DOI: https://doi.org/10.26641/2307-0404.2014.1.24703

Effectiveness of preeclampsia prognosis in pregnancy.

T. O. Loskutova

Abstract


With the purpose to develop and assess the effectiveness of prediction method of pre-eclampsia (PE) 177 women in III trimester of pregnancy were examined. Of them: 133 women with preeclampsia of varying severity, 44 - with uncomplicated pregnancy. Prediction method is based on testing of thrombophilia genes, level of antibodies to β2 glycoprotein-1, D-dimer, value of atherogenicity coefficient. Using maximum likelihood method risk function was designed and formula which allows to estimatie probability of pre-eclampsia development was made. For practical applications, a graphical representation of likelihood of pre-eclampsia development from the calculated risk function is given. The sensitivity of the proposed model is 82,5% (95% CI 74,2-88,9%), specificity – 90,9% (95% CI 78,3-88,9%). To evaluate the effectiveness this prediction method was tested on a group of 108 pregnant women who were tested in the first trimester. 84 pregnant women were in the group with the predicted low risk (P(y)<0,683) and 24 in the group with a predicted high risk (P (y)≥0,683) of pre-eclampsia development. Analyzing the effectiveness of a prediction method it was proved that in the group with predicted high risk of PE absolute risk of preeclampsia increased by 54.7% (95% CI 50,3-59,08), PE of mild severity – by 21,34% (95% CI 16,75-25,92), PE of moderate severity – by 33,33% (95% CI 28,7-37,9), preterm delivery – by 30,86% (95% CI 41,8-50,57), cesarean section in preterm labor and placenta abruption – by 9,5% (95% CI 4,8-14,2 ), fetal distress during labor – by 14,3% (95% CI 9,6-18,97), perinatal losses by 14.2% (95% CI 9,6-18,97), fetal growth retardation – by 42,9% (95% CI 38,3-47,4), the need for neonatal intensive care – by 26,1% (95% CI 21,5-30,6). Practical use of the proposed model allows to identify pregnant women with high risk of pre-eclampsia, to conduct preventive measures, to review plan of prenatal care as for timely hospitalization and to determine fetus state.

Keywords


pregnancy; pre-eclampsia; gene polymorphism; hemostasis; antiphospholipid antibodies; prognosis; probability; risk group

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References


Макацария А.Д. Тромбофилии и противотромботическая терапия в акушерской практике / А.Д. Макацария, В.О. Бицадзе.-М.: Триада Х, 2003. – 904 с.

Оксидативный стресс в генезе акушерских осложнений / Л.В. Ванько, В.Г. Сафронова, Н.К. Мат¬ве¬ева, Г.Т. Сухих. – М.: ГЭОТАР-Медиа, 2010. – 264с.

Определение наследственной предрасположенности к некоторым частым заболеваниям при беременности: метод. рекомендации / В.С. Баранов, Т.Э. Иващенко, А.С. Глотов [и др.]; под ред. В.С. Ба¬ранова и Э.К. Айламазяна. – СПб.: Изд-во «Н-Л», 2009. – 68 с.

Про затвердження клінічних протоколів з акушерської та гінекологічної допомоги: Наказ від 31.12.2004 р. / Міністерство охорони здоров’я Украї¬ни. – К., 2004. – № 676.

Риски и их оценка в медико-биологических исследованиях: метод. рекомендации / С.А. Максимов, С.Ф. Зинчук, Е.А. Давыдова, В.Г. Зинчук. – Кемерово, 2010. – 28 с.

Роль молекулярно-генетичеких факторов тромбофилии в развитии преэклампсии у женщин восточного региона Украины / В.К. Чайка, Е.Н. Но¬сенко, Б. Мертил [и др.] // Таврич. мед.-биол. вестник. – 2010. – Т. 148, №3. – С.222-224.

Турчин В.Н. Теория вероятностей и математическая статистика. Основные понятия, примеры и задачи / В.Н. Турчин. – Днепропетровск: ИМА-ПРЕСС, 2012. – 576 с.

-455G/A beta-fibrinogen gene polymorphism, factor V Leiden, prothrombin G20210A mutation and MTHFR C677T, and placental vascular complications / R.C. Camilleri, D. Peebles, C. Portmann [et al.] // Blood Coagulation Fibrinolysis. – 2004. – Vol. 15, N 2. – Р.139-147.

Brenner B. Thrombophilia and pregnancy compli¬cations / B. Brenner // Pathophysiol. Haemost. Thromb. – 2006 – Vol. 35, N 1-2 – P. 28-35.

Pathophysiology of hypertension in pre-eclam¬psia: a lesson in integrative physiology / А.С. Palei, F.T. Spradley, J.P. Warrington [et al.] // Acta. Physiol. – 2013. – Vol 208, N 4. – P. 224-233.

Relationship between thrombophilic disorders and type of severe early hypertensive disorders of pregnancy / W.Ganzevoort, A. Rep, J.I. DeVries [et al.] // Hypertens. Pregnancy. – 2007.–Vol. 26, N 4 –P. 433-445.

Makatsariya AD, Bitsadze VO. [Thrombophilia and antithrombotic therapy in obstetric practice]. M.: Triada Kh. 2003; 904 p. Russian.

Van'ko LV, Safronova VG, Matveeva NK, Sukhikh GT. [Oxidative stress in the genesis of obstetric complications]. M.: GEOTAR-Media. 2010; 264 p. Russian.

Baranov VS, Ivashchenko TE, Glotov AS. [Determination of genetic predisposition to certain diseases common in pregnancy: guidelines]. SPb.: «Iz-vo N-L». 2009; 68 p. Russian.

[On approval of clinical protocols for obstetric and gynecological care: Order of 31.12.2004 № 676]. Mіnіsterstvo okhoroni zdorov’ya Ukraїni. K; 2004. Ukrainian.

Maksimov SA, Zinchuk SF, Davydova EA, Zinchuk VG. [Risks and their evaluation in biomedical research: guidelines].– Kemerovo, 2010; 28 p. Russian.

Chayka VK, Nosenko EN, Mertil B. [The role of molecular genetic factors of thrombophilia in the development of preeclampsia, in women of eastern region of Ukraine]. Tavr. med.-biol. vestnik. 2010;148(3):222-224. Russian.

Turchin VN. [Probability theory and mathematical statistics. Basic concepts, examples and problems]. Dnepropetrovsk: IMA-PRESS. 2012; 576 p. Russian.

Camilleri RC, Peebles D, Portmann C. -455G/A beta-fibrinogen gene polymorphism, factor V Leiden, prothrombin G20210A mutation and MTHFR C677T, and placental vascular complications. Blood Coagulation Fibrinolysis. 2004;15 (2):139-147.

Brenner B. Thrombophilia and pregnancy compli¬cations. Pathophysiol. Haemost. Thromb. 2006; 35(1-2): 28-35.

Palei АС, Spradley FT, Warrington JP. Pathophysiology of hypertension in pre-eclampsia: a lesson in integrative physiology. Acta. Physiol. 2013; 208 (4): 224-233.

Ganzevoort W, Rep A, DeVries JI. Relationship between thrombophilic disorders and type of severe early hypertensive disorders of pregnancy. Hypertens. Pregnancy. 2007; 26 (4): 433-445


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