Tissue factor pathway inhibitor for prediction of placenta-mediated adverse pregnancy outcomes in high-risk women: AngioPred study.

Aurélie Di Bartolomeo,Silvy Laporte,Edouard Noblot,Tiphaine Raia-Barjat,Céline Chauleur,Céline Chapelle,Jean-Christophe Gris

doi:10.1371/journal.pone.0173596

Abstract

ObjectiveThe study aimed to evaluate if the rate of tissue factor pathway inhibitor during pregnancy and following delivery could be a predictive factor for placenta-mediated adverse pregnancy outcomes in high-risk women.MethodsThis was a prospective multicentre cohort study of 200 patients at a high risk of occurrence or recurrence of placenta-mediated adverse pregnancy outcomes conducted between June 2008 and October 2010. Measurements of tissue factor pathway inhibitor resistance (normalized ratio) and tissue factor pathway inhibitor activity were performed for the last 72 patients at 20, 24, 28, 32, and 36 weeks of gestation and during the postpartum period.ResultsOverall, 15 patients presented a placenta-mediated adverse pregnancy outcome. There was no difference in normalized tissue factor pathway inhibitor ratios between patients with and without placenta-mediated adverse pregnancy outcomes during pregnancy and in the post-partum period. Patients with placenta-mediated adverse pregnancy outcomes had tissue factor pathway inhibitor activity rates that were significantly higher than those in patients without at as early as 24 weeks of gestation. The same results were observed following delivery.ConclusionAmong high-risk women, the tissue factor pathway inhibitor activity of patients with gestational vascular complications is higher than that in other patients. Hence, these markers could augment a screening strategy that includes an analysis of angiogenic factors as well as clinical and ultrasound imaging with Doppler measurement of the uterine arteries.

Highlights

Placenta-mediated adverse pregnancy outcomes (or placental vascular pathology (PVP)) represents a heterogeneous group of multisystem disorders that can be maternal [pre-eclampsia (PE); eclampsia; retroplacental hematoma; hemolysis; elevated liver enzymes; low platelets (HELLP) syndrome] or foetoplacental through placental hypoperfusion, leading to intrauterine growth retardation (IUGR) or oligohydramnios
There was no difference in normalized tissue factor pathway inhibitor ratios between patients with and without placenta-mediated adverse pregnancy outcomes during pregnancy and in the post-partum period
TFPI for placenta-mediated adverse pregnancy outcomes prediction in high-risk women could augment a screening strategy that includes an analysis of angiogenic factors as well as clinical and ultrasound imaging with Doppler measurement of the uterine arteries

Summary

Introduction

Placenta-mediated adverse pregnancy outcomes (or placental vascular pathology (PVP)) represents a heterogeneous group of multisystem disorders that can be maternal [pre-eclampsia (PE); eclampsia; retroplacental hematoma; hemolysis; elevated liver enzymes; low platelets (HELLP) syndrome] or foetoplacental through placental hypoperfusion, leading to intrauterine growth retardation (IUGR) or oligohydramnios. PE complicates between 2% and 8% of pregnancies[1], making placenta-mediated adverse pregnancy outcomes fairly common. The introduction of closer monitoring, transfer to adapted level maternity, and antenatal steroids can significantly reduce maternal and foetal morbidity, which underscores the importance of early identification.[4] Once PE occurs, the only curative treatment is delivery, and placenta-mediated adverse pregnancy outcomes risk factors are well-known, there is still no validated screening strategy for predicting the occurrence of this pathology in high-risk patients.[5,6]

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Discussion

Conclusion