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Pathogenetically differentiated management of pregnancy in patients with retrochorial hematoma

https://doi.org/10.17749/2313-7347.2020.14.1.15-24

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Abstract

Introduction. Intrauterine hematomas commonly found in routine ultrasound examinations represent one of causes resulting in early pregnancy loss. The most common is retrochorial hematoma resulting from fetal egg detachment from the uterine wall. Retrochorial hematoma often leads to pregnancy complications and affects gestational process.

Aim: to develop a personalized approach to the diagnosis, prevention and management of pregnancy with retrochorial hematomas in the early stages.

Materials and methods. A prospective examination of 70 females, aged 22 to 37 years old, with retrochorial hematoma was performed at gestational age ranging from 5 to 12 weeks. Here, we examined serum level for lupus anticoagulant, antiphospholipid antibodies (AFA), antibodies to cardiolipin, fi2-glycoprotein I, to annexin V and prothrombin, and ADAMTS-13. All women were examined for genetic mutations linked to high thrombogenic risk and low thrombogenic risk polymorphisms. Patients were also examined for urinary tract infections.

Results. It was found that 43 (61 %) females had aggravated obstetric anamnesis (non-developing pregnancy, spontaneous miscarriage in early stages, antenatal fetal death), whereas 13 (18.5 %) subjects had burdened familial thrombotic history (heart attack, stroke, and thrombosis occurred before the age of 55 years in first-line relatives). In addition, 22 (31.4 %) females were found to have genetic and acquired forms of thrombophilia; 6 (8.5 %) were detected to have circulatory ADAMTS-13 inhibitor; 5 females were confirmed to have decreased blood coagulation factor activity; and 38 (54.2 %) had vaginal dysbiosis.

Conclusion. Our work demonstrates that a personified and pathogenetically differentiated algorithm for diagnostics and management of pregnant women with chorionic detachments in early stages allows to lower frequency of early abortions and increases the therapeutic effectiveness.

About the Authors

Kh. G. Sultangadzhieva
Sechenov University
Russian Federation

Khadizhat G. Sultangadzhieva - Postgraduate Student, Department of Obstetrics and Gynecology, Institute of Children’s Health.

Bild 2,8 Trubetskaya St., Moscow 119991



J. Kh. Khizroeva
Sechenov University
Russian Federation

Jamilya Kh. Khizroeva - MD, Dr Sci Med, Professor, Department of Obstetrics and Gynecology, Institute of Children’s Health.

Bild 2,8 Trubetskaya St., Moscow 119991



References

1. Makatsariya A.D., Bitsadze V.O., Baimuradova S.M. et al. Antiphospholipid syndrome - the immune thrombophilia in obstetrics and gynecology. Ed. A.D. Makatsariya. [Antifosfolipidnyj sindrom -immunnaya trombofiliya v akusherstve i ginekologii. Pod red. A.D. Makatsariya]. Moskva: Triada-X, 2013. 485 s. (In Russ.).

2. Norman S.M., Odibo A.O., Macones G.A. et al. Ultrasound-detected subchorionic hemorrhage and the obstetric implications. Obstet Gynecol. 2010;116(2 Pt 1):311-5. DOI: 10.1097/AOG.0b013e3181e90170.

3. Goldstein S.R., Subramanyam B.R., Raghavendra B.N. et al. Subchorionic bleeding in threatened abortion: sonographic findings and significance. AJR Am J Roentgenol. 1983;141(5):975-8. DOI: 10.2214/ajr.141.5.975.

4. Sultangadzhieva K.G. Pathogenesis of chorionic detachment and intrauterine hematomas in early pregnancy: a literature review. [Patogenez vozniknoveniya otslojki horiona i vnutrimatochnyh gematom na rannih srokah beremennosti: obzor sovremennyh nauchnyh dannyh]. Akusherstvo, ginekologiya ireprodukciya. 2019;13(4):354-68. (In Russ.). DOI: 10.17749/2313-7347.2019.13.4.354-368.

5. Bitsadze V.O., Khizroeva D.Kh., Makatsariya N.A. et al. Antiphospholipid antibodies, their pathogenetic and diagnostic issues in obstetric practice. [Antifosfolipidnye antitela, ih patogeneticheskoe i diagnostich-eskoe znachenie pri akusherskoj patologii]. Akusherstvo, ginekologiya ireprodukciya. 2014;8(2):39—60. (In Russ.).

6. Potdar N., Gelbaya T.A., Konje J.C., Nardo L.G. Adjunct low-molecular-weight heparin to improve live birth rate after recurrent implantation failure: a systematic review and meta-analysis. Hum Reprod Update. 2013;19(6):674-84. DOI: 10.1093/humupd/dmt032.

7. Carp H. A systematic review of dydrogesterone for the treatment of threatened miscarriage. Gynecol Endocrinol. 2012;28(12):983-90. DOI: 10.3109/09513590.2012.702875.

8. Coomarasamy A., Devall A.J., Cheed V. et al. A randomized trial of progesterone in women with bleeding in early pregnancy. N Engl J Med. 2019;380(19):1815-24. DOI: 10.1056/NEJMoa1813730.

9. Peitsidis P., Kadir R.A. Antifibrinolytic therapy with tranexamic acid in pregnancy and postpartum. Expert Opin Pharmacother. 2011;12(4):503-16. DOI: 10.1517/14656566.2011.545818.

10. Wang D., Luo Z.Y., Yu Z.P. et al. The antifibrinolytic and anti-inflammatory effects of multiple doses of oral tranexamic acid in total knee arthroplasty patients: a randomized controlled trial. J Thromb Haemost. 2018;16(12):2442—53. DOI: 10.1111/jth.14316.

11. Kovalyova J.V. Subchorionic hematoma. Causes, pathogenesis, diagnostic and treatment management. [Retrohorial’naya gematoma. Voprosy etiopatogeneza, diagnostiki i terapii]. Zhurnalakusherstva i zhenskih boleznej. 2013;62(4):37—47. (In Russ.).

12. Bitsadze V.O., Makatsariya A.D. Use of low molecular weight heparins in obstetric practice. [Primenenie nizkomolekulyarnyh geparinov v akusherskoj praktike]. RMZh. 2000;8(18):772-7. (In Russ.).

13. Khizroeva D.Kh. Antiphospholipid syndrome and failures of extracorporal fertilization. [Antifosfolipidnyj sindrom i neudachi ekstrakorporal’nogo oplodotvoreniya]. Prakticheskaya medicina. 2013;(6):154—60. (In Russ.).

14. De Sancho M.T., Khalid S., Christos P.J. Outcomes in women receiving low-molecular-weight heparin during pregnancy. Blood Coagul Fibrinolysis. 2012;23(8):751-55. DOI: 10.1097/MBC.0b013e328358e92c.

15. Rodger M.A., Gris J.C., de Vries J.I.P. et al; Low-Molecular-Weight Heparin for Placenta-Mediated Pregnancy Complications Study Group. Low-molecular-weight heparin and recurrent placenta-mediated pregnancy complications: a meta-analysis of individual patient data from randomised controlled trials. Lancet. 388(10060):2629-41. DOI: 10.1016/S0140-6736(16)31328-9.

16. Nagy S., Bush M., Stone J. et al. Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy. Obstet Gynecol. 2003;102(1):94-100. DOI: 10.1016/s0029-7844(03)00403-4.

17. Palatnik A., Grobman W.A. The relationship between first-trimester subchorionic hematoma, cervical length, and preterm birth. Am J Obstet Gynecol. 2015;213(3):403.e1-4. DOI: 10.1016/j.ajog.2015.05.019.

18. Seki H., Kuromaki K., Takeda S., Kinoshita K. Persistent subchorionic hematoma with clinical symptoms until delivery. Int J Gynaecol Obstet. 1998;63(2):123-8. DOI: 10.1016/s0020-7292(98)00153-2.

19. Ozkaya E., Altay M., Gelisen O. Significance of subchorionic haemorrhage and pregnancy outcome in threatened miscarriage to predict miscarriage, pre-term labour and intrauterine growth restriction. J Obstet Gynaecol. 2011;31(3):210-2. DOI: 10.3109/01443615.2010.545899.


For citation:


Sultangadzhieva K.G., Khizroeva J.K. Pathogenetically differentiated management of pregnancy in patients with retrochorial hematoma. Obstetrics, Gynecology and Reproduction. 2020;14(1):15-24. (In Russ.) https://doi.org/10.17749/2313-7347.2020.14.1.15-24

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ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)