Pathological placentation and prediction of preeclampsia and intrauterine growth restriction in the first trimester
Objective. To generalize an update on the echographic, biochemical, and molecular genetic markers of pathological placentation associated with the prediction of preeclampsia (PE) and intrauterine growth restriction (IUGR) in the first trimester of pregnancy.Kholin A.M., Khodzhaeva Z.S., Gus A.I.
Material and methods. There are the data of clinical trials and the meta-analyses of randomized clinical trials published in the past 15 years.
Results. Placenta is a multi-functional organ that regulates the key aspects of pregnancy maintenance and fetal development. Consideration is given to the issues of early prediction of PE and IUGR in the evaluation of the placenta with uterine artery Doppler studies, 3D power Doppler angiography, and placental biomarkers. There have been publications on a lot of multiparameter algorithms to predicting PE and IUGR in the first trimester, some of them are validated in prospective studies. There is evidence for the effectiveness of programs for the prediction and prevention of PE in the first trimester with 62 and 82% decreases in the rate of premature and early PE, respectively. The screening tools for IUGR are less perfect and require further investigation. There is a need for further clinical trials evaluating the function of the placenta and for definition of its phenotypes within the syndromes of PE and IUGR for prospective trials to confirm the effectiveness of predictive models and therapeutic interventions.
Conclusion. There is substantial progress in the development of prognostic and prophylactic strategies, beginning from the first trimester, which can reduce the prevalence of PE and IUGR at an early stage. A better understanding of placentation processes can contribute to the emergence of new prognostic markers and to the improvement of strategies for predicting adverse pregnancy outcomes associated with placental dysfunction.
Keywords
preeclampsia
intrauterine growth restriction
prediction
first-trimester prenatal screening
prevention
biomarkers
uterine artery Doppler study
3D power Doppler angiography
mean blood pressure
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Received 08.09.2017
Accepted 22.09.2017
About the Authors
Alexey Kholin, M.D., Research Associate, Department of Maternal Fetal Medicine, Department of Imaging, National Medical Research Center of Obstetrics, Gynecology,and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russiaю 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: a_kholin@oparina4.ru
Zulfiya Khodzhaeva, M.D., Ph.D., Professor, Head of Department, Department of Maternal-Fetal Medicine, National Medical Research Center of Obstetrics, Gynecology,
and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russiaю 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: z_khodzhaeva@oparina4.ru
Alexander Gus, M.D., Ph.D., Head of Department, Department of Imaging, National Medical Research Center of Obstetrics, Gynecology, and Perinatology named
after Academician V.I. Kulakov, Ministry of Health of Russiaю 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: a_gus@oparina4.ru
For citations: Kholin A.M., Khodzhaeva Z.S., Gus A.I. Pathological placentation and prediction
of preeclampsia and intrauterine growth restriction in the first trimester.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (5): 12-9. (in Russian)
https://dx.doi.org/10.18565/aig.2018.5.12-19
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