Di Bartolomeo Aurélie, Chauleur Céline, Gris Jean-Christophe, Chapelle Céline, Noblot Edouard, Laporte Silvy, Raia-Barjat Tiphaine
Department of Gynaecology and Obstetrics, University Hospital, Saint Etienne, France.
INSERM UMR 1059, Saint Etienne University Jean Monnet, Saint Etienne, France.
PLoS One. 2017 Mar 22;12(3):e0173596. doi: 10.1371/journal.pone.0173596. eCollection 2017.
The study aimed to evaluate if the rate of tissue factor pathway inhibitor during pregnancy and following delivery could be a predictive factor for placenta-mediated adverse pregnancy outcomes in high-risk women.
This was a prospective multicentre cohort study of 200 patients at a high risk of occurrence or recurrence of placenta-mediated adverse pregnancy outcomes conducted between June 2008 and October 2010. Measurements of tissue factor pathway inhibitor resistance (normalized ratio) and tissue factor pathway inhibitor activity were performed for the last 72 patients at 20, 24, 28, 32, and 36 weeks of gestation and during the postpartum period.
Overall, 15 patients presented a placenta-mediated adverse pregnancy outcome. There was no difference in normalized tissue factor pathway inhibitor ratios between patients with and without placenta-mediated adverse pregnancy outcomes during pregnancy and in the post-partum period. Patients with placenta-mediated adverse pregnancy outcomes had tissue factor pathway inhibitor activity rates that were significantly higher than those in patients without at as early as 24 weeks of gestation. The same results were observed following delivery.
Among high-risk women, the tissue factor pathway inhibitor activity of patients with gestational vascular complications is higher than that in other patients. Hence, these markers could augment a screening strategy that includes an analysis of angiogenic factors as well as clinical and ultrasound imaging with Doppler measurement of the uterine arteries.
本研究旨在评估孕期及产后组织因子途径抑制物的水平是否可作为高危女性胎盘介导的不良妊娠结局的预测因素。
这是一项前瞻性多中心队列研究,于2008年6月至2010年10月对200例有胎盘介导的不良妊娠结局发生或复发风险的高危患者进行研究。对最后72例患者在妊娠20、24、28、32和36周以及产后期间进行组织因子途径抑制物抵抗(标准化比值)和组织因子途径抑制物活性的测量。
总体而言,15例患者出现了胎盘介导的不良妊娠结局。在孕期和产后,有胎盘介导的不良妊娠结局的患者与无该结局的患者之间,组织因子途径抑制物标准化比值无差异。有胎盘介导的不良妊娠结局的患者,早在妊娠24周时其组织因子途径抑制物活性率就显著高于无该结局的患者。产后也观察到了相同的结果。
在高危女性中,有妊娠血管并发症的患者的组织因子途径抑制物活性高于其他患者。因此,这些标志物可完善一种筛查策略,该策略包括分析血管生成因子以及结合子宫动脉多普勒测量的临床和超声成像。