Prenatal screening as a predictor of gestational complications

Objective.To analyze the course and outcomes of pregnancies in women at high risk of fetal chro-mosomal abnormalities, preeclampsia, fetal growth retardation, and preterm birth according to the results of prenatal screening. Patients and methods. This prospective study included 443 women with singleton pregnancies. Study participants were divided into two groups: Group 1 included women at high risk of complica-tions (n = 235), while Group 2 (control) comprised women at low risk of gestational complications (n = 208). Patients in Group 1 were further subdivided into 4 subgroups: subgroup 1A included women at risk of fetal chromosomal abnormalities (CA) (n = 69); subgroup 1B included women at risk of preeclampsia (PE) (n = 66); subgroup 1C included women at risk of fetal growth retardation (FGR) (n = 48); and subgroup 1D included women at risk of preterm birth (PB) (n = 52). Confirmed chromosomal abnormalities were considered as an exclusion criterion. Results. Threatened miscarriage (TM) and bleeding in the first trimester were significantly more common in patients from Group 1. In the second trimester, the risk of TM was increased among women from subgroups 1A, 1B, 1C, and particularly 1D. In the third trimester, we observed sig-nificant differences in the frequency of FGR between group 1 (subgroups 1A, 1С, 1D) and controls. In subgroups 1A, 1B, 1C, and 1D, the incidence of PE and FGR was higher in patients who did not receive aspirin. The frequency of threatened PB was higher in subgroups 1B, 1C, and 1D compared to Group 2 (p < 0.05). Conclusion. High prenatal risk of fetal CA should be considered as a risk factor for PB, TM, FGR, and PE. Key words: prenatal screening, chromosomal abnormalities, preeclampsia, fetal growth retarda-tion, preterm birth, pregnancy, perinatal risk

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Antiphospholipid antibodies, genetic thrombophilia and fetal growth retardation

Obstetrics Gynecology and Reproduction ◽

10.17749/2313-7347/ob.gyn.rep.2021.278 ◽

2022 ◽

Vol 15 (6) ◽

pp. 695-704

Author(s):

E. A. Orudzhova

Keyword(s):

Pregnant Women ◽

Fetal Growth ◽

Growth Retardation ◽

Antiphospholipid Antibodies ◽

Controlled Trial ◽

Factor V Leiden ◽

Control Group ◽

Fetal Growth Retardation ◽

Group 2 ◽

Group 1

Aim: to study the role of antiphospholipid antibodies (AРA) and genetic thrombophilia as a potential cause of the development or a component in the pathogenesis of early and late fetal growth retardation (FGR).Materials and Methods. There was conducted a prospective randomized controlled trial with 118 women enrolled. The main group consisted of 83 patients, whose pregnancy was complicated by FGR degrees II and III, stratified into two groups: group 1 – 36 pregnant women with early FGR, group 2 – 47 pregnant women with late FGR. Women were subdivided into subgroups according to the FGR severity. The control group consisted of 35 pregnant women with a physiological course of pregnancy. АРА were determined according to the Sydney antiphospholipid syndrome criteria by enzyme immunoassay (ELISA): against cardiolipin, β2 -glycoprotein 1, annexin V, prothrombin, etc. (IgG/IgM isotypes); lupus anticoagulant – by the three-stage method with Russell's viper venom; antithrombin III and protein C levels – by chromogenic method; prothrombin gene polymorphisms G20210A and factor V Leiden – by polymerase chain reaction; homocysteine level – by ELISA.Results. AРA circulation (medium and high titers), genetic thrombophilic defects and/or hyperhomocysteinemia were detected in 40 (48.2 %) patients with FGR, which was significantly higher than that in the control group (p < 0.05): in group 1 (41.7 % of women) AРA (30.6 %) and AРA with genetic thrombophilia or hyperhomocysteinemia (11.1 %) were revealed; in group 2 (51.1 % of women) AРA (21.3 %), AРA with hyperhomocysteinemia (4.3 %), genetic thrombophilia (25.5 %), and due to hyperhomocysteinemia (2.1 %) were found. No differences in prevalence of thrombophilia rate in patients were observed related to FGR severity, but a correlation between the FGR severity and AРA titers was found.Conclusion. Testing for the presence of AРA, genetic thrombophilia and hyperhomocysteinemia should be recommended for patients with FGR (including those with FGR in medical history), especially in the case of its early onset. It is recommended to determine the full AРA spectrum.

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Effects of preterm birth and fetal growth retardation on cardiovascular risk factors in young adulthood

Early Human Development ◽

10.1016/j.earlhumdev.2008.10.008 ◽

2009 ◽

Vol 85 (4) ◽

pp. 239-245 ◽

Cited By ~ 75

Author(s):

Kari Anne Indredavik Evensen ◽

Sigurd Steinshamn ◽

Arnt Erik Tjønna ◽

Tomas Stølen ◽

Morten Andre Høydal ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Preterm Birth ◽

Cardiovascular Risk Factors ◽

Young Adulthood ◽

Fetal Growth ◽

Growth Retardation ◽

Fetal Growth Retardation

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Fetal growth retardation: Associated malformations and chromosomal abnormalities

American Journal of Obstetrics and Gynecology ◽

10.1016/0002-9378(93)90491-z ◽

1993 ◽

Vol 168 (2) ◽

pp. 547-555 ◽

Cited By ~ 146

Author(s):

R.J.M. Snijders ◽

C. Sherrod ◽

C.M. Gosden ◽

K.H. Nicolaides

Keyword(s):

Fetal Growth ◽

Growth Retardation ◽

Chromosomal Abnormalities ◽

Fetal Growth Retardation ◽

Associated Malformations

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Controlled study of subcutaneous heparin and dipyridamole in women at high risk to fetal growth retardation

Pregnancy Hypertension ◽

10.1007/978-94-009-8697-8_81 ◽

1980 ◽

pp. 577-580 ◽

Cited By ~ 2

Author(s):

B. P. Gill ◽

J. Bonnar

Keyword(s):

High Risk ◽

Fetal Growth ◽

Growth Retardation ◽

Controlled Study ◽

Fetal Growth Retardation ◽

Subcutaneous Heparin

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Predictive value of hyperhomocysteinemia in pregnant women with chronic hypertension

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2011-17-4-379-383 ◽

2011 ◽

Vol 17 (4) ◽

pp. 379-383

Author(s):

V. S. Chulkov ◽

N. K. Vereina ◽

S. P. Sinitsin

Keyword(s):

Pregnant Women ◽

Fetal Growth ◽

Growth Retardation ◽

Prognostic Significance ◽

Placental Insufficiency ◽

Chronic Hypertension ◽

Fetal Growth Retardation ◽

Group 2 ◽

Insufficiency Syndrome ◽

Design And Methods

Objective. To investigate homocysteine levels in pregnant women with chronic hypertension in different terms of pregnancy, and to evaluate the prognostic significance of hyperhomocysteinemia in the development of preeclampsia, placental insufficiency syndrome and fetal growth retardation. Design and methods. It is a cohort prospective study. Pregnant women were divided into 2 groups: group 1 was formed by women with chronic hypertension (n = 80), group 2 consisted of 40 women without hypertension. Results. Pregnant women with chronic hypertension had higher homocysteine levels throughout the pregnancy compared to those without hypertension. Homocysteine level was higher in pregnancy complicated by preeclampsia, placental insufficiency and fetal growth retardation syndrome. Conclusion. Homocysteine levels above 5,8 mmol/l in the III trimester of pregnancy may be used as a prognostic risk factor for preeclampsia development.

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Evaluation of Serial 2-D Sonographic Placental Volumetry and Umbilical Arterial Doppler and Their Correlation with Uterine Arterial Doppler in Predicting Adverse Fetomaternal Outcomes – An Observational Study from a Tertiary Care Centre in Pune, India

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/595 ◽

2021 ◽

Vol 8 (36) ◽

pp. 3276-3281

Author(s):

Samrat Ghosh ◽

Ankur Shah ◽

Ritwik Chakraborti ◽

Debraj Sen

Keyword(s):

At Risk ◽

Fetal Growth ◽

Growth Retardation ◽

Tertiary Care ◽

Screening Tools ◽

Morbidity And Mortality ◽

Receiver Operating Curve ◽

Fetal Growth Retardation ◽

Perinatal Morbidity ◽

Placental Volume

BACKGROUND An important part of human placental development is the extensive modification of maternal vasculature by trophoblasts. Fetal growth retardation (FGR) and preeclampsia (PE) are associated with deficient trophoblastic invasion and modification of the uterine spiral arteries leading to small-caliber vessels of high resistance which impairs placental blood flow, creating a hypoxic environment and subsequent oxidative stress. FGR and pre-eclampsia are important causes of maternal and perinatal morbidity and mortality and it is important to identify such ‘at risk’ pregnancies during routine antenatal care. Ultrasonography (USG) and colour-Doppler are readily available tools that may be used for identifying such ‘at risk’ pregnancies. The purpose of this study was to evaluate the accuracy of 2-D sonographic placental volumetry, umbilical arterial doppler and uterine arterial doppler in predicting adverse fetomaternal outcomes and compare the accuracy of these three tests with each other in terms of sensitivity and specificity. METHODS A total of 100 women were randomly selected from the antenatal clinics, and were subject to serial ultrasounds at 12 - 16 weeks, 20 - 24 weeks, and 28 - 32 weeks. The 2-D sonographic placental volume, umbilical and uterine arterial resistivity index (RI), and pulsatility index (PI) were measured. The pregnancies were followed up till delivery and the measurements were plotted against the actual placental weight and development of FGR and/or pre-eclampsia. RESULTS In pregnancies with FGR or pre-eclampsia, the placental volumes were low, and correspondingly the uterine and umbilical arterial RI and PI were high (increased impedance) as compared to the normal pregnancies. For the prediction of adverse outcomes, a receiver operating curve (ROC) analysis showed that placental volume and umbilical artery RI and PI had high sensitivity in the 1st-trimester, and high specificity in the 2nd-trimester. CONCLUSIONS 2-D sonographic placental volumetry and umbilical arterial Doppler studies may be used as 1st-trimester screening tools to predict adverse fetomaternal outcomes. These patients may be subjected to more intensive follow-up to minimize maternal and perinatal morbidity and mortality. KEYWORDS Doppler Ultrasonography; Fetal Growth Retardation; Placenta; Pre-eclampsia; Umbilical Arteries; Uterine Artery

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Continuous-Wave Doppler Investigation of Uteroplacental Vessels in High-Risk Pregnancies as Predictor of Fetal Growth Retardation and Pregnancy-Induced Hypertension

Gynecologic and Obstetric Investigation ◽

10.1159/000292456 ◽

1994 ◽

Vol 38 (2) ◽

pp. 90-95 ◽

Cited By ~ 2

Author(s):

Wolfgang Hütter ◽

Dieter Grab ◽

Diane Schneider ◽

Rainer Terinde ◽

Alfred Wolf

Keyword(s):

High Risk ◽

Fetal Growth ◽

Growth Retardation ◽

Continuous Wave ◽

Pregnancy Induced Hypertension ◽

Fetal Growth Retardation ◽

Continuous Wave Doppler ◽

Induced Hypertension

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Literature Reviews: Neonatology: Fetal Growth Retardation: Associated Malformations and Chromosomal Abnormalities Snijders RJM, Sherrod C, Gosden CM, Nicolaides KH. Am J Obstet Gynecol. 1993;168:547-555

Clinical Pediatrics ◽

10.1177/000992289303201215 ◽

1993 ◽

Vol 32 (12) ◽

pp. 755-755

Keyword(s):

Fetal Growth ◽

Growth Retardation ◽

Obstet Gynecol ◽

Chromosomal Abnormalities ◽

Fetal Growth Retardation ◽

Literature Reviews ◽

Associated Malformations

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Clinical significance of regulatory antibodies content evaluation in pregnant women with fetal growth retardation

Kazan medical journal ◽

10.17816/kmj1990 ◽

2014 ◽

Vol 95 (6) ◽

pp. 836-840

Author(s):

V K Lazareva ◽

R S Zamaleeva ◽

N A Cherepanova

Keyword(s):

At Risk ◽

Pregnant Women ◽

Fetal Growth ◽

Growth Retardation ◽

Protein A ◽

Serum Levels ◽

Control Group ◽

Fetal Growth Retardation ◽

Pregnancy And Childbirth ◽

Grade Ii

Aim. To identify the possibility of fetal growth retardation prediction at early stages of pregnancy by revealing changes in the content of some regulatory autoantibodies. Methods. A comprehensive examination of 388 pregnant women at risk of gestational complications was performed. After standardization of groups 185 pregnant women were selected for the analysis. Out of these, 80 patients with fetal growth retardation were included into the main group, 80 matched pairs were selected from the group of pregnant women at risk of fetal growth retardation (comparison group). The control group consisted of 25 healthy pregnant women with physiological pregnancy and childbirth. Patients with fetal growth retardation were divided into three subgroups. The first subgroup consisted of 40 pregnant women with grade I of fetal growth retardation, 24 pregnant women with grade II of fetal growth retardation formed the second subgroup, and 16 pregnant women with grade III of fetal growth retardation were included into the third subgroup. Along with the standard methods of examination the serum levels of regulatory class G antibodies binding with double-stranded deoxyribonucleic acid, β2-glycoprotein, total phospholipids, human chorionic gonadotropin, collagen, pregnancy-associated plasma protein-A, insulin, and the level of anti-neutrophil cytoplasmic antibodies, on the dates of 11-14 and 26-28 weeks of pregnancy. Results. The peculiarities of the regulatory autoantibodies content in pregnant women with fetal growth retardation and in women at risk of this condition were revealed. Pregnant women with grade I and II of fetal growth retardation had higher values of autoantibodies, whereas severe forms of fetal growth retardation were characterized by diverse changes of the examined regulatory autoantibodies with a predominance of low values. In case of pregnant women at risk of fetal growth retardation changes in the content of regulatory autoantibodies were diverse. Conclusion. The revealed changes in the content of regulatory autoantibodies can be used for prediction of fetal growth retardation in pregnant women.

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