ACADEMIC AND RESEARCH PEER-REVIEWED MEDICAL JOURNALISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
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Placenta Accreta Forecasting Using Serum Marker Values

DOI:10.31550/1727-2378-2020-19-1-6-11
For citation: Lukashevich A A., Aksenenko V.A., Milovanov A.P., Dubovoy A.A., Nezhdanov I.G., Mozheyko L.N. Placenta Accreta Forecasting Using Serum Marker Values. Doctor.Ru. 2020; 19(1): 6–11. (in Russian) DOI: 10.31550/1727-2378-2020-19-1-6-11
4 February 16:03

Study Objective: to study some stages in placenta accreta pathogenesis and to determine serum concentration of cytotrophoblastic invasion markers: type and type 9 matrix metalloproteinases (MMP-2 and MMP-9), their inhibitors (TIMP-1 and TIMP-2), kisspeptin 1, as well as the possibility of their use as placenta accreta predictors.

Study Design: comparative study.

Materials and Methods. The study enrolled 150 women: 50 patients with placenta previa accreta (study group), 50 patients with placenta previa (comparison group), and 50 patients with caesarean section delivery not associated with placenta abnormalities (controls). The study material was blood serum. Heterogeneous enzyme immunoassay was used during the study. Immunohistochemical material was sampled intraoperatively: myometrium and basal layer fragments and a central placenta area were excised.

Study Results. Pregnant women with placenta accreta had statistically significant (p < 0.05) increase in MMP-2, MMP-9, TIMP-1, TIMP-2 and kisspeptin 1 as compared to serum concentrations in controls. Based on the data we obtained, critical values will be 380.8 pg/mL for MMP-2; 240.1 ng/mL for MMP-9; 8.5 ng/mL for TIMP-1; 6.1 ng/mL for TIMP-2, and 145.2 pg/mL for kisspeptin 1. If these concentrations are exceeded, there is statistically significant (p < 0.05) correlation with the probability of abnormal placenta invasion and ingrowth (placenta accreta). If the MMP-9/TIMP-1 concentration ratio is below 49.9, there is significant (p < 0.05) correlation with placenta accreta if women with placenta accreta and compared with patients with placenta previa, but without ingrowth.

Conclusion. The data obtained allow considering MMP-2, MMP-9, TIMP-1, TIMP-2, kisspeptin as placenta accreta predictors. Their accuracy of 81.4%, sensitivity of 78.8%, and specificity of 84.0% make it possible to forecast an abnormal placenta invasion — placenta accreta.

Contribution: Lukashevich, A.A. — collection of material, literature review, immunofluorescent assay; Aksenenko, V.A. — organisation of works, study approval; Milovanov, A.P. — immunohistochemical and morphological examinations; Dubovoy, A.A. — support in statistical data processing, immunofluorescent assay; Nezhdanov, I.G. and Mozheyko, L.N. — support in article preparation.

Conflict of interest: The authors declare that they do not have any conflict of interests.

Received: 13.06.2019
Accepted: 07.10.2019


A.A. Lukashevich (Corresponding author) — Stavropol State Medical University of the Ministry of Health of the Russian Federation; 310 Mira Str., Stavropol, Russian Federation 355017. E-mail: kshatriy1991@gmail.com

V.A. Aksenenko — Stavropol State Medical University of the Ministry of Health of the Russian Federation; 310 Mira Str., Stavropol, Russian Federation 355017. eLIBRARY.RU SPIN: 3927-5491. E-mail: aksenenko_@mail.ru

A.P. Milovanov — Scientific and Research Centre of Human Morphology; 3 Tsyurupa Str., Moscow, Russian Federation 117198. eLIBRARY.RU SPIN: 8242-5670. ORCID: http//orcid.org/0000-0001-8804-0258. E-mail: a_p_milovanov@mail.ru

A.A. Dubovoy — Stavropol State Medical University of the Ministry of Health of the Russian Federation; 310 Mira Str., Stavropol, Russian Federation 355017. eLIBRARY.RU SPIN: 2181-1359. E-mail: alexanderdubovoy@gmail.com

I.G. Nezhdanov — Stavropol State Medical University of the Ministry of Health of the Russian Federation; 310 Mira Str., Stavropol, Russian Federation 355017. eLIBRARY.RU SPIN: 6834-8847. E-mail: obstetrics26@gmail.com

L.N. Mozheyko — Stavropol State Medical University of the Ministry of Health of the Russian Federation; 310 Mira Str., Stavropol, Russian Federation 355017. E-mail: obstetrics26@gmail.com

Доктор.ру

Fig. Mean values of matrix metalloproteinase inhibitors TIMP-1 and TIMP-2 in study group and controls (N)

ris1_1.jpg

Table 1
Type 2 and type 9 matrix metalloproteinase (MMP-2, MMP-9), their inhibitors (TIMP-1, TIMP-2), kisspeptin 1 in study group

t1_1.jpg
* Statistically significant differences vs. controls (p < 0.05).

Table 2
Immune expression rates of type 2 and type 9 matrix metalloproteinase (MMP-2, MMP-9) and their inhibitors (TIMP-1, TIMP-2) in various cells of uterus-pacenta area (scores of 1 to 3)

t1_2.jpg

Notes: presented are mean values, standard errors and reliability of Mann-Whitney test (р < 0.05), as well as the number of villi (upper row) and cells (bottom rows) studied.

4 February 16:03
LITERATURE
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