Possibilities for early prediction of perinatal outcomes in the I trimester in patients with placenta previa, complicated by abnormal placenta invasion

• Tatyana B. Makukhina
• Grigoriy A. Penzhoyan
• Elena S. Lebedenko
• Vadim A. Khorolsky
• Alina V. Solntseva
• Fatima В. Kazanchi

Abstract

Aim - to study the diagnostic capabilities of serological biochemical markers in the I trimester in patients with abnormal placentation to predict perinatal outcomes and optimize treatment.

Material and methods. Retrospective analysis of the charts of 48 patients with abnormal placentation: with placenta previa without abnormal placenta invasion (PP) - n=23; with abnormal placenta invasion (AIP) - n=25. The parity, the number (n) of pregnancies and previous cesarean sections, the level of PAPP-A and β-hCG in the I trimester in multiples of the median (MoM) (Me, 25-75%), the term and order of delivery, the volume of blood loss during delivery (ml), the newborn weight (g), the presence of fetal growth retardation syndrome (FGR), an Apgar score of 5^th minutes, the need for intensive care/resuscitation of the newborn were compared.

Results. In the AIP group the frequency of repeated cesarean sections was higher, the volume of blood loss during delivery was greater than in PP group without AIP (p<0.001). Differences in the level of PAPP-A and β-hCG between the groups were not significant. A positive correlation of the weight of the newborn with the level of PAPP-A, β-hCG, as well as the Apgar score by 5^th minutes with β-hCG reached a confidence level (ρ=0.346, 0.290, 0.397; p=0.019, 0.053, 0.017, respectively).

Conclusions. The value of the detected correlati on of serological markers in the I trimester with perinatal outcomes in patients with placenta previa/abnormal invasion does not have independent significance for optimizing treatment and requires further study.

Keywords:placenta previa, abnormally invasive placenta, РАРР-А, P-hCG, perinatal outcomes

Литература/References

1. Bartels H.C., Postle J.D., Downey P., Donal J., Brennan D.J. Placenta AccretaSpectrum: A Review of Pathology, Molecular Biology, and Biomarkers. Hindawi Disease Markers. 2018. Article ID 1507674. 11 p. doi.org/10.1155/ 2018/1507674

2. Townsend R., Khalil A., Premakumar Y., Allotey J., Snell K.I.E., Chan C., et al.; IPPIC Network. Prediction of pre-eclampsia: review of reviews. Ultrasound Obstet Gynecol. 2019; 54 (1): 16-27. doi: 10.1002/uog. 20117

3. Barrett S.L., Bower C., Hadlow N.C. Use of the combined first-trimester screen result and low PAPP-A to predict risk of adverse fetal outcomes. Prenat Diagn. 2008; 28 (1): 28-35. doi: 10.1002/pd.1898

4. Pihl K., SorensenT.L., Norgaard-Pedersen B., LarsenS.O., Nguyen T.H., Krebs L., et al. Christiansen M. First-trimester combined screening for Down syndrome: prediction of low birth weight, small for gestational age and preterm delivery in a cohort of non-selected women. Prenat Diagn. 2008; 28 (3): 247-53. doi: 10.1002/pd.1946

5. Jauniaux E., Alfirevic Z., Bhide A.G., Belfort M.A., Burton G.J., Collins S.L., et al. Sentilhes L on behalf of the Royal College of Obstetricians and Gynaecologists. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG. 2018. doi: 10.1111/1471-0528.15306

6. Desai N., Krantz D., Roman A., Fleischer A., Boulis S., Rochelson B. Elevated first trimester PAPP-A is associated with increased risk of placenta accrete. Prenatal Diag. 2014; 34: 159-62. doi: 10.1002/pd.4277

7. Thompson O., Otigbah C., Nnochiri A., Sumithran E., Spencer K. First trimester maternal serum biochemical markers of aneuploidy in pregnancies with abnormally invasive placentation. BJOG. 2015; 122: 1370-6. doi: 10.1111/1471-0528.13298

8. Lyell D.J., Faucett A.M., Baer R.J., Blumenfeld Y.J., Druzin M.L., El-Sayed YY, et al. Maternal serum markers, characteristics and morbidly adherent placenta in women with previa. J Perinatol. 2015; 35 (8): 570-4. doi: 10.1038/jp.2015.40

9. Penzhoyan G.A., Makukhina T.B. Significance of the routine first-trimester antenatal screening program for aneuploidy in the assessment of the risk of placenta accreta spectrum disorders. J Perinat Med. Published Online: 2019-11-14. doi: https://doi.org/10.1515/jpm-2019-0261

10. Costa S.L., Proctor L., Dodd J.M., Toal M., Okun N., Johnson J.A., et al. Screening for placental insufficiency in high-risk pregnancies: is earlier better? Placenta. 2008; 29 (12): 1034-40. doi: 10.1016/j.pla-centa.2008.09.004

11. Dreux S., Salomon LJ., Muller F, Goffinet F, Oury JF; ABA Study Group, Sentilhes L. Second-trimester maternal serum markers and placenta accrete. Prenatal Diag. 2012; 32 (10): 1010-2. doi: 10.1002/pd.3932

12. Buke B., Akkaya H., Demir S., Sagol S., §im§ek D., Ba§ol G., et al. Relationship between first trimester aneuploidy screening test serum analytes and placenta accrete. J Matern Fetal Neonatal Med. 2018; 31 (1): 59-62. doi: 10.1080/14767058.2016.1275546

13. ACOG. Placenta accreta spectrum. Replace Committee Opinion № 529, July 2012. ACOG/SMFM Consensus OB@GYN. 2018; 132 (6): 259-75.

14. Jauniaux E., Dimitrova I., Kenyon N., Mhallem M., Kametas N.A., Zosmer N., Hubinont C., Nicolaides K.H., Collins S.L. Impact of placenta previa with placenta accreta spectrum disorder on fetal growth. Ultrasound Obstet Gynecol. 2019 Feb 19. doi: 10.1002/uog.20244

15. Tantbirojn P., Crum C.P., Parast M.M. Pathophysiology of placenta creta: the role of decidua and extravillous trophoblast. Placenta. 2008; 29: 639-45. doi: 10.1016/j.placenta.2008.04.008

16. Hannon T., Innes B.A., Lash G.E., Bulmer J.N., Robson S.C. Effects of local decidua on trophoblast invasion and spiral artery remodeling in focal placenta creta - an immunohistochemical study. Placenta. 2012; 33: 998-1004. doi: 10.1016/j.placenta.2012.09.004

17. Weiner E., Miremberg H., Grinstein E., Mizrachi Y., Schreiber L., Bar J., Kovo M. The effect of placenta previa on fetal growth and pregnancy outcome, in correlation with placental pathology. J Perinatol. 2016; 36: 1073-8. doi: 10.1038/jp.2016.140

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