Pathology of placenta placement and thrombophilia: an inconspicuous connection

Aim: to test the hypothesis about a connection between genetic and acquired thrombophilia, as well as the characteristics of delivery in women with placental abnormalities.

Materials and Methods. A prospective controlled cohort non-randomized interventional study assessing the characteristics of delivery and the presence of thrombophilia was conducted in 135 women with placental abnormalities. Pregnant women were divided into 3 groups: group 1 included 42 women with a history of placental abnormalities; group 2 – 61 pregnant women with placenta previa first discovered during ongoing pregnancy; group 3 – 32 women with recurrent placenta previa. The control group included 120 pregnant women who had a normal placenta position and no complicated obstetric history. All women had a clinically assessed course of pregnancy, underwent ultrasound, testing for congenital and/or acquired thrombophilia by detecting antiphospholipid antibodies (APA), identification of genetic forms of thrombophilia: mutations in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene, mutations in the prothrombin gene G20210A, factor V Leiden mutations, assessment of present fibrinogen and plasminogen activator inhibitor 1 gene polymorphism.

Results. Thrombophilia was found in a significant percentage of patients with placenta previa (74.81 %), and the majority – with the multigene form belonged to group 3. The combination of genetic thrombophilia and APA circulation was detected in 22.22 % of patients. Signs of fetal growth restriction (FGR) were identified in all study groups: 4 (9.52 %) in group 1, 6 (9.84 %) in group 3, 6 (18.75 %) in group 3 and in 6 (6.67 %) in control group. All patients in the study groups underwent delivery by cesarean section (CS) – in 31 patients it was premature at 35–37 weeks due to increased fetoplacental insufficiency and the development of fetal distress syndrome: in 10 (23.8 %) pregnant women of group 1, in 12 (19.7 %) of group 2, and in 9 (28.1 %) women from group 3. In 104 women, CS was performed at 37–38 weeks of gestation. In the group of women with recurrent placenta previa (group 3) the frequency of complications during delivery significantly differed from similar those in groups 1 and 2 (p < 0.05) and control group (p < 0.001): 13 (40.6 %) cases of uterine hypotension were identified, 6 (18.8 %) uterine atony cases and 5 (15.6 %) cases of placenta accreta, which required hysterectomy in 7 (21.9 %) patients. In 4 (12.5 %) cases, clinically significant signs of deep vein thrombosis (DVT) were detected.

Conclusion. The study results indicate a connection between placenta previa, genetic thrombophilia and emergence of complications during delivery. The need to adjust approaches to the management of pregnancy delivery by taking such risk factors into consideration was discovered.

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