medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-889medvis-889Research ArticleМАЛЫЙ ТАЗSMALL PELVISОценка типов трофобластического кровотока у беременных с тромбофилией на сроке с 7-й по 10-ю неделю методом объемной реконструкцииTrophoblastic volumetric bloodflow evaluation in women with trombophylia on 7–10th week of pregnancyhttps://orcid.org/0000-0001-9185-6119АсриянцМ. А.AsriyantsM. A.

Асриянц Мария Александровна – канд. мед. наук, ассистент кафедры лучевой диагностики

350063 Краснодар, ул. Седина, д. 4Тел.: +7-928-03-66-66-4

Mariya A. Asriyants – Cand. of Sci. (Med.), assistant of Radiology Department

4, Sedina str., Krasnodar 350063Phone: +7-928-03-66-66-4

385mouse@gmail.comhttps://orcid.org/0000-0001-8195-5930АстафьеваО. В.AstafievaO. V.

Астафьева Ольга Викторовна – доктор мед. наук, профессор кафедры лучевой диагностики

350063 Краснодар, ул. им. М. Седина, 4

Olga V. Astafieva – Doct. of Sci. (Med.), Professor of Radiology Department

4, M. Sedin str., 350063 Krasnodar

ФГБОУ ВО “Кубанский государственный медицинский университет” Минздрава РоссииРоссияKuban State Medical University of the Ministry of Health Care of the Russian FederationRussian Federation202119052021253131139Copyright © Асриянц М.А., Астафьева О.В., 20212021Асриянц М.А., Астафьева О.В.Asriyants M.A., Astafieva O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/889Цель исследования

Цель исследования: сравнить показатели объемного кровотока в хорионе с разными типами нарушения трофобластического кровотока для их количественной верификации у беременных с тромбофилией в I триместре.

Материал и методы

Материал и методы. Проведено ультразвуковое исследование (УЗИ) эмбриона и экстраэмбриональных структур с применением метода цветового допплеровского картирования (ЦДК) у 129 беременных женщин в возрасте от 18 до 45 лет на сроке беременности с 7-й по 10-ю неделю. По данным ЦДК выделено 4 типа трофобластического кровотока. Дополнительно всем беременным проведена объемная реконструкция хориона с применением программы VOKAL для оценки васкуляризации хориона в полученном объеме с определением количественных показателей – индекса васкуляризации (VI), индекса потока (FI), индекса перфузии (VFI) в соответствующем типе кровотока, представленного по данным ЦДК.

Результаты

Результаты. Анализ количественных показателей, полученных при выполнении объемной реконструкции хориона с использованием программы VOCAL, при различных типах трофобластического кровотока в режиме ЦДК показал высокую достоверность (p < 0,05) в значении VI и VFI между всеми типами кровотока, что указывает на высокую надежность классификации трофобластического кровотока в режиме ЦДК.

Заключение

Заключение. Учитывая высокую надежность предложенной классификации рекомендовано использовать ее в описательных протоколах при проведении УЗИ плода с применением режима допплерометрии.

Spontaneous abortion occur in 15–20% of all detected pregnancies, and 45–70% of all spontaneous miscarriages take place up to 10 weeks. Thrombophilia is one of the main causes of miscarriage and its effect on the course of pregnancy remains poorly understood. In this regard, there is great interest in the problem of diagnosing thrombophilia and further prevention of thrombosis in obstetric practice.

Purpose

Purpose. Compare the parameters of volumetric blood flow in the chorion with different types of trophoblastic blood flow disturbance in pregnant women with thrombophilia in the first trimester for their quantitative verification.

Materials and methods

Materials and methods. The study included 129 pregnant women at the 7th to 10th week of gestation with a diagnosis of thrombophilia and a control group - pregnant women with a normal course of this pregnancy and a successful outcome of past pregnancies.

The patients were divided into III clinical groups:

I

I. Pregnant women with a normal course of this pregnancy and a successful outcome of past pregnancies (n = 33) – comparison group;

II

II. Pregnant women with thrombophilia, in whom current pregnancy occurred on anticoagulant therapy (n = 28);

III

III. Pregnant women with thrombophilia without taking anticoagulant drugs before registration of pregnancy (n = 68).

Ultrasound was performed on Voluson E8 and S8 machines. All pregnant women underwent transabdominal and transvaginal ultrasound in B-mode, in color-doppler (CD) mode, and volumetric reconstruction of chorion was performed using the VOCAL program. In B-mode, the state of the embryo and extraembryonic structures were examined. The identification of trophoblastic vessels was carried out using the CD – region of interest was placed in the trophoblast area detected in B-mode, size and shape was adapted for a particular section.

Using three-dimensional echography, the chorion volume was performed. The degree of blood supply in chorionic volume were calculated; vascularization index (VI), flow index (FI) and perfusion index (VFI) were displayed on a histogram with quantitative indicators.

Results

Results

In the CD mode, the types of trophoblastic blood flow were identified in the chorionic vessels:

1) continuous type – blood flow loci are continuously identified over the entire area of the basal surface of the trophoblast;

2) intermittent type – blood flow loci are unevenly identified along the basal surface of the trophoblast;

3) single loci – single blood flow loci are identified along the basal surface of the trophoblast;

4) lack of blood flow – blood flow loci are not determined along the basal surface of the trophoblast.

Assessment of the quantitative parameters of the volumetric blood flow was used in the corresponding type of blood flow to verify the classification of types of trophoblastic blood flow in the CD mode.

Statistical analysis of the volumetric blood flow indices using three-dimensional chorionic reconstruction showed a high degree of reliability (p < 0.0001) in the VI and VFI values between all corresponding types of blood flow.

Discussion

Discussion. High incidence of spontaneous abortion and the significant role of thrombophilia in this pathology leads to necessity of expanding the research in this area. There has been a lot of research done over the past decade. The quantitative threshold values of the resistance indices in the chorionic vessels were calculated using pulse-wave Doppler, the chorionic blood supply indices were determined using volumetric reconstruction for various pathologies.

However, we have not previously met the classification of chorionic blood supply in the CD mode. This technique is very simple to perform and is a highly informative for predicting miscarriage in the first trimester. For the first time, we proposed the above classification of trophoblastic blood flow; for the first time, we proved the reliability of the classification developed by us using the method of volumetric reconstruction of the chorion with an assessment of trophoblastic blood flow, which allows us to recommend its use when writing a protocol for ultrasound of the fetus in the first trimester in pregnant women with thrombophilia.

Conclusion

Conclusion. The classification of trophoblastic blood flow was verified by three-dimensional echography with quantitative indicators of the volumetric blood flow of the trophoblast vessels, with a high degree of reliability (p < 0.001) which to indicates the reliability of this classification. It can be recommended to conduct a multicenter study for investigating fetal ultrasound with the additional use of the CD in the first trimester in pregnant women with a diagnosis of thrombophilia.

трофобластневынашиваниетромбофилиядопплерометрияЗD-реконструкцияVOCALtrophoblastmiscarriagethrombophiliaDoppler velometry3D reconstructionVOCALReferencesАдамян Л.В., Артымук Н.В., Белокриницкая Т.Е., Петрухин В.А., Смольнова Т.Ю., Сутурина Л.В., Тетруашвили Н.К., Филиппов О.С., Чечнева М.А., Шмаков Р.Г. Выкидыш в ранние сроки беременности: диагностика, тактика ведения. Проблемы репродукции. 2018; 24 (S6): 338–357.Adamyan L.V., Artymuk N.V., Belokrinickaja T.E., Petruhin V.A., Smol'nova T.Ju., Suturina L.V., Tetruashvili N.K., Filippov O.S., Chechneva M.A., Shmakov R.G. Miscarriage in early pregnancy: diagnosis, management tactics. Reproduction problems. 2018; 24 (S6): 338–357. (In Russian)Ахундова Г.И., Шамхалова И.А. Эхографические и допплерометрические показатели в оценке течения беременности у женщин с угрозой выкидыша в ранние сроки. Вестник украинской медицинской стоматологической академии. 2018; 18, 3 (63): 19–25.Akhundova G.I., Shamkhalova I.A. Echographic and Doppler metric in assessing the course of pregnancy in women with a threat of early miscarriage. Bulletin of the Ukrainian Medical Dental Academy. 2018; 18, 3 (63): 19–25. (In Russian)Фатеева Н.В., Кузнецов Р.А. Патоморфология ворсинчатого хориона и гравидарного эндометрия при самопроизвольных выкидышах раннего срока на фоне хронического воспаления. Медицина, фармацевтика, здоровье – 2017. Статья в сборнике трудов конференции. 2017: 52–55.Fateeva N.V., Kuznetsov R.A. Pathomorphology of the chorionic villus and gravid endometrium in spontaneous early miscarriages against the background of chronic inflammation. Medicine, pharmaceuticals, health – 2017. An article in the proceedings of the conference. 2017: 52–55. (In Russian)Посисеева Л.В., Перетятко Л.П., Кузнецов Р.А., Малышкина А.И., Фатеева Н.В., Красильникова А.К., Парейшвили В.В. Формы недостаточности развивающейся плаценты при ранних самопроизвольных абортах: патоморфологические и функциональные критерии. Российский вестник акушера-гинеколога. 2019; 19 (4): 1–16. https://doi.org/10.17116/rosakush20191904111Posiseeva L.V., Peretiatko L.P., Kuznetsov R.A., Malyshkina A.I., Fateeva N.V., Krasil'nikova A.K., Pareishvili V.V. Forms of insufficiency of the developing placenta in early spontaneous abortions: pathomorphological and functional criteria. Russian Bulletin of Obstetrician-Gynecologist. 2019; 19 (4): 1–16. https://doi.org/10.17116/rosakush20191904111 (In Russian)Радзинский В.Е., Оразмурадов А.А. Беременность ранних сроков. От предгравидарной подготовки к здоровой гестации. Status Praesens. 2018; 800.Radzinsky V.E., Orazmuradov A.A. Early pregnancy. From pre-gravid preparation to healthy gestation. Status Praesens. 2018; 800. (In Russian)Фролова Н.И., Белокриницкая Т.Е., Страмбовская Н.Н., Белозерцева Е.П. Полиморфизм генов, ассоциированных с нарушениями гемостаза и фолатного обмена, у пациенток с рецидивирующими потерями в ранние сроки. Забайкальский медицинский вестник. 2018; 1: 37–44.Frolova N.I., Belokrinickaja T.E., Strambovskaja N.N., Belozerceva E.P. Polymorphism of genes associated with impaired hemostasis and folate metabolism in patients with recurrent losses in the early stages. Transbaikal Medical Bulletin. 2018; 1: 37–44. (In Russian)Фролова Н.И., Белокриницкая Т.Е., Страмбовская Н.Н., Белозерцева Е.П. Распространенность и межгенные взаимодействия полиморфизмов, ассоциированных с нарушениями гемостаза и фолатного обмена, при повторных ранних самопроизвольных выкидышах. Гинекология. 2019; 21 (2): 18–22. https://doi.org/10.26442/20795696.2019.2.190345Frolova N.I., Belokrinickaja T.E., Strambovskaja N.N., Belozerceva E.P. Prevalence and intergenic interactions of polymorphisms associated with impaired hemostasis and folate metabolism, with repeated early spontaneous miscarriages. Gynecology. 2019; 21 (2): 18–22. https://doi.org/10.26442/20795696.2019.2.190345 (In Russian)Al-Achkar W., Wafa A., Ammar S., Moassass F., Jarjour R.A. Association of Methylenetetrahydrofolate Reductase C677T and A1298C Gene Polymorphisms With Recurrent Pregnancy Loss in Syrian Women. Reprod Sci. 2017; 24 (9): 1275–1279. https://doi.org/10.1177/1933719116682874Al-Achkar W., Wafa A., Ammar S., Moassass F., Jarjour R.A. Association of Methylenetetrahydrofolate Reductase C677T and A1298C Gene Polymorphisms With Recurrent Pregnancy Loss in Syrian Women. Reprod Sci. 2017; 24 (9): 1275–1279. https://doi.org/10.1177/1933719116682874Kamali M., Hantoushzadeh S., Borna S., Neamatzadeh H., Mazaheri M., Noori-Shadkam M., Haghighi F. Association between Thrombophilic Genes Polymorphisms and Recurrent Pregnancy Loss Susceptibility in the Iranian Population: a Systematic Review and MetaAnalysis. Iran Biomed J. 2018; 22 (2): 78–89. https://doi.org/10.22034/ibj.22.2.78Kamali M., Hantoushzadeh S., Borna S., Neamatzadeh H., Mazaheri M., Noori-Shadkam M., Haghighi F. Association between Thrombophilic Genes Polymorphisms and Recurrent Pregnancy Loss Susceptibility in the Iranian Population: a Systematic Review and MetaAnalysis. Iran Biomed J. 2018; 22 (2): 78–89. https://doi.org/10.22034/ibj.22.2.78Djurovic J., Stojkovic O., Todorovic J., Brajic A., Stankovic S., Obradovic S., Stamenkovic G. Genetics of suspected thrombophilia in Serbian females with infertility, including three cases, homozygous for FII 20210A or FV 1691A mutations. Hum. Fertil. (Camb.). 2017; 20 (2): 132–139. https://doi.org/10.1080/14647273.1016.1255785Djurovic J., Stojkovic O., Todorovic J., Brajic A., Stankovic S., Obradovic S., Stamenkovic G. Genetics of suspected thrombophilia in Serbian females with infertility, including three cases, homozygous for FII 20210A or FV 1691A mutations. Hum. Fertil. (Camb). 2017; 20 (2): 132–139. https://doi.org/10.1080/14647273.1016.1255785Рудзевич А.Ю. Изменения гемостаза у беременных с тромбофилией, возможность профилактики осложнений беременности при приобретенной тромбофилии и антифосфолипидном синдроме. Научное обозрение. Медицинские науки. 2019; 1: 48–54.Rudzevich A.Yu. Changes in hemostasis in pregnant women with thrombophilia, the possibility of preventing pregnancy complications in acquired thrombophilia and antiphospholipid syndrome. Scientific Review. Medical sciences. 2019; 1: 48–54. (In Russian)Skeith L., Carrier M., Kaaja R., Martinelli I., Petroff D., Schleußner E., Laskin C.A., Rodger M.A. A meta-analysis of low-molecular-weight heparin to prevent pregnancy loss in women with inherited thrombophilia. Blood. 2016; 127 (13): 1650–1655.Skeith L., Carrier M., Kaaja R., Martinelli I., Petroff D., Schleußner E., Laskin C.A., Rodger M.A. A meta-analysis of low-molecular-weight heparin to prevent pregnancy loss in women with inherited thrombophilia. Blood. 2016; 127 (13): 1650–1655.Зламанец И.М., Харламова Г.С., Катанцева И.С. Тромбофилия, как фактор риска развития синус-тромбоза у послеродовой пациентки. Нейрохирургия и неврология Казахстана. 2019; 2: 91–94.Zlamanets I.M., Kharlamova G.S., Katantseva I.S. Thrombophilia as a risk factor for the development of sinus thrombosis in a postpartum patient. Neurosurgery and neurology of Kazakhstan. 2019; 2: 91–94. (In Russian)Croles F.N., Nasserinejad K., Duvekot J.J., Kruip M.J., Meijer K., Leebeek F.W. Pregnancy, thrombophilia, and the risk of a first venous thrombosis: systematic review and bayesian meta-analysis. Br. Med. J. 2017; 359: 4452. https://doi.org/10.1136/bmj.j4452Croles F.N., Nasserinejad K., Duvekot J.J., Kruip M.J., Meijer K., Leebeek F.W. Pregnancy, thrombophilia, and the risk of a first venous thrombosis: systematic review and bayesian meta-analysis. Br. Med. J. 2017; 359: 4452. https://doi.org/10.1136/bmj.j4452Холин А.М., Муминова К.Т., Нагоев Т.М., Ходжаева З.С., Гус А.И. Прогнозирование преэклампсии в первом триместре на основе клинико-анамнестических факторов, биомаркеров и 3D-энергетической допплеровской оценки васкуляризации плацентарного ложа. Акушерство и гинекология. 2018; 8: 56–65. https://doi.org//10.18565/aig.2018.8.56-65Holin A.M., Muminova K.T., Nagoev T.M., Hodzhaeva Z.S., Gus A.I. Prediction of preeclampsia in the first trimester based on clinical and anamnestic factors, biomarkers and 3D energy Doppler assessment of placental bed vascularization. Obstetrics and gynecology. 2018; 8: 56–65. https://doi.org/10.18565/aig.2018.8.56-65 (In Russian)Фомина М.П. 3D-допплерометрия плацентарного кровотока в прогнозировании неразвивающейся беременности. Вестник Российского университета дружбы народов. Серия: Медицина. 2013; 5: 44–50.Fomina M.P. 3D-Dopplerometry of placental blood flow in predicting an undeveloped pregnancy. Bulletin of the Peoples' Friendship University of Russia. Series: Medicine. 2013; 5: 44–50. (In Russian)

The authors declare that there are no conflicts of interest present.