Оцінка показників комплексної стратифікації ризиків розвитку прееклампсії в пацієнток із ретрохоріальними гематомами

Abstract

Purpose - to assess the prognostic value of a comprehensive study of the influence of indicators of angiogenic/antiangiogenic profile in women with retrochorial hematoma (RCH) in the І trimester, uterine artery (UA) dopplerometry data in stratifying the risks of developing placental dysfunction in these women. Materials and methods. A prospective analysis of the course of pregnancy was carried out in 137 women with a threat of miscarriage aged 20 to 47 years, who made up two comparison groups: the Group I - 60 patients with RCH, the Group II - 77 patients with a threat of abortion without hematoma. Results. The average age of women of the Group I was 31.2±0.6 years, of the Group II - 32.2±0.6 years. The gestational age at enrollment was equal 6.1±0.55 weeks in the Group I and 7.2±0.61 weeks in the Group II. A direct, reliable correlation of weak strength was established in pairs: the presence of the human chorionic gonadotropin (hCG) and the pulsatility index (PI) in UA >95 percentile, hCG and a higher level of hCG in the I and II trimesters of pregnancy. A reduced level of PAPP-A was significantly associated with cases of preeclampsia (PE) in the anamnesis, increased Body Mass Index, a high level of PI in UA, including with PI levels >95 percentile, as well as with a reduced level of free estriol. Significant inverse correlations were established between the level of PLGF and indicators of PE in history, the level of PI in UA and the content of hCG. At the same time, the level of alpha-fetoprotein in the studied patients was directly associated with increased levels of PI in UA and hCG. It was established that the risk of early PE was more inherent for women with the presence of PCH in the І trimester of pregnancy, while the percentage of the development of late PE with and/or without fetal growth retardation was more often higher in women with a threat of termination of pregnancy in the І trimester trimesters without the formation of RHG. Conclusions. The occurrence of RHG at the stage of early placentation increases the risks of developing placental dysfunction and obstetric complications associated with it. PRISCA-1, PLGF, PI of UA, as well as the calculation of the risk of developing PE in the trimester І using the FMF calculator should be used to form a risk group for the development of placenta-associated complications. Indicators of PI of UA >99 percentile in the І trimester of pregnancy in combination with a decrease in PAPP-A ˂0.45 MoM should be considered critical. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patients was obtained for conducting the studies. No conflict of interests was declared by the authors.