Published April 29, 2022 | Version v1
Journal article Open

OBSTETRIC AND PERINATAL PATHOLOGY IN PREGNANT WOMEN WHO HAD COMPLICATIONS FROM THE GROUP OF THE GREAT OBSTETRICAL SYNDROMES

Creators

  • 1. SHEI "Uzhgorod national university", Uzhgorod , Ukraine

Description

The objective: to analyze the obstetric and perinatal outcomes of childbirth in pregnant women who had complications from the group of the great obstetrical syndromes.
Materials and methods. A retrospective statistical analysis of obstetric and perinatal outcomes of childbirth of 239 pregnant women (the Ist group – main one) who had complications from the group of the great obstetrical syndromes (GOS). They were divided into three subgroups: Ia subgroup included 103 pregnant women with severe preeclampsia (PE), Ib subgroup – 67 pregnant women with placental insufficiency, with clinical manifestation of fetal intrauterine growth retardation (IUGR), Ic subgroup – 69 pregnant women with spontaneous preterm birth in the gestational age 22-36 weeks. The control group (CG) included 56 practically healthy pregnant women with a normal reproductive history and uncomplicated course of this pregnancy.
Statistical processing of the study results was performed using standard programs Microsoft Excel 5.0 and Statistica 6.0.
Results. The incidence of gestational diabetes mellitus in patients of the I group (28 (11.7 %) women) was higher than in CG (2 (3.6 %) persons). Cervical insufficiency was diagnosed in every fifth patient of Ic subgroup (12 (17.3 %) patients; χ2=15.56, p<0.01; OR=9.25; CI 95%: 2.55–33.54 relative to CG), gestational anemia – in 179 (74.8 %) pregnant women in the I group and 18 (32.1 %) women in CG (p<0.01).
A significantly high rate of mild congenital malformations was present in subgroup Ib (7 (10.4 %) of pregnant women; χ2=12.67, p<0.01; OR=7.93; CI 95%: 2.14-29.26). 21 patients in the I group had with antenatal fetal death, 6 (5.8 %) – severe PE, 11 (16.4 %) – IUGR. Five cases of early neonatal mortality was diagnosed in the I group. The rate of perinatal mortality in the I group was high and amounted to 108.7 ‰.
The operative delivery in the I group was performed in 127 (53.1 %) patients which is significantly more than in CG (χ2=42.93, p<0.01; OR=4.93; CI 95%: 2.99– 8.13). In 24 (18.9 %) pregnant women in the I group the indication for operative delivery was acute distress, which is significantly more than in CG (2 (3.6 %) women; χ2=7.36, p<0.01; OR=5.17; CI 95%: 1.2–22.28). The mean score on the Apgar scale in newborns in CG was significantly higher compared with the I group (p<0.01).
Conclusions. The course of pregnancy and childbirth in women who had complications from the group of the great obstetrical syndromes was accompanied by the development of gestational diabetes, gestational anemia and cervical insufficiency. Complications such as fetal distress, severe preeclampsia, fetal growth retardation with decompensated hemodynamic disorders of the uterine and placental blood circulation, led to a high frequency of cesarean section in these patients.

Files

Obstetric and perinatal pathology in pregnant women who had complications from the group of the Great Obstetrical Syndromes.pdf

Files (344.7 kB)

Additional details

References

  • Di Renzo GC. The Great Obstetrical Syndromes. J Matern Fetal Neonatal Med. 2009;22(8):633-5. doi: 10.1080/14767050902866804.
  • Romero R. Prenatal medicine: The child is the father of the man 1996. J Matern Fetal Neonatal Med. 2009;22(8):636-9. doi: 10.1080/14767050902784171.
  • Kim YM, Chaiworapongsa T, Gomez R, Bujold Emmanuel, Yoon BH, Rotmensch S, et al. Failure of physiologic transformation of the spiral arteries in the placental bed in preterm premature rupture of membranes. Am J Obstet Gynecol. 2012;187(5):1137-42. doi: 10.1067/mob.2002.127720.
  • Kim YM, Bujold E, Chaiworapongsa T, Gomez R, Yoon BH, Thaler HT et al. Failure of physiologic transformation of the spiral arteries in patients with preterm labor and intact membranes. Am J Obstet Gynecol. 2013:189(4):1063-9. doi: 10.1067/s0002-9378(03)00838-x.
  • Romero R, Mazor M, Munoz H, Gomez R, Galasso M, Sherer DM. The preterm labor syndrome. Ann N Y Acad Sci. 1994;734:414-29. doi: 10.1111/j.1749-6632.1994.tb21771.x.
  • Romero R, Espinoza J, Mazor M, Chaiworapongsa T. The preterm parturition syndrome. In: Critchely H, Bennett P, Thornton S, editors. Preterm Birth. London: RCOG Press; 2004, pp. 28-60.
  • Romero R, Espinoza J, Gotsch F, Kusanovic JP, Friel LA, Erez O, et al. The use of high-dimensional biology (genomics, transcriptomics, proteomics, and metabolomics) to understand the preterm parturition syndrome. BJOG. 2006;113(3):118-35. doi: 10.1111/j.1471-0528.2006.01150.x.
  • Sibai BM. Preeclampsia: an inflammatory syndrome? Am J Obstet Gynecol. 2004;191(4):1061-2. doi: 10.1016/j.ajog.2004.03.042.
  • Sibai B, Dekker G, Kupferminc M. Preeclampsia. Lancet. 2015;365(9461):785-99. doi: 10.1016/S0140-6736(05)17987-2.
  • Roberts JM, Gammill HS. Preeclampsia: recent insights. Hypertension. 2015;46(6):1243-9. doi: 10.1161/01.HYP.0000188408.49896.c5.
  • Redman CW, Sargent IL. Latest advances in understanding preeclampsia. Science. 2015;308(5728):1592-4. doi: 10.1126/science.1111726.
  • Stella CL, Sibai BM. Preeclampsia: Diagnosis and management of the atypical presentation. J Matern Fetal Neonatal Med. 2016;19(7):381-6. doi: 10.1080/14767050600678337.
  • Ness RB, Sibai BM. Shared and disparate components of the pathophysiologies of fetal growth restriction and preeclampsia. Am J Obstet Gynecol. 2006;195(1):40-9. doi: 10.1016/j.ajog.2005.07.049.
  • Espinoza J, Romero R, Nien JK, Gomez R, Kusanovic JP, Gonçalves LF, et al. Identification of patients at risk for early onset and/or severe preeclampsia with the use of uterine artery Doppler velocimetry and placental growth factor. Am J Obstet Gynecol. 2007;196(4):326.e1-e13. doi: 10.1016/j.ajog.2006.11.002.
  • Kusanovic JP, Romero R, Hassan SS, Gotsch F, Edwin S, Chaiworapongsa T, et al. Maternal serum soluble CD30 is increased in normal pregnancy, but decreased in preeclampsia and small for gestational age pregnancies. J Matern Fetal Neonatal Med. 2007;20(12):867-78. doi: 10.1080/14767050701482993.
  • Romero R, Nien JK, Espinoza J, Todem D, Fu W, Chung H, et al. A longitudinal study of angiogenic (placental growth factor) and anti-angiogenic (soluble endoglin and soluble vascular endothelial growth factor receptor-1) factors in normal preg- nancy and patients destined to develop preeclampsia and deliver a small for gestational age neonate. J Matern Fetal Neonatal Med. 2008;21(1):9-23. doi: 10.1080/14767050701830480.
  • Chaiworapongsa T, Romero R, Gotsch F, Nien JK, Goncalves L, ES, Kim YM, et al. Low maternal concentrations of soluble vascular endothelial growth factor receptor-2 in preeclampsia and small for gestational age. J Matern Fetal Neonatal Med. 2008;21(1):41-52. doi: 10.1080/14767050701831397.
  • Di Renzo GC. The role of an ''Anti-angiogenic state'' in complications of pregnancy. J Matern Fetal Neonatal Med. 2008;21(1):3-7. doi: 10.1080/14767050701855081.
  • Korteweg FJ, Gordijn SJ, Timmer A, Holm JP, Ravisé JM, Erwich JJHM. A placental cause of intra-uterine fetal death depends on the perinatal mortality classification system used. Placenta. 2008;29(1):71-80. doi: 10.1016/j.placenta.2007.07.003.
  • Gabbay-Benziv R, Baschat A. Gestational diabetes as one of the "Great obstetrical syndromes" – the maternal, placental, and fetal dialog. Best Pract Res Clin Obstet Gynaecol. 2015;28(2):150-5. doi: 10.1016/j.bpobgyn.2014.04.025.
  • Soto E, Romero R, Kusanovic JP, Ogge G, Hussein Y, Yeo L, et al. Late-Onset Preeclampsia Is Associated with an Imbalance of Angiogenic and Anti-Angiogenic Factors in Patients with and without Placental Lesions Consistent with Maternal Underperfusion. J Maternal-Fetal Neonatal Med. 2012;25(5):498-507. doi: 10.3109/14767058.2011.591461.
  • Brosens I, Pijnenborg R, Vercruysse L, Romero R. The Great obstetrical syndromes are associated with disorders of deep placentation. Am J Obstet Gynecol. 2011;204(3):193-201. doi: 10.1016/j.ajog.2010.08.009.
  • Mintser AP. Statisticheskiye metody issledovaniya v klinicheskoy meditsine. Prakt med. 2010;3:41-5.
  • Lang TA, Sesik M. Kak opisyvat statistiku v meditsine: rukovodstvo dlya avtorov, redaktorov i retsenzentov. Moskva: Prakticheskaya Meditsina; 2011. 480 s.
  • Glants S. Mediko-biologicheskaya statistika: per. s angl. Moskva: Praktika; 1998. 459 s.
  • Gabbay-Benziv R, Baschat A. Gestational diabetes as one of the "Great obstetrical syndromes" – the maternal, placental, and fetal dialog. Best Practice & Research Clinical Obstetrics & Gynaecology. 2015;28(2):150-5. doi: 10.1016/j.bpobgyn.2014.04.025.
  • Taylor BD, Ness RB, Klebanoff MA, Tang G, Roberts JM, Hougaard DM, et al. The impact of female fetal sex on preeclampsia and the maternal immune milieu. Pregnancy Hypertens. 2018;12:53-7. doi: 10.1016/j.preghy.2018.02.009.
  • Taylor BD, Haggerty CL, Ness RB, Hougaard DM, Skogstrand K, Roberts JM, et al. Fetal sexual dimorphism in systemic soluble fms-like tyrosine kinase 1 among normotensive and preeclamptic women. Am J Reprod Immunol. 2018;80(5):e13034. doi: 10.1111/aji.13034.