EVALUATION OF CERTAIN BIOCHEMICAL AND ANGIOGENIC MARKERS IN THE FIRST TRIMESTER OF PREGNANCY IN WOMEN WITH UMBILICAL CORD PATHOLOGY
Authors: Dubetskyi B. I. , Makarchuk O. M. 
Published: October 2022

At the stage of formation of fetoplacental complex, various factors of the external and internal environment create prerequisites for subsequent unfavorable course of pregnancy and childbirth. Their influence falls on the period of formation and differentiation of extraembryonic structures in the first trimester of pregnancy. That is why umbilical cord pathologies are considered to be one of the main causes of the development of fetal distress, low birth weight and post-hypoxic states of newborns.

The purpose of the research: to analyze changes in the parameters of certain biochemical and angiogenic markers in patients with umbilical cord pathology.

Research materials and methods. Medical documentation of 56 patients (the main group) with umbilical cord pathology and abnormalities of its insertion (27 pregnant women with a single umbilical artery and 29 women with velamentous insertion) was processed. The comparison group included 30 patients with normal structural components of the umbilical cord. The level of free ȕ-hCG, PAPP-A, free estriol, AFP, placental lactogen, certain growth factors PIGF and sFlt-1 was evaluated using the method of immunoenzymatic analysis. “Astraia Obstetrics” software (“Astraia software gmbH”, Germany) was used to determine the risk of preeclampsia, chromosomal abnormalities, fetal growth retardation, and premature birth.

Research results and their discussion. An imbalance in the concentration of PAPP-A and β-hCG, when its low levels corresponded to high levels of β-hCG, was revealed in the main group. An increase in the average values of the level of PAPP-A MoM was established in almost half of the observations (42.9%), a significantly higher level of free ȕ-hCG was noted in 28.6 % of samples. The combined indicators of the concentration of PlGF in women with umbilical cord pathology were significantly lower (by 1.6 times) compared to the data of the comparison group; placental lactogen has a tendency to decrease. The combined values of the concentration of PlGF in women with umbilical cord pathology were significantly lower (by 1.6 times) compared to the data of the comparison group, and the indicators of the level of sFlt-1 – by 1.5 times (p<0.05). This made it necessary to evaluate the calculated parameters of the angiogenic coefficient, which reflects the depth of vascular disorders and the severity of vascular imbalance.. At the same time, this ratio was found to be 2.0 times lower in the patients of the comparison group compared to the combined total indicator in the main group - in pregnant women with umbilical cord pathology - 155.7 units. (p<0.05)

Conclusions. Among pregnant women with umbilical cord pathology, a high proportion of the increased PAPP-A indicator, probably a lower level of free β-chorionic gonadotropin subunit, and low parameters of placental lactogen in the third trimester of pregnancy were observed. The combined indicators of the concentration of PlGF in women with umbilical cord pathology were significantly lower (by 1.6 times), and the indicators of sFlt-1 level – by 1.5 times higher compared to the data of the comparison group, which can be a marker of the abnormal formation of fetoplacental complex with the deterioration of the intrauterine fetal condition, as well as an increase in the angiogenic factor.  The use of “Astraia Obstetrics” module in combination with prenatal biochemical screening made it possible to assign 23.2 % of examined patients with umbilical cord pathology to the risk group for the development of chromosomal abnormalities, preeclampsia, fetal growth retardation and premature birth.