ORIGINAL RESEARCH
Obstetrics and Gynecology
doi: 10.25005/2074-0581-2025-27-3-559-571
THE IMPACT OF CHANGES IN HEMOSTASIS PARAMETERS ON THE PROBABILITY OF DEVELOPING FETAL GROWTH RETARDATION IN AVERAGE AND HIGH-RISK PREGNANT WOMEN

N.F. KUNESHKO1, A.V. ERSHOV2, A.V. LAZARCHUK2

1Odintsovo Regional Hospital, Odintsovo, Russian Federation
2I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation

Objective: To evaluate the state of the hemostasis system in pregnant women who are at high risk for IUGR and placental insufficiency (PI). The assessment will focus on how the timing of detecting these derangements and implementing corrections affects the outcomes.

Methods: he parameters of the hemostasis system were studied using a conventional coagulation test and thromboelastography (TEG) in 621 pregnant women at average and high risk of developing IUGR. These women were admitted for observation at different stages of pregnancy. The patients were categorized into four groups according to the timing of their admission during the pregnancy stages. Group I (n=195) included women observed starting from the first trimester, Group II (n=191) included women followed from the second trimester, and Group III (n=148) consisted of women observed from the third trimester. Group IV included women who had received preconception care (n=87). The control group (n=112) comprised women with a normal singleton pregnancy.

Results: In pregnant women from Group I, early recognition and timely management of hemostasis abnormalities helped prevent the development of secondary thrombophilia. In Group II, the observation of hypercoagulation, platelet activation, and early signs of disseminated intravascular coagulation (DIC) syndrome prompted the use of low-molecular-weight heparins. In Group III, some patients experienced complications during pregnancy due to decompensated placental insufficiency, which led to DIC, requiring a multi-faceted treatment approach.

Conclusion: Research shows that examining the hemostasis system during preconception care and early pregnancy can be beneficial for identifying potential abnormalities. Timely medical intervention to correct these issues can reduce the incidence of PI, prevent IUGR, and prolong the duration of pregnancy until a successful outcome is achieved. Timely medical interventions, such as those provided during antenatal care, can significantly reduce the occurrence of PI and IUGR and extend the pregnancy duration until a healthy outcome is achieved.

Keywords: Pregnancy, fetal growth retardation, placental insufficiency, hemostasis, thromboelastogram.

Download file:

References
  1. Murashko AV, Simonova MS, Goryunova AG. Gemostaziologicheskie pokazateli u beremennykh zhenshchin s arterial'noy gipertenziey i sindromom zaderzhki razvitiya ploda [Hemostasiological indices in pregnant women with arterial hypertension and intrauterine growth restriction (IUGR)]. Arkhiv akusherstva i ginekologii im. V.F. Snegiryova. 2018;5(1):9-11. https://doi. org/10.18821/2313-8726-2018-5-1-9-11
  2. Othman M, Pradhan A. Laboratory testing of hemostasis in pregnancy: A brief overview. Methods Mol Biol. 2023;2663:111-25. https://doi.org/10.1007/978- 1-0716-3175-1_7
  3. Mustafin IG, Kurmanbaev TE, Shmidt AA, Timoshkova YuL, Atayants KM. «Global'nye» metody issledovaniya sistemy gemostaza v sovremennoy akusherskoy praktike [“Global” assays of hemostasis in modern obstetrical practice]. Kazanskiy meditsinskiy zhurnal. 2019;100(6):958-65. https://doi.org/10.17816/ KMJ2019-958
  4. Warren BB, Moyer GC, Manco-Johnson MJ. Hemostasis in the pregnant woman, the placenta, the fetus, and the newborn infant. Semin Thromb Hemost. 2023;49(4):319-29. https://doi.org/10.1055/s-0042-1760332
  5. Murashko AV, Drapkina YuC, Korolyova NS. Techenie beremennosti i svyortyvayushchaya sistema krovi [The course of pregnancy and blood coagulation system]. Arkhiv akusherstva i ginekologii im. V.F. Snegiryova. 2016;3(4):181-7. https://doi.org/10.18821/2313-8726-2016-3-4-181-187
  6. Orudzhova EA, Samburova NV, Anichkova EV, Gotsiridze KE, Bitsadze VO. Trombofilii v patogeneze zaderzhki rosta ploda [Thrombophilia in the pathogenesis of fetal growth retardation]. Akusherstvo, ginekologiya i reproduktsiya. 2021;15(2):189-200. https://doi.org/10.17749/2313-7347/ob.gyn. rep.2021.223
  7. Bellart J, Gilabert R, Fontcuberta J, Carreras E, Miralles RM, Cabero L. Coagulation and fibrinolytic parameters in normal pregnancy and in pregnancy complicated by intrauterine growth retardation. Am J Perinatol. 1998;15(2):81-5. https://doi.org/10.1055/s-2007-993903
  8. O'Keefe D, Lim HY, Tham J, Ho P, Hui L. Assessing maternal clotting function with novel global coagulation assays: A prospective pilot study. Int J Lab Hematol. 2021;43(3):458-67. https://doi.org/10.1111/ijlh.13389
  9. Vereina NK, Dolgushina VF, Fartunina YuV, Kolyada EV. Izmeneniya v sisteme gemostaza u beremennykh s zaderzhkoy rosta ploda [Changes in the hemostasis system in pregnant women with fetal growth retardation]. Tromboz, gemostaz i reologiya. 2020;3:55-61. https://doi.org/10.25555/THR.2020.3.0929
  10. Strizhakov AN, MM, Ignatko IV, Popova NG, Florova VS, Kuznetsov AS. Prognozirovanie sindroma zaderzhki rosta ploda u beremennykh vysokogo riska [Prediction of fetal growth retardation syndrome in highrisk pregnant women]. Akusherstvo i ginekologiya. 2017;7:34-44. https://doi. org/10.18565/aig.2017.7.34-44
  11. Ren K, Wei Y, Qiao R, Shi H, Gong X, Zhao Y. Changes in coagulation during twin pregnancies. Clin Appl Thrombosis/Hemostasis. 2020;26:107602962098389. https://doi.org/10.1177/1076029620983898
  12. Zhao H, Cheng H, Huang M, Mei F. Application of thromboelastography in diagnosing normal pregnancies and pregnancies with complications. J Clin Lab Anal. 2022;36(6):e24446. https://doi.org/10.1002/jcla.24446
  13. Mukhopadhyay T, Subramanian A. An overview of the potential sources of diagnostic errors in (classic) thromboelastography curve interpretation and preventive measures. Pract Lab Med. 2020;22:e00193. https://doi.org/10.1016/j. plabm.2020.e00193
  14. Yang J, Yang H, Tang A. Trimester-specific reference intervals for kaolin-activated thromboelastography (TEG®) in healthy Chinese pregnant women. Thromb Res. 2019;184:81-5. https://doi.org/10.1016/j.thromres.2019.09.030
  15. Amgalan A, Allen T, Othman M, Ahmadzia HK. Systematic review of viscoelastic testing (TEG/ROTEM) in obstetrics and recommendations from the women's SSC of the ISTH. J Thromb Haemost. 2020;18(8):1813-38. https://doi. org/10.1111/jth.14882
  16. Tiscia GL, De Laurenzo A, Cappucci F. Thromboelastography parameters in Italian pregnant women: D o antithrombotic drugs change reference values? J Investig Med. 2020;68(4):902-5. https://doi.org/10.1136/jim-2019-001261
  17. González A, Peguero A, Meler E, Camprubí-Camprubí M, Rovira C, Gomez-Roig MD, et al. Treatment of early-onset fetal growth restriction with low molecular weight heparin does not prolong gestation: A randomized clinical trial. Am J Obstet Gynecol. 2024:S0002-9378(24)01127-X. https://doi.org/10.1016/j. ajog.2024.10.055
  18. Putilova NV, Nesterova EA, Pestryaeva LA. Otsenka sistemy gemokoagulyatsii u beremennykh s platsentarnoy nedostatochnost'yu i ikh novorozhdyonnykh [Evaluation of the blood coagulation system in pregnant women with placental insufficiency and their newborns]. Rossiyskiy vestnik akushera-ginekologa. 2017;17(1):913. https://doi.org/10.17116/rosakush20171719-13
  19. Karapati E, Sokou R, Iliodromiti Z, Tsaousi M, Sulaj A, Tsantes AG, et al. Assessment of hemostatic profile in neonates with intrauterine growth restriction: A systematic review of literature. Semin Thromb Hemost. 2024;50(2):169-81. https://doi.org/10.1055/s-0043-1762893
  20. Cao Y, Liang T, Peng J, Zhao X. Factors influencing thrombelastography in pregnancy. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2023;48(2):198-205. https://doi. org/10.11817/j.issn.1672-7347.2023.210530
  21. Sokou R, Foudoulaki-Paparizos L, Lytras T, Konstantinidi A, Theodoraki M, Lambadaridis I, et al. Reference ranges of thromboelastometry in healthy full-term and pre-term neonates. Clin Chem Lab Med. 2017;55(10):1592-7. https://doi. org/10.1093/bja/aeq258
  22. Sokou R, Konstantinidi A, Stefanaki C, Tsantes AG, Parastatidou S, Lampropoulou K, et al. Thromboelastometry: Studying hemostatic profile in small for gestational age neonates – a pilot observational study. Eur J Pediatr. 2019;178(4):551-7. https://doi.org/10.1007/s00431-019-03331-w

Authors' information:

Kuneshko Nart Faruk,
Candidate of Medical Sciences, Deputy Chief Physician for Obstetrics and Gynecology, Head of Odintsovo Maternity Hospital
Scopus ID: 59234417100
ORCID ID: 0000-0002-2754-5129
SPIN: 7791-8924
E-mail: drnartfaruk@mail.ru

Ershov Anton Valeryevich,
Doctor of Medical Sciences, Professor of the Pathophysiology Department, I.M. Sechenov First Moscow State Medical University
Scopus ID: 55682513700
ORCID ID: 0000-0001-5758-8552
SPIN: 2059-3248
E-mail: salavatprof@mail.ru

Lazarchuk Arina Vladimirovna,
Clinical Resident, Department of Obstetrics, Gynecology, and Perinatal Medicine, N.F. Filatov Clinical Institute of Children's Health, I.M. Sechenov First Moscow State Medical University
Scopus ID: 58509356900
ORCID ID: 0000-0003-2136-1641
SPIN: 2004-3570
E-mail: arina.lazarchuk@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Lazarchuk Arina Vladimirovna
Clinical Resident, Department of Obstetrics, Gynecology, and Perinatal Medicine, N.F. Filatov Clinical Institute of Children's Health, I.M. Sechenov First Moscow State Medical University

119991, Russian Federation, Moscow, Trubetskaya str., 8, Bld. 2

E-mail: arina.lazarchuk@mail.ru

Tel.: +7 (985) 1793780


This work is licensed under a Creative Commons Attribution 4.0 International License.

Materials on the topic:
  1. THE IMPACT OF CONGENITAL UTERINE ANOMALIES ON PREGNANCY OUTCOMES
  2. PERINATAL OUTCOMES IN PATIENTS WITH EARLY AND LATE SEVERE PREECLAMPSIA
  3. EFFICACY OF EMERGENCY TRANSVAGINAL CERVICAL CERCLAGE
  4. PSYCHOLOGICAL IMPACT OF THE COVID-19 PANDEMIC ON PREGNANT WOMEN IN DUSHANBE
  5. HIGH-SENSITIVITY C-REACTIVE PROTEIN IN THE FIRST TRIMESTER OF PREGNANCY IN OBESE PATIENTS WITH GESTATIONAL DIABETES
  6. PREMATURE PLACENTAL ABRUPTION: EPIDEMIOLOGY, RISK FACTORS, AND MEDICAL AND SOCIOECONOMIC ASPECTS
  7. RATES AND CATEGORIES OF PRETERM BIRTHS IN MATERNITY CARE FACILITIES OF VARIOUS LEVELS
  8. RISK FACTORS FOR SPONTANEOUS PRETERM BIRTH
  9. PREMATURE SEPARATION OF THE NORMALLY IMPLANTED PLACENTA
  10. MORPHOFUNCTIONAL FEATURES OF THE PLACENTA IN PREGNANT WOMEN WITH TUBERCULOSIS

◄ Back to the list