Clinical Study Of Maternal Coagulation Indicators In Fetal Growth Restriction

Background:Fetal growth restriction(FGR)is a condition in which the fetus does not grow to its genetic potential due to maternal,fetal,and placental cord pathologies,and is usually characterized by an ultrasound estimate of fetal weight or abdominal circumference below the 10 th percentile for the appropriate gestational age.The Gordijn study reached an expert consensus that FGR can be classified as early-onset FGR(<32 weeks)and late-onset FGR(≥32 weeks)according to the first week of gestation,when fetal genetic abnormalities are excluded.)Because of the atypical clinical presentation of FGR and the lack of specificity of domestic and international diagnostic criteria,the underdiagnosis rate,misdiagnosis rate and perinatal mortality rate are high.However,early recognition and diagnosis of FGR is a major challenge for obstetrics.Studies have shown that localized ischemic necrosis of the placenta in FGR will lead to enhanced coagulation.Whether FGR can be predicted by simple and easy coagulation indicators needs to be explored,and there are few studies on the differences in clinical outcomes(placental histopathological findings,pregnancy outcomes and neonatal outcomes)between different types of FGR and normal pregnancies.Objective:A retrospective study was conducted to collect coagulation indexes,placental histopathological findings,pregnancy outcomes and neonatal outcomes from FGR and normal pregnancies admitted and delivered in the obstetrics department of our hospital,to investigate the changes of coagulation indexes in different types of FGR and the predictive value of coagulation indexes for different types of FGR,and to provide a basis for early detection and intervention of FGR.To provide clinical information and reference for the outcome of FGR by comparing the clinical outcomes(placental histopathological findings,pregnancy outcomes,and neonatal outcomes)of different types and normal pregnancies.Methods:1.Based on the diagnostic criteria of fetal growth restriction,the completeness of clinical diagnosis and treatment data and the inclusion and exclusion criteria,a total of 86 cases of early-onset FGR were collected as the early-onset group,96 cases of late-onset FGR were collected as the late-onset group,and100 cases without congenital hematologic disorders,coagulation disorders,thrombosis and anticoagulant drugs and pregnancy complications were collected as the control group.The data were statistically analyzed using SPSS 26.0 to compare the general clinical data(age,BMI,whether they were primiparous,menstrual,whether they had a history of adverse pregnancy and childbirth,whether they had regular obstetric examinations,natural conception,assisted reproduction);coagulation-related indexes [coagulation system function indexes: activated partial thromboplastin time(APTT),fibrinogen(FIB),prothrombin time(PT),prothrombin time(TT);anticoagulation system functional indexes: antithrombin III(AT-III),protein S(PS),protein C(PC);fibrinolytic system functional indexes:D-dimer(D-Dimer),fibrinogen degradation products(FDP);platelet functional indexes: platelet count(PLT),platelet pressure product(PCT),mean platelet volume(MPV),platelet distribution width(PDW);thromboelastography: clot reaction time(R),clot formation time(K),fibrinogen level(Angle)and maximum amplitude of thrombus(MA),coagulation composite index(CI)];histopathological findings of the placenta(placental weight,placental volume,placental thickness,placental coefficient,widest umbilical cord diameter,placental infarction,focal calcification,chorionic thrombohematoma,chorioamnionitis,chorionic occlusive endovasculitis,interstitial fibrin deposition);pregnancy outcome(week of labor,2-h postpartum hemorrhage,spontaneous delivery,cesarean delivery,whether cesarean delivery was due to fetal distress);neonatal outcome(prematurity,neonatal weight,1-minute Apgar score,5-minute Apgar score,10-minute Apgar score,NIC admission);and neonatal outcome(preterm birth,neonatal weight,1-minute Apgar score,5-minute Apgar score,10-minute NIC admission).minute Apgar score,admission to NICU,neonatal hypoglycemia,neonatal pneumonia,neonatal hypoxic-ischemic encephalopathy,neonatal respiratory distress syndrome,and neonatal necrotizing small bowel colitis).The differences were statistically significant at P < 0.05.2.To compare the differences in coagulation-related indexes between the early-onset and late-onset groups and the control group,the predictive value of coagulation-related indexes for early-onset FGR and late-onset FGR was calculated by plotting the area under the subject’s working characteristic curve(AUC).Results:1.Coagulation indexes The differences of FIB,APTT,TT,PC,FDP,D-Dimer,PLT,PCT,PDW,Angel,K and CI in the three groups were not statistically significant(P>0.05);the MA was significantly higher,R was significantly shorter,PT was significantly shorter,PS was significantly smaller,AT-III was significantly smaller and MPV was significantly larger in the early-onset group compared with the control group.The differences were statistically significant(P<0.05);in the late hairstyle group,MA was significantly higher,PT was significantly shorter and PS was significantly smaller than in the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in coagulation indexes between the early-and late-styled group(P> 0.05).2.Predictive value of coagulation-related indicators for fetal growth restriction Plotting ROC curves showed that the area under the curve for MA,MPV,AT-III,PT,PS,and R predicting premature FGR were0.787,0.720,0.697,0.750,0.709,and 0.712,respectively(P<0.05),which were statistically significant.the threshold,corresponding sensitivity,and specificity of MA,MPV,AT-III,PT,PS,and R predicted premature FGR with thresholds,corresponding sensitivities,and specificities of 65.00,80.0%,and 76.7%;11.00,76.7%,and 63.3%;88.00,76.7%,and 63.3%;11.35,83.3%,and 66.7%;66.50,70.0%,and 70.0%;and 6.65,and 76.7%,70.0%.the area under the curve for MA,PT,and PS prediction of late-stage FGR was0.746,0.704,and 0.686(P<0.05)statistically significant.the threshold,corresponding sensitivity,and specificity of MA,PT,and PS prediction of late-stage FGR were 64.5,73.3%,and 76.7%;11.05,60.0%,and 80.0%;68,76.7%,and60.0%.3.Histopathological findings of the placenta There were no significant differences in placental thickness and placental coefficient among the three groups(P>0.05).The early-onset group showed reduced placental weight,reduced placental volume,shortened widest diameter of umbilical cord,increased placental infarction,increased focal calcification,increased chorionic thrombotic hematoma,increased chorioamnionitis,and increased chorionic occlusive endovasculitis compared with the control group,and the differences were statistically significant(P <0.05).There was a statistically significant difference(P <0.05)between the late-stage group and the control group in terms of decreased placental weight,decreased placental volume,shortened widest diameter of the umbilical cord,increased placental infarction,increased focal calcification,increased chorionic thrombotic hematoma,increased chorioamnionitis,and increased chorioretinal occlusive endovasculitis.The differences were statistically significant(P< 0.05)in reduced placental weight,reduced placental volume,shortened widest diameter of the umbilical cord,increased placental infarction,and reduced focal calcification in the early-onset group compared with the late-onset group.4.Neonatal outcome There were significantly more cases of preterm birth,significantly lower neonatal weight,significantly lower Apgar score at 1 minute,lower Apgar score at 5 minutes,lower Apgar score at 10 minutes,more admissions to NICU,more cases of neonatal hypoglycemia,more neonatal pneumonia,more neonatal respiratory distress syndrome,more neonatal necrotizing small intestine,and more neonatal colitis than the control group.The difference was statistically significant(P <0.05).The differences were statistically significant(P<0.05)in the number of preterm babies,neonatal weight loss,NICU admission,neonatal hypoglycemia,and neonatal respiratory distress syndrome in the late-staging group compared with the control group;the differences were statistically significant(P<0.05)in the1-minute Apgar score,5-minute Apgar score,10-minute Apgar score,neonatal pneumonia,neonatal hypoxic-ischemic encephalopathy,and neonatal necrotizing small intestine The comparison of colitis was not statistically significant(P>0.05).There was a statistically significant difference in the number of preterm infants,decreased neonatal weight,decreased 1-minute Apgar score,decreased 5-minute Apgar score,increased admission to the NICU,increased neonatal hypoglycemia,increased neonatal pneumonia,and increased neonatal respiratory distress syndrome in the early-onset group compared to the late-onset group(P <0.05).Conclusions:1.Both early-onset FGR and late-onset FGR suggest a hypercoagulable state of blood;when the coagulation indexes are in a hypercoagulable state during pregnancy(when MA is significantly elevated,R is significantly shortened,PT is significantly shortened,PS is significantly reduced,AT-III is significantly reduced,and MPV is significantly increased),the occurrence of fetal growth restriction should be alerted.2.The histopathological findings of the placenta are critical for fetal growth restriction;there is an increasing trend of placental weight,placental volume,and widest diameter of the umbilical cord in early-onset fetal growth restriction,late-onset fetal growth restriction,and normal pregnancies.Placental infarction is more common in early-onset fetal growth restriction;focal placental calcification is more common in late-onset fetal growth restriction.3.The Apgar score of early-onset FGR improved gradually over time,but there were more neonatal complications;both early-onset and late-onset fetal growth restriction were prone to sudden fetal distress and cesarean delivery,and perinatal outcome was of concern.