Toward a new taxonomy of obstetrical disease: improved performance of maternal blood biomarkers for the great obstetrical syndromes when classified according to placental pathology

Romero, Roberto; Jung, Eun-Jung; Chaiworapongsa, Tinnakorn; Erez, Offer; Gudicha, Dereje W.; Kim, Yeon Mee; Kim, Jung-Sun; Kim, Bomi; Kusanovic, Juan Pedro; Gotsch, Francesca; Taran, Andreea B.; Yoon, Bo Hyun; Hassan, Sonia S.; Hsu, Chaur‐Dong; Chaemsaithong, Piya; Gomez‐Lopez, Nardhy; Yeo, Lami; Kim, Chong Jai; Tarca, Adi L.

doi:10.1016/j.ajog.2022.04.015

Cited by 46 publications

(45 citation statements)

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“…Based on the prevalence of placental vascular insults described recently in the literature 18,33 , uteroplacental malperfusion appears to be operative in the vast majority of cases of unexplained fetal death, in at least 40% of cases with pre-eclampsia and SGA, and in one-third of cases with preterm delivery with intact membranes or PPROM. These pregnancy complications tend to coexist and overlap; for example, suboptimal fetal growth is common in patients with pre-eclampsia and gestational hypertension (outlined above), and is associated with spontaneous preterm birth 64 .…”

Section: Commentmentioning

confidence: 99%

Evolutionary perspective of uteroplacental malperfusion: subjacent insult common to most pregnancy complications

Espinoza

2023

Ultrasound in Obstet & Gyne

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Section: Commentmentioning

confidence: 99%

Evolutionary perspective of uteroplacental malperfusion: subjacent insult common to most pregnancy complications

Espinoza

2023

Ultrasound in Obstet & Gyne

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“…Assessment-based management of placenta-mediated pregnancy complications: Pragmatism until a precision medicine approach evolves Benjamin Brenner 1,2 | Emmanouil Papadakis 3 | Ian A. Greer 4 | Jean-Christophe Gris 5,6,7 such as foetal growth restriction (FGR) or preeclampsia, rather than the underlying disease mechanism. Such classification is a poor descriptor of the pathophysiologic process, as it lacks specificity and is limited to the description of late, downstream consequences of abnormal processes.…”

Section: R E V I E Wmentioning

confidence: 99%

“…Thus, a new taxonomy for these obstetrical disorders based on the pathological mechanism underlying the complications would open new doors in identifying women at risk and delivering targeted treatments. 7 Thrombophilic disorders, prothrombotic tendency or hypercoagulable states could result in alterations in the maternal vascular system. Thrombophilia was naturally investigated for its association with placental diseases, considered to be potentiated through local thrombosis.…”

Section: R E V I E Wmentioning

confidence: 99%

Assessment‐based management of placenta‐mediated pregnancy complications: Pragmatism until a precision medicine approach evolves

Brenner

Papadakis²,

Greer

et al. 2023

Br J Haematol

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Summary The management of pregnant women with thrombophilia and a history of gestational vascular complications remains debatable. Treatment of the latter is often based on clinical outcome rather than disease mechanism. While the use of venous thromboembolism prophylaxis in pregnancy is recommended for those at increased risk, the ability of anticoagulant and/or antiplatelet agents to lower the risk of placenta‐mediated complications in this clinical setting remains controversial. The available guidelines are inconsistent in some situations, which reflects the limited evidence base. This review critically discusses risk assessment models (RAMs) and management strategies of women with thrombophilia and pregnancy complications, using clinical vignettes. RAMs, taking into account obstetric and thrombotic history as well as thrombophilia status, could drive a precision medicine approach, based on disease mechanism, and guide individual therapeutic interventions in high‐risk clinical settings.

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“…For example, we diagnose preterm labor, but we cannot always differentiate whether it is caused by infection, vascular disease, myometrial overactivity, or something else. Therefore, one should not expect that there is any universal marker that has prognostic value in all cases [2,[5][6][7]14].…”

Section: особливості клінічної характеристики вагітних з проявами вел...mentioning

confidence: 99%

“…The risk of great obstetric syndromes development, such as preeclampsia, fetal growth retardation (FGR) and premature birth in primigravida women is inversely proportional to their age [3,6,14]. This is a confirmation of the research results obtained by us, namely: young reproductive age of pregnant women, extragenital pathology (represented in most cases by hypertension, diseases of the thyroid gland, gastrointestinal tract and kidneys); complicated gynecological history (menstrual cycle disorders, chronic adnexitis, polycystic ovaries and colpitis); complicated course of gestation (anemia, threat of termination), i.e., that unfavorable background in which there is a high probability of great obstetrical syndromes development.…”

Section: а к у ш е р с т в оmentioning

confidence: 99%

Peculiarities of clinical characteristics of pregnant with symptoms of Great obstetrical syndromes

Lemish

2022

RHW

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The objective: to establish the risk factors for development of great obstetrical syndromes (GOS) on the basis of a prospective analysis of somatic, reproductive, obstetric anamnesis in pregnant women with clinical manifestations of GOSMaterials and methods. We conducted the analyses of somatic, reproductive and obstetrical history of 572 pregnant with clinical symptoms of GOS, who had the following complications: 21 – preeclampsia, 38 – preterm deliveries, 13 – placental abruption, 457 – gestational anemia, 27 – intrauterine growth retardation, 16 – fetal distress, that were diagnosed based on clinical, functional, laboratory, ultrasound, cardiotocographic and morphological investigations. All these complications are included in the group of GOS.Statistical analyze was conducted by using standard programs of Microsoft Excel 5.0 and Statistica 6.0.Results. The average age of the pregnant women was 26.5±2.3 years, most of them were in young reproductive age. The prevailing diseases in the structure of somatic pathology were thyroid gland pathology – 427 (74.6 %) persons, anemia 182 (31.8 %), arterial hypertension – 114 (19.9 %), kidney diseases – 241 (42.1 %) and diseases of gastro-intestinal tract –187 (32.7 %). Disorders of menstrual cycle were determined in 137 (23.9 %) women, chronic pelvic inflammatory diseases – 98 (17.1 %), background diseases of cervix (erosion, cervical dysplasia) had 142 (24.8 %) patients in anamnesis, colpitis – 296 (51.7 %), polycystic ovaries – 74 (12.9 %). The following pregnancy complications were diagnosed as preeclampsia – in 21 (3.7 %) persons, threatened preterm interruption of pregnancy in different gestational terms – in every third pregnant women (192 individuals – 33.7 %), anemia – 457 (79.9 %), preterm delivery – 38 (6.6 %) women, placental abruption – 13 (2.3 %), fetal growth retardation – in 27 cases (4.7 %), fetal distress – 16 (2.8 %). The rate of cesarean section in this group was 28.8 %.Conclusions. The identified peculiarities of somatic, reproductive history and obstetrical and perinatal pathology in pregnant with complications from GOS group allowed to define the following risk factors of their development: young reproductive age, significant frequency of socio-hygienic, medical and demographic and socio-psychological problems, complicated somatic, gynecological and reproductive history.

show abstract

Toward a new taxonomy of obstetrical disease: improved performance of maternal blood biomarkers for the great obstetrical syndromes when classified according to placental pathology

Cited by 46 publications

References 266 publications

Evolutionary perspective of uteroplacental malperfusion: subjacent insult common to most pregnancy complications

Evolutionary perspective of uteroplacental malperfusion: subjacent insult common to most pregnancy complications

Assessment‐based management of placenta‐mediated pregnancy complications: Pragmatism until a precision medicine approach evolves

Peculiarities of clinical characteristics of pregnant with symptoms of Great obstetrical syndromes

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