Clinical significance of predictive and diagnostic indices of fetal pathology associated with placental insufficiency in women with endometriosis
- Authors: Lipatov I.S.1, Tezikov Y.V.1, Amosov M.S.1
-
Affiliations:
- Samara State Medical University
- Issue: Vol 70, No 5 (2021)
- Pages: 37-48
- Section: Original Research
- Submitted: 15.01.2021
- Accepted: 15.09.2021
- Published: 02.11.2021
- URL: https://journals.eco-vector.com/jowd/article/view/58314
- DOI: https://doi.org/10.17816/JOWD58314
- ID: 58314
Cite item
Abstract
BACKGROUND: Modern achievements of pharmacology, surgery and reproductive medicine have determined an increase in the implementation of reproductive function in endometriosis of various localization. The onset of pregnancy in presence of impaired endometrial receptivity and progesterone resistance, pro-inflammatory and pro-thrombotic status, abnormal functioning of the immune system, structural changes in the reproductive organs leads to impaired formation of the embryo (feto) placental system, early reproductive losses, complicated pregnancy and adverse perinatal outcomes. In this regard, the “endometriosis and pregnancy” issue requires close study and specific proposals to optimize pregnancy management.
AIM: The aim of this study was to develop predictive (PIs) and diagnostic (DIs) indices of placenta-associated fetal pathology in pregnant women with endometriosis, to determine their prognostically and diagnostically significant parameters.
MATERIALS AND METHODS: This prospective study in the dynamics of gestation included a comprehensive clinical and laboratory examination of 175 pregnant women with endometriosis (100 subjects with adenomyosis and 75 subjects with ovarian endometriosis). To develop PIs and DIs, two comparison groups with fetal pathology due to placental insufficiency were retrospectively identified, depending on the location of endometriosis. Group I consisted of 49 pregnant women with adenomyosis and placental insufficiency isolated from other pregnancy complications, accompanied by growth retardation and/or chronic fetal hypoxia; Group II comprised 29 pregnant women with ovarian endometriosis and placental insufficiency isolated from other pregnancy complications, accompanied by growth retardation and/or chronic fetal hypoxia. The control group (Group III) included 30 healthy pregnant women with a normal course of gestation. The examination was performed at 10-14 weeks, 20-24 weeks, and 28-34 weeks of gestation and included an assessment of placental insufficiency markers such as placental growth factor (PlGF), placental α-1-microglobulin (PAMG-1), tumor necrosis factor (TNFα), lymphocytes with membrane receptor FasR (L CD95+), C-reactive protein, placental alkaline phosphatase (PAPh), and fetal hemoglobin (HbF). The information value of individual parameters and indices was determined by ROC analysis, odds ratio, and clinical epidemiology tests.
RESULTS: Pregnancy in presence of endometriosis in 100% of cases was complicated by placental insufficiency of varying severity (with fetal pathology in 81.5% of cases), the frequency of which had statistically significant differences between the groups of pregnant women with adenomyosis and ovarian endometriosis (χ2 = 4.06, p = 0.04). To predict growth retardation and / or chronic fetal hypoxia, we have developed PI I (PlGF / TNFα × 100) and PI II (PAMG-1 / PlGF × 100), which characterize the state of placental angio-and vasculogenesis depending on systemic inflammatory response level. For early diagnosis of fetal pathology, we have proposed DI I (CRP / PAPh × 100), DI II (HbF / PlGF × 100) and DI III (L CD95+ / PAPh × 100), which allow for diagnosing placental alterations with impaired placental energy supply due to an increase in inflammatory status. Evaluation of prognostic and diagnostic significance of PIs and DIs showed that the most informative tools are PI I (Se = 86.1%, Sp = 80.5%) and DI I (Se = 88.3%, Sp = 83.7%).
CONCLUSIONS: The use of PIs allows for risk stratification of pregnant women from the 1st trimester of gestation to address the issue of the prevention method. The clinical capabilities of DIs optimize obstetric tactics for the timely prescription of therapy for placental insufficiency and targeted diagnosis of fetal pathology. Pregnant women with endometriosis should be classified as a high perinatal risk group, and therefore the proposed PIs and DIs should be included in the dynamic examination complex.
Full Text
About the authors
Igor S. Lipatov
Samara State Medical University
Email: i.lipatoff2012@yandex.ru
ORCID iD: 0000-0001-7277-7431
SPIN-code: 9625-2947
MD, Dr. Sci. (Med.), Professor
Russian Federation, SamaraYury V. Tezikov
Samara State Medical University
Email: yra.75@inbox.ru
ORCID iD: 0000-0002-8946-501X
SPIN-code: 2896-6986
MD, Dr. Sci. (Med.), Professor
Russian Federation, SamaraMikhail S. Amosov
Samara State Medical University
Author for correspondence.
Email: jyckee@mail.ru
ORCID iD: 0000-0002-7487-3280
SPIN-code: 5800-6716
MD
Russian Federation, SamaraReferences
- Savelyeva GM. My view on the current state of obstetrics and perinatology. Russian Bulletin of the obstetrician-gynecologist. 2019;19(5):43−51. (In Russ.). doi: 10.17116/rosakush2019190217
- Jarmolinskaja MI, Ajlamazjan JeK. Genital’nyj jendometrioz. Razlichnye grani problemy. Saint Petersburg: Jeko-Vektor; 2017. (In Russ.)
- Máté G, Bernstein LR, Török AL. Endometriosis is a cause of infertility. Does reactive oxygen damage to gametes and embryos play a key role in the pathogenesis of infertility caused by endometriosis? Front Endocrinol (Lausanne). 2018;9:725. doi: 10.3389/fendo.2018.00725
- Harada T, Taniguchi F, Amano H, et al. Adverse obstetrical outcomes for women with endometriosis and adenomiosis: A large cohort of the Japan environment and childrens study. PLos One. 2019;14(8):e0220256. DOI: 10.137/journal.pone.0220256
- Krasnopolskaya KV, Popov AA, Fedorov AA, Ershova IYu. Algorithm for overcoming infertility secondary to ovarian endometriotic cyst: a view of a reproductive specialist and a surgeon. Obstetrics and gynecology. 2020;11:78−84. (In Russ.). doi: 10.18565/aig.2020.11.78-84
- De Ziegler D, Pirtea P, Carbonnel M, et al. Assisted reproduction in endometriosis. Best Pract Res Clin Endocrinol Metab. 2019;33(1):47−59. doi: 10.1016/j.beem.2018.10.001
- Philippe R, Errico Z, Dan C. Endometriosis and pregnancy outcome. Fertil Steril. 2018;110(3):406−407. DOI: 10.1016/j. fertnstert. 2018.06.029
- Tanbo T, Fedorcsak P. Endometriosis-associated infertility: aspects of pathophysiological mechanisms and treatment options. Acta Obstet Gynecol Scand. 2017;96(6):659−667. doi: 10.1111/aogs.13082
- Farland LV, Prescott J, Sasamoto N, et al. Endometriosis and risk of adverse pregnancy outcomes. Obstet Ginecol. 2019;134(3):527−536. doi: 10.1097/AOG. 0000000000003410
- Uccella S, Manzoni P, Cromi A, et al. Pregnancy after endometriosis: maternal and neonatal outcomes according to the location of the disease. Am J Perinatol. 2019;36(S2):S91−S98. doi: 10.1055/s-0039-1692130
- Yarmolinskaya MI, Seyidova CI. Effect of genital endometriosis on fertility and gestation course. Journal of obstetrics and women’s diseases. 2020;69(3):47−56. doi: 10.17816/JOWD69347-56
- Leite DFB, Morillon AC, Melo Junior EF, et al. Examining the predictive accuracy of metabolomics for small-for-gestational-age babies: a systematic review. BMJ Open. 2019;9(8):e031238. doi: 10.1136/bmjopen-2019-031238
- Bekmukhambetov Y. Metabolic and immunologic aspects of fetoplacental insufficiency. Am J Reprod Immunol. 2016;76(4):299−306. doi: 10.1111/aji.12544
- Tezikov YuV, Lipatov IS. Results of carbogenotherapy for the prevention of placental insufficiency. Russian Bulletin of the obstetrician-gynecologist. 2011;11(5):71−77. (In Russ.)
- Zheleznyak OA. System approach and its application in medicine. Health care of Kyrgyzstan. 2016;(1):8−10. (In Russ.)
- Lipatov IS, Tezikov YuV, Santalova GV, Ovchinnikova MA. Prevention of recurrent herpetic infection in pregnant women and intrauterine infection of the fetus with the herpes simplex virus. Russian Bulletin of the obstetrician-gynecologist. 2014;14(4):63−68. (In Russ.)
- Strizhakov AN, Tezikov YuV, Lipatov IS, et al. Standardization of diagnostics and clinical classification of chronic placental insufficiency. Voprosy of gynecology, obstetrics and perinatology. 2014;13(3):5−12. (In Russ.)
- Kotel’nikov GP, Shpigel’ AS. Dokazatel’naja medicina. Nauchno obosnovannaja medicinskaja praktika. 2nd ed. Moscow: GEOTAR-Media; 2012. (In Russ.)
- Lang T, Altman D. Basic description of statistical analysis in articles published in biomedical journals. The leadership of the “Statistical analyses and methods in the published literature (SAMPL)”. Medical technologies. Evaluation and selection. 2014;1(15):11−16. (In Russ.)
- Jendometrioz: Diagnostika, lechenie i reabilitacija: klinicheskie rekomendacii po vedeniju bol’nyh. Moscow, 2016. (In Russ.). [cited 20 Aug 2021]. Available from: https://www.ulsu.ru/media/uploads/nina-baratyuk %40mail.ru/2018/03/24/ %D0 %AD %D0 %BD %D0 %B4 %D0 %BE %D0 %BC %D0 %B5 %D1 %82 %D1 %80 %D0 %B8 %D0 %BE %D0 %B7 %2C %202016.pdf
- Leeners B, Damaso F, Ochsenbein-Kolble N, Farquhar C. The effect of pregnancy on endometriosis – facts or fiction? Hum Reprod Update. 2018;24(3):290−299. doi: 10.1093/humupd/dmy004
- Yarmolinskaya MI, Shalina MA, Khachaturyan AR, et al. Adenomyosis: from scientific discoveries to the practical aspects of prescribing drug therapy. Obstetrics and gynecology. 2020;(3):182−190. (In Russ.). doi: 10.18565/aig.2020.3.182-190
- Denisova VM, Yarmolinskaya MI. Pelvic endometriosis and pregnancy: different sides of the problem. Journal of obstetrics and women’s diseases. 2015;64(1):44−52. (In Russ.). doi: 10.17816/JOWD64144-52
- Davidson LM, Coward K. Molecular mechanisms of membrane interaction at implantation. Birth Defects Res C Embryo Today. 2016;108(1):19−32. doi: 10.1002/bdrc.21122