Distention of placental intervillous spaces as a marker of thrombophiliaassociated complications of pregnancy
- Authors: Chechneva M.A.1, Budykina T.S.1, Zakharov S.M.1, Biryukova N.V.1, Kulikova O.N.1, Ovchinnikova V.V.1
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Affiliations:
- Moscow Regional Research Institute of Obstetrics and Gynecology, Ministry of Health of Russia
- Issue: No 10 (2020)
- Pages: 63-70
- Section: Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/329503
- DOI: https://doi.org/10.18565/aig.2020.10.63-70
- ID: 329503
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Abstract
Aim. To investigate the course and outcomes of pregnancy in patients with massive placental structural changes with the distention of intervillous spaces (DIS) based on the correction of hypercoagulability. Materials and methods. The study included 139 pregnant women with confirmed thrombophilia and placental structural changes detected by ultrasound as a massive DIS. During pregnancy, placental thickness and structure and pregnancy outcomes were analyzed depending on the treatment. Group 1 (n=64) did not receive or irregularly used anticoagulant or antiplatelet therapy. Group 2 (n=75) throughout pregnancy received treatment based on laboratory testing results. Results. The study analyzed the course of pregnancy in patients with thrombophilia and structural changes in the placenta. In patients receiving continuous anticoagulant therapy based on laboratory testing results and achieving normal coagulation parameters, placental thickness decreased, followed by normalization of placental echotexture. Improvement in perinatal outcomes included a 4-fold reduction in missed miscarriage rate, a 3.5-fold decrease in placental abruption rate, and a 1.5-fold reduction in intrauterine growth restriction rate; the full-term delivery rate increased four-fold. Conclusion. Placental echotexture assessment can be used as an additional diagnostic test for thrombophilia and hypercoagulability and a criterion for treatment effectiveness.
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About the authors
Marina A. Chechneva
Moscow Regional Research Institute of Obstetrics and Gynecology, Ministry of Health of Russia
Email: marina-chechneva@yandex.ru
Dr. Med. Sci., Head of the Department of Ultrasound Diagnostics
Tat’yana S. Budykina
Moscow Regional Research Institute of Obstetrics and Gynecology, Ministry of Health of RussiaDr. Med. Sci., Head of Clinical Diagnostic Laboratory
Saveliy M. Zakharov
Moscow Regional Research Institute of Obstetrics and Gynecology, Ministry of Health of RussiaPh.D. Student
Natalia V. Biryukova
Moscow Regional Research Institute of Obstetrics and Gynecology, Ministry of Health of RussiaPh.D., Researcher at the Obstetric Observatory Department
Olga N. Kulikova
Moscow Regional Research Institute of Obstetrics and Gynecology, Ministry of Health of RussiaResearcher at the Clinical Diagnostic Laboratory
Vladlena V. Ovchinnikova
Moscow Regional Research Institute of Obstetrics and Gynecology, Ministry of Health of RussiaPh.D
References
- Croles F.N., Nasserinejad K., Duvekot J.J., Kruip M.J., Meijer K., Leebeek FW. Pregnancy, thrombophilia, and the risk of a first venous thrombosis: systematic review and bayesian meta-analysis. BMJ. 2017; 359: j4452. https://dx.doi. org/10.1136/bmj.j4452.
- American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 197: Inherited T hrombophilias in Pregnancy. Obstet. Gynecol. 2018; 132(1): e18-34. https:// dx.doi.org/10.1097/AOG.0000000000002703.
- Sim cox L.E., Ormesher L., Tower C., Greer I. A. Thrombophilia and preg nancy complications. Int. J. Mol. Sci. 2015; 16(12): 28418-28. https:// dx.doi.org/10.3390/ijms161226104.
- Stevens S.M., Woller S.C., Bauer K.A., Kasthuri R., Cushman M., Streiff M. et al. Guidance for the evaluation and treatment of hereditary and acquired thrombophilia. J. Thromb. Thrombolysis. 2016; 41(1): 154-64. https:// dx.doi.org/10.1007/s11239-015-1316-1.
- Diuski D., Mierzynski R., Poniedziaiek-Czajkowska E., Leszczynska-Gorzelak B. Adverse pregnancy outcomes and inherited thrombophilia. J. Perinat. Med. 2018; 46(4): 411-7. https://dx.doi.org/10.1515/jpm-2017-0059.
- Middeldorp S. Inherited thrombophilia: a double-edged sword. Hematology Am. Soc. Hematol. Educ. Program. 2016; 2016(1): 1-9. https://dx.doi.org/ 10.1182/ asheducation-2016.1.1.
- Skeith L., Carrier M., Kaaja R., Martinelli.I, Petroff D., Schleu§neY E. et al. A meta-analysis of low-molecular-weight heparin to prevent pregnancy loss in women with inherited thrombophilia. Blood. 2016; 127(13): 1650-5. https:// dx.doi.org/10.1182/blood-2015-12-626739.
- Arachchillage D.R.J., Makris M. Inherited thrombophilia and pregnancy complications: Should we test? Semin. Thromb. Hemost. 2019; 45(1): 50-60. https://dx.doi.org/10.1055/s-0038-1657782.
- Сухих Г.Т., Филиппов О.С., Белокриницкая Т.Е., Бицадзе В.О., Гурьянов В.А., Долгушина Н.В., Калинина Б.А., Кан Н.Е., Кирющенков П.А., Кириенко А.И., Корнеева И.Е., Леваков С.А., Леонтьев С.Г., Макацария А.Д., Павлович С.В., Пырегов А.В., Рунихина Н.К., Тютюнник В.Л., Федорова Т.А., Ходжаева З.С., Шмаков Р.Г., Явелов И.С. Профилактика венозных тромбоэмболических осложнений в акушерстве и гинекологии. Клинические рекомендации. Протокол. М.; 2014. [Sukhih G.T., Filipov O.S. et al. Prevention of venous thromboembolic complications in obstetrics and gynecology. Clinical recommendations. Protocol. Moscow; 2014. (in Russian)].
- Момот А.П., Николаева М.Г., Сердюк Г.В., Елыкомов В.А., Мамаев А.Н., Романов В.В., Фадеева Н.И., Кудинова И.Ю., Белозеров Д.Е., Трухина Д.А., Максимова Н.В., Вахлова Ж.И. Оценка состояния системы гемостаза при физиологически протекающей беременности. Методические рекомендации (проект). Российский вестник акушера-гинеколога. 2018; 18(3, вып. 2). [Momot A.P., Nikolaeva M.G., Serdiuk G.V., Elykomov V.A. et al. Evaluation of haemosthasis system in physiological pregnancy. Methodological recommendations (project). Russian Bulletin of obstetrician-gynecologist. 2018; №3; 2. (in Russian)].
- Чечнева М.А., Будыкина Т.С., Бирюкова Н.В., Захаров С.М., Торшина З.В., Овчинникова В.В. Эхоструктура плаценты как маркер гиперкоагуляции. Российский вестник акушера-гинеколога. 2020; 20(3): 78-84. [Chechneva M.A., Budykina T.S., Biryukova N.V., Zakharov S.M., Torshina Z.V., Ovchinnikova V.V. Echostructure of the placenta as a marker of hypercoagulation. Russian Bulletin of obstetrician-gynecologist. 2020; 20(2) (in Russian)].
- Сухих Г.Т., Серов В.Н., Адамян Л.В., Филиппов О.С., Баев О.Р., Клименченко Н.И., Тетруашвили Н.К., Тютюнник В.Л., Ходжаева З.С., Холин А.М. Преждевременные роды - клинические рекомендации (протокол). М.; 2014. [Premature birth - clinical recommendations (a protocol) (in Russian)].
- Баринова И.В., Кондриков Н.И. Массивный субхориальный тромбоз. Архив патологии. 2012; 74(6): 55-8. [Barinova I.V., Kondrikov N.I. Massive subchorial thrombosis. Archives of pathology. 2012; 6: 57-60. (in Russian)]
- Петрухин В.А., Реброва Т.В., Чечнева М.А., Баринова И.В., Мельников А.П., Малова А.Н. Массивный субхориальный тромбоз. Российский вестник акушера-гинеколога. 2015; 15(4): 49-54. https://dx.doi.org/10.17116/ rosakush201515449-54. [Petrukhin V.A., Rebrova T.V., Chechneva M.A., Barinova I.V., Melnikov A.P., Malova A.N. Massive subchorial thrombosis. Russian Bulletin of obstetrician-gynecologist. 2015; 15(4): 49-54 (in Russian)]. https://dx.doi.org/10.17116/rosakush201515449-54.
- Жаркин Н.А., Лавенюкова Е.М., Мирошников А.Е. Преждевременная отслойка нормально расположенной плаценты. Эпидемиология, факторы риска, прогнозирование, исходы. Российский вестник акушера-гинеколога. 2018; 18(3): 20-4. https://dx.doi.org/10.17116/rosakush201818320-24.
- Levine T.A., Grunau R.E., McAuliffe F.M., Pinnamaneni R., Foran A., Alderdice F.A. Early childhood neurodevelopment after intrauterine growth restriction: a systematic review. Pediatrics. 2015; 135(1): 126-41. https:// dx.doi.org/10.1542/peds.2014-1143.
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