development of arterio-arterial anastomoses, and vascular and angiogenic factors during the formation of an early monochorionic pregnancy. Objective: To investigate the role of vascular endothelial factors in the development of sFGR in monochorionic twin pregnancy. Materials and methods: The study included 51 patients with monochorionic diamniotic twins. Group 1 comprised patients with sFGR (n=31) and Group 2 consisted of patients with uncomplicated monochorionic twin pregnancies (n=20). The study retrospectively analyzed the role of maternal vascular and angiogenic factors at 18-26 weeks’ gestation in the development of sFGR. The analysis also included the evaluation of perinatal outcomes, the course of the early neonatal period, stay in the intensive care unit, and length of hospital stay at the second stage of nursing. Results: The mean age of participants was 31.6 (5.13) years. There were no statistically significant differences in concentrations of vascular and angiogenic factors, pregnancy and early neonatal outcomes. However, high concentrations of maternal VEGF-R1, VEGFC, and HIF-1a were associated with neonatal mortality, and a high concentration of HIF-1a was associated with stillbirth. These findings may be used in clinical practice to predict antenatal and early neonatal loss. Pregnant women with sVEGF-R1 greater than 0.787ng/mL and Ang-2greater than 8255.91 ng/mL were found to have an increased risk of low-birthweight babies. Conclusion: Comparative assessment of vascular and angiogenic factors in sFGR pregnancies offers the opportunity to prevent the progression of this condition by timely fetoscopic intervention, improve perinatal outcomes, and minimize the risks of severe antenatal and neonatal complications.

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Kristina A. Gladkova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: k_gladkova@oparina4.ru
Ph.D., Senior Researcher at the Fetal Medicine Unit, Institute of Obstetrics, Head of the lst Obstetric Department of Pregnancy Pathology

Viktoriya A. Sakalo

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: v_sakalo@oparina4.ru
Ph.D., Junior Researcher at the Department of Pregnancy Pathology, Institute of Obstetrics, doctor at the lst Obstetric Department of Pregnancy Pathology

Valentina V. Vtorushina

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: v_vtorushina@oparina4.ru
Ph.D., doctor of laboratory and clinical diagnostics at the Laboratory of Clinical Immunology

Aleksandra A. Piskulina

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: a_piskylina@oparina4.ru
clinical resident

Ekaterina R. Frolova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: e_frolova@oparina4.ru
graduate student at the High Risk Pregnancy Department

Kirill V. Kostyukov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: k_kostyukov@oparina4.ru
Dr. Med. Sci, Senior Researcher at the Fetal Medicine Unit, Institute of Obstetrics, Head of the Department of the Ultrasound and Functional Diagnosis

Zulfiya S. Khodzhaeva

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: z_khodzhaeva@oparina4.ru
Dr. Med. Sci., Professor, Deputy Director of Obstetrics Institute

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