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Semin Thromb Hemost 2003; 29(2): 213-218
DOI: 10.1055/s-2003-38837
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Assessment of Uterine Placental Circulation in Thrombophilic Women

Zeev Weiner1 , Johnny S. Younis2 , Zeev Blumenfeld3 , Eliezer Shalev1
  • 1Department of Obstetrics and Gynecology, Haemek Medical Center, Afula, Israel
  • 2Department of Obstetrics and Gynecology, Porya Medical Center, Afula, Israel
  • 3Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
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Publikationsverlauf

Publikationsdatum:
23. April 2003 (online)

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ABSTRACT

Thrombophilia is associated with several complications of pregnancy including first and second trimester fetal loss, intrauterine fetal death, intrauterine growth restriction, preeclampsia, and placental abruption. Few studies have documented thrombotic lesions observed on the pathologic examination of the placenta in women with severe pregnancy complications. Moreover, a significantly higher rate of factor V Leiden and prothrombin G20210A gene mutations have been found in placentas with thrombotic events compared with normal placentas. In addition, clinical studies have been performed, using Doppler ultrasonography, to assess the uterine placental circulation in women with thrombophilia. Doppler studies of the umbilical artery in cases of intrauterine growth retardation have shown a high systolic to diastolic ratio (S/D) ratio, suggesting an increase in the resistance of the placental small vessels. When these placental vessels were examined after delivery, significant differences were found in comparison with placental vessels of normal pregnancies. Most of the Doppler studies of the umbilical and uterine arteries in pregnancies with thrombophilia were performed in women with antiphospholipid antibodies. The other pathologic conditions associated with thrombophilia and complications of pregnancy were published only recently. These few studies have demonstrated abnormal umbilical and uterine arteries blood flow in complicated pregnancies. Finally, few Doppler studies also suggest improved uterine placental circulation when women with thrombophilia received thromboprophylaxis.

KEYWORDS

Thrombophilia - pregnancy - placental circulation - thrombosis - thromboprophylaxis

REFERENCES

  • 1 Sibai B M. Thrombophilias and adverse outcomes of pregnancy-what should a clinician do?.  N Engl J Med . 1999;  340 50-52
    CrossrefPubMedGoogle Scholar
  • 2 Kupferminc M J, Eldor A, Steinman N. et al . Increased frequency of genetic thrombophilia in women with complications of pregnancy.  N Engl J Med . 1999;  340 9-13
    CrossrefPubMedGoogle Scholar
  • 3 Brenner B, Sarig G, Weiner Z. et al . Thrombophilic polymorphisms are common in women with fetal loss without apparent cause.  Thromb Haemost . 1999;  82 6-9
    PubMedGoogle Scholar
  • 4 Younis J S, Brenner B, Ohel G. et al . Activated protein C resistance and factor V Leiden can be associated with first-trimester as well as second-trimester recurrent pregnancy loss.  Am J Reprod Immunol . 2000;  43 31-35
    CrossrefPubMedGoogle Scholar
  • 5 Rothbart H, Ohel G, Younis J, Lanir N, Brenner B. High prevalence of activated protein C resistance due to factor V Leiden mutation in cases of intrauterine fetal death.  J Matern Fetal Med . 1999;  8 228-230
    CrossrefPubMedGoogle Scholar
  • 6 Khong T, de Wolf F, Robertson W B, Bronsens I. Inadequate maternal vascular response to placentation in pregnancies complicated by pre-eclampsia and by small for gestational age infants.  Br J Obstet Gynaecol . 1986;  93 1049-1059
    CrossrefPubMedGoogle Scholar
  • 7 Dizon-Townson D S, Nelson L M, Easton K, Ward K. The factor V Leiden mutation may predispose women to severe preeclampsia.  Am J Obstet Gynecol . 1996;  175 902-905
    CrossrefPubMedGoogle Scholar
  • 8 Lindoff C, Ingemarsson I, Matinson G. et al . Preeclampsia is associated with a reduced response to activated protein C.  Am J Obstet Gynecol . 1997;  176 457-460
    PubMedGoogle Scholar
  • 9 Grandone E, Margaglione M, Colaizzo D. et al . Factor V Leiden, C>T MTHFR polymorphism and genetic susceptibility to preeclampsia.  Thromb Haemost . 1997;  77 1052-1054
    PubMedGoogle Scholar
  • 10 Nagy B, Toth T, Rigo Jr J. et al . Detection of factor V Leiden mutation in severe pre-eclamptic Hungarian women.  Clin Gent . 1998;  53 478-481
    CrossrefPubMedGoogle Scholar
  • 11 Dekker G A, de Vries I P J, Doelitzsch P M. et al . Underlying disorders associated with severe early-onset preeclampsia.  Am J Obstet Gynecol . 1996;  173 1042-1048
    PubMedGoogle Scholar
  • 12 Wiener-Megnagi Z, Ben-Shlomo I, Goldberg Y, Shalev E. Resistance to activated protein C and the Leiden mutation.  J Obstet Gynecol . 1998;  179 1565-1567
    CrossrefPubMedGoogle Scholar
  • 13 Goddijn-Wessel T A, Wouters M G, van der Molen F E. et al . Hyper-homocysteinemia: a risk factor for placental abruption or infarction.  Eur J Obstet Gynecol Reprod Biol . 1996;  66 23-29
    CrossrefPubMedGoogle Scholar
  • 14 Arias F, Romero R, Joist H, Kraus F T. Thrombophilia: a mechanism of disease in women with adverse pregnancy outcome and thrombotic lesions in the placenta.  J Matern Fetal Med . 1998;  7 277-286
    CrossrefPubMedGoogle Scholar
  • 15 Dizon-Townson D S, Meline L, Nelson L M, Varner M, Ward K. Fetal carriers of the factor V Leiden mutation are prone to miscarriage and placental infarction.  Am J Obstet Gynecol . 1997;  177 402-405
    CrossrefPubMedGoogle Scholar
  • 16 Vern T Z, Alles A J, Kowal-Vern A, Longtine J, Roberts D J. Frequency of factor V (Leiden) and prothrombin G20210A in placentas and their relationship with placental lesions.  Hum Pathol . 2000;  31 1036-1043
    CrossrefPubMedGoogle Scholar
  • 17 Mousa H A, Alfirevici Z. Do placental lesions reflect thrombophilia state in women with adverse pregnancy outcome?.  Hum Reprod . 2000;  15 1830-1833
    CrossrefPubMedGoogle Scholar
  • 18 Brosens I, Robertson W B, Dixon H G. The physiological response of the vessels of the placental bed to normal pregnancy.  J Pathol Bacteriol . 1967;  93 569-579
    CrossrefPubMedGoogle Scholar
  • 19 Brosens I A. Morphological changes in the uteroplacental bed in pregnancy hypertension.  Clin Obstet Gynecol . 1977;  4 573-593
    PubMedGoogle Scholar
  • 20 Schulman H, Weiner Z. Doppler ultrasound in pregnancy. In: Burns P, Taylor G, eds. Clinical Application of Doppler Ultrasound, 2nd ed New York: Raven Press; 1995
    Google Scholar
  • 21 Jaffe R, Jauniaux E, Hustin J. Maternal circulation in the first-trimester human placenta. Myth or reality?.  Am J Obstet Gynecol . 1997;  176 695-705
    PubMedGoogle Scholar
  • 22 Jauniaux E, Jurkovic D, Campbell S. In vivo investigation of the placental circulation by Doppler echography.  Placenta . 1995;  16 323-331
    CrossrefPubMedGoogle Scholar
  • 23 Jauniaux E, Jurkovic D, Campbell S, Kurjak A, Hustin J. Investigation of placental circulations by color Doppler ultrasound.  Am J Obstet Gynecol . 1991;  164 486-488
    PubMedGoogle Scholar
  • 24 McCowan M L, Ritchie K, Mo L Y, Bascom P A, Sherret H. Uterine artery flow velocity waveforms in normal and growth-retarded pregnancies.  Am J Obstet Gynecol . 1988;  158 499-504
    PubMedGoogle Scholar
  • 25 Trudinger B J, Giles W B. Clinical and pathological correlations of umbilical and uterine artery waveforms.  Clin Obstet Gynecol . 1989;  32 669-678
    PubMedGoogle Scholar
  • 26 Harrington K, Cooper D, Lees C, Hecher K, Campbell S. Doppler ultrasound of the uterine arteries: the importance of bilateral notching in the prediction of pre-eclampsia, placental abruption or delivery of a small-for-gestational-age baby.  Ultrasound Obstet Gynecol . 1996;  7 182-188
    CrossrefPubMedGoogle Scholar
  • 27 Bower S, Schuchter K, Campbell S. Doppler ultrasound screening as part of routine antenatal scanning: prediction of pre-eclampsia and intrauterine growth retardation.  Br J Obstet Gynecol . 1993;  100 989-994
    PubMedGoogle Scholar
  • 28 Fleischer A, Schulman H, Farmakides G, Bracero L. Umbilical velocity waveforms in intrauterine growth retardation.  Am J Obstet Gynecol . 1985;  151 502-505
    PubMedGoogle Scholar
  • 29 Rochelson B R, Schulman H, Fleischer A. et al . The clinical significance of Doppler umbilical artery velocimetry in the small for gestational age fetus.  Am J Obstet Gynecol . 1987;  156 1223-1226
    PubMedGoogle Scholar
  • 30 Giles W B, Trudinger B J, Baired P. Fetal umbilical artery flow velocity waveforms and placental resistance: pathological correlation.  Br J Obstet Gynecol . 1985;  92 31-38
    PubMedGoogle Scholar
  • 31 Fox H. Pathology of the placenta. In: Bennington JL, ed. Major Problems in Pathology London: Saunders 1978: 101-128
    Google Scholar
  • 32 McCowan L M, Mullen B M, Ritchie K. Umbilical artery flow velocity waveforms in the placental vascular bed.  Am J Obstet Gynecol . 1987;  157 900-906
    PubMedGoogle Scholar
  • 33 Donohoe S, Geary M, Kingdom J C. et al . Maternal cardiolipin, beta 2-glycoprotein-I and prothrombin antibody expression in high-risk pregnancies with bilateral abnormal uterine Doppler waveforms.  Ultrasound Obstet Gynecol . 1999;  13 317-322
    PubMedGoogle Scholar
  • 34 Cruso A, De-Carolis S, Ferrazzani S, Valesini G, Caforio L, Mancuso S. Pregnancy outcome in relation to uterine artery flow velocity waveforms and clinical characteristics in women with antiphospholipid syndrome.  Obstet Gynecol . 1993;  82 970-977
    PubMedGoogle Scholar
  • 35 Kerslake S, Morton K E, Versi E. et al . Early Doppler studies in lupus pregnancy.  Am J Reprod Immunol . 1992;  28 172-175
    PubMedGoogle Scholar
  • 36 Blumenfeld Z, Weiner Z, Lorber M, Sujov P, Thaler I. Anticardiolipin antibodies in patients with recurrent pregnancy wastage: treatment and uterine blood flow.  Obstet Gynecol . 1991;  78 584-589
    PubMedGoogle Scholar
  • 37 Younis J S, Ohel G, Brenner B. et al . The effect of thrombophylaxis on pregnancy outcome in patients with recurrent pregnancy loss associated with factor V Leiden mutation.  Br J Obstet Gynaecol . 2000;  107 415-419
    PubMedGoogle Scholar