Coagulation and hemodynamic parameters in premature and growth restricted fetuses
DOI:
https://doi.org/10.15574/HW.2024.5(174).4247Keywords:
fetal growth restriction, prematurity, preterm parturition, fibrinolysis, D-dimer, middle cerebral arteryAbstract
Premature birth and fetal growth retardation complicate 20% of pregnancies. Intraventricular hemorrhages cause up to 35% of neonatal losses. There is no complete understanding of the mechanisms of development and ways to prevent these complications.
Aim - to compare the indicators of newborns blood coagulation and fibrinolysis with growth retardation and prematurity, taking into account their hemodynamic prenatal characteristics for differential diagnostic of hemostasis disorders.
Materials and methods. 86 newborns and their mothers were examined. The indicators of pH, fibrinogen and D-dimer in mothers and newborns at 28-34 weeks of gestation after moderate premature birth (MPB group) and with growth restriction (FGR group) and after full-term childbirth (FT) were compared. On the eve of childbirth, hemodynamics of the uterine, umbilical cord and middle cerebral arteries were measured.
Results. The fibrinogen concentration in newborns is 2.29, 2.47 and 2.15 times lower than maternal ones respectively. The ratio of fibrinogen/D-dimer in mothers of the MPB group is 1.02x103 vs 6.7×103 and 6.5×103 of other groups. The ratio of fibrinogen/D-dimer of newborns is 2.0×103; 1.9×103 and 3.5×103 respectively. That is, in the FGR group, fibrinolysis is slowed down by 75-84% compared to MPB and FT. The peak blood flow velocity is higher in the MPB group (pulsatility index 1.99±0.204) with reduced vascular resistance (resistance index 0.87±0.048). The indicators are within the normal range in the FT group (1.17±0.062 and 1.54±0.101, respectively). Vascular resistance in the FGR group is reduced - 0.64±0.062.
Conclusions. The newborns fibrinogen content is up to 2.5 times lower than the mother's, on the contrary, the D-dimer content is 1.5-2 times higher, except for growth restricted newborns. There is a decrease in the D-dimer content in fetuses with growth retardation against the background of slow blood circulation, which indicates a decrease in fibrinolysis.
The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committee of the participating institution. Informed consent was obtained from all patients.
No conflict of interests was declared by the authors.
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