Prediction of thrombophilia in patients with unexplained recurrent pregnancy loss using a statistical model

Wang, Tongfei; Kang, Xiaomin; He, Lin; Liu, Zhilan; Xu, Haijing; Zhao, Aimin

doi:10.1002/ijgo.12213

Cited by 17 publications

(14 citation statements)

References 15 publications

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“…All women enrolled underwent an extensive screening as described in a previous study to elucidate all known potential etiologies of RPL. 19 Patients with a history of at least three consecutive first-trimester pregnancy losses with unexplained etiology (i.e. negative for uterine anatomic abnormalities, negative for genetic anomalies, negative for autoimmune diseases) were included in the URPL group.…”

Section: Materialsandmethodsmentioning

confidence: 99%

Low‐dose aspirin improves endometrial receptivity in the midluteal phase in unexplained recurrent pregnancy loss

Wang

Kang

Zhao

et al. 2020

Intl J Gynecology & Obste

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Objective To evaluate differences in Doppler parameters and pregnancy outcomes, if any, and to determine the predictive accuracy of such indices, as well as the effects of low‐dose aspirin (LDA) in unexplained recurrent pregnancy loss (URPL). Methods An observational study was conducted at Ren Ji Hospital, Shanghai, China, from May 2015 to December 2016. The endometrial thickness, and the pulsatility index (PI), resistive index (RI), and systolic‐to‐diastolic ratio (S/D) values of endometrial and uterine artery blood flow were collected. Receiver operating characteristic (ROC) curve analysis was used to analyze data from URPL patients (three or more first‐trimester spontaneous abortions with unknown etiology) and patients with normal fertility. A second ultrasonography examination was performed in URPL patients who had received daily LDA for 2 months. Results There were 190 URPL patients and 35 control patients. Endometrial thickness was significantly thinner in URPL patients than control patients (P=0.005). The PI, RI, and S/D values for endometrial blood flow and the mean PI, RI, and S/D values for uterine arteries were significantly higher in URPL patients (P<0.001). The predictive accuracy of the indices mentioned above were 0.660, 0.802, 0.852, 0.837, 0.784, 0.929, and 0.929, respectively. Following LDA supplementation, URPL patients showed a significant reduction in resistance to endometrial and uterine artery blood flow (P<0.001). Conclusion URPL patients had impaired uterine perfusion. Doppler parameters are valuable in predicting women at high risk of URPL. LDA could be effective in improving endometrial receptivity.

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Section: Materialsandmethodsmentioning

confidence: 99%

Low‐dose aspirin improves endometrial receptivity in the midluteal phase in unexplained recurrent pregnancy loss

Wang

Kang

Zhao

et al. 2020

Intl J Gynecology & Obste

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“…TAFI is essential for the precise regulation of the local coagulation–fibrinolysis system. 5 , 18 ElDanasori et al 18 investigated the TAFI function in early pregnancy population and found that in addition to regulating the balance of coagulation–fibrinolysis during pregnancy, the high concentration level of TAFI in the low fibrinolytic state could inhibit the formation of fibrin degradation products, reduce the apoptosis of placental trophoblast cells, and was beneficial to normal pregnancy. RSA can be caused by genetic polymorphisms in the maternal hemostatic system.…”

Section: Discussionmentioning

confidence: 99%

“…Precise regulation of the coagulation–fibrinolysis system under normal physiological hypercoagulability plays an important role in embryo implantation and trophoblastic invasion, and abnormal coagulation mechanisms may be a risk factor in women with RSA. 5 Thrombin-activatable fibrinolysis inhibitor (TAFI), also known as procarboxypeptidase U, plasma procarboxypeptidase B, or procarboxypeptidase R, is a procarboxypeptidase that is mainly synthesized by the liver and exists as an inactive zymogen in the blood circulation. TAFI can be activated by thrombin, thrombin–thrombin regulatory protein, and plasmin, and regulates early trophoblast cell invasion.…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Polymorphism of Thrombin-Activatable Fibrinolysis Inhibitor Gene +1040C/T and a Cohort of Chinese Women With Recurrent Spontaneous Abortion

Fang

Cai

et al. 2021

Clin Appl Thromb Hemost

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The balance between coagulation and fibrinolysis is essential for a successful pregnancy. This study aimed to explore the genetic variant of +1040C/T in the coding region of thrombin-activatable fibrinolysis inhibitor (TAFI) gene in women with recurrent spontaneous abortion (RSA) and in unrelated healthy controls and to investigate the possible association between TAFI +1040C/T polymorphism and RSA. Peripheral blood samples were collected from 137 Chinese patients with RSA and 103 unrelated healthy Chinese controls. The TAFI +1040C/T polymorphism was analyzed using SNaPshot SNP typing after DNA extraction. The frequency of the C allele was lower in RSA patients compared with the controls (0.78 vs 0.84). A subanalysis of the TAFI +1040C/T polymorphism in the 2 populations of RSA women (groups 2RSA and >2RSA) showed that the +1040CT genotype was significantly higher and the +1040CC genotype was significantly lower than from that found in controls. The allele +1040C was associated with a reduced risk of RSA in both group 2RSA (OR = 0.418, 95%CI, 0.255-0.685) and group >2RSA (OR = 0.473, 95%CI, 0.274-0.819) compared with controls. Our data indicate a protective role for TAFI +1040C allele against RSA, and may be associated with the genetic susceptibility of RSA.

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“…Patients in the RPL group were grouped according to the number of spontaneous abortion times. All patients enrolled underwent comprehensive examinations by using currently existing methods to evaluate all known etiologies of RPL, in accordance with the previously described diagnostic flow chart . Patients were subsequently grouped according to the different etiologies of RPL.…”

Section: Methodsmentioning

confidence: 99%

Characteristics of midluteal phase uterine artery hemodynamics in patients with recurrent pregnancy loss

Yang

et al. 2019

J of Obstet and Gynaecol

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Aim To study the association in resistance to uterine artery blood flow and recurrent pregnancy loss (RPL) and find its potential influencing factors. Methods A retrospective study was conducted in 870 RPL and 237 non‐RPL patients visiting to the Clinic from January 2014 to February 2018. All participants underwent comprehensive examinations and were scanned by transvaginal Doppler ultrasonography during the midluteal phase to measure the pulsatility index (PI), resistance index (RI) and systolic/diastolic ratio (S/D) values of the left and right main uterine arteries. P value less than 0.05 was considered statistically significant. Results The mean PI, RI and S/D values for uterine arteries were significantly higher in RPL patients than in non‐RPL patients (P < 0.001). When subjects were grouped according to the different etiologies of RPL, significant higher indices of uterine arteries were found in RPL patients with antiphospholipid syndrome (P < 0.001), autoimmune diseases (P < 0.001), endocrinological abnormalities (P < 0.05), thrombophilia (P < 0.001), uterine anomalies (P < 0.01) and unexplained RPL (P < 0.001). No differences were found between patients with chromosomal anomalies and uterine arteries blood flow (P > 0.05). In RPL patients, mean PI, mean RI and mean S/D values shows no difference among groups (P > 0.05). The Similar results were observed in age and number of spontaneous abortion (P > 0.05). Conclusion Impaired uterine artery blood perfusion may be an underlying pathology to RPL, and it can be used as an independent risk factor for pregnancy failure.

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Prediction of thrombophilia in patients with unexplained recurrent pregnancy loss using a statistical model

Abstract: The LRM is a valuable model for prediction of thrombophilia in URPL patients.

Cited by 17 publications

References 15 publications

Low‐dose aspirin improves endometrial receptivity in the midluteal phase in unexplained recurrent pregnancy loss

Low‐dose aspirin improves endometrial receptivity in the midluteal phase in unexplained recurrent pregnancy loss

Relationship Between Polymorphism of Thrombin-Activatable Fibrinolysis Inhibitor Gene +1040C/T and a Cohort of Chinese Women With Recurrent Spontaneous Abortion

Characteristics of midluteal phase uterine artery hemodynamics in patients with recurrent pregnancy loss

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