Pathogenesis of chorionic detachment and intrauterine hematomas in early pregnancy: a literature review

Aim: to systematize scientific data on the frequency and pathogenesis of retrochorial and retroroamniotic hematomas in early pregnancy, including the recently published data.Materials and methods. We used sources from the electronic databases PubMed, Embase, eLibrary and articles in peerreviewed open access journals. The search was conducted using the keywords in Russian and English: retrochorial hematoma, retrochorial hemorrhage, subamniotic hematoma, pregnancy outcomes in subamniotic haematoma, pregnancy outcomes in subchorial haematoma, angiogenesis, embryogenesis, placentogenesis. The analysis included sources from the recent 30 years. We excluded publications on multiple pregnancies, ectopic pregnancy, and other sources that did not focus on the pathogenesis of chorionic detachment.Results. The following factors play a role in the occurrence of chorionic detachment: intrauterine malformations, bacterial/viral infection, chronic endometritis, immunological factors, maternal coagulation disorders (hemorrhagic diathesis, genetic thrombophilia, antiphospholipid syndrome, chronic forms of DIC), severe arterial hypertension, and habitual miscarriages.Conclusion. Knowledge of the pathogenetic mechanisms of chorionic detachment is necessary for a differential diagnosis and subsequent successful preservation of pregnancy

Pathogenetically differentiated management of pregnancy in patients with retrochorial hematoma

Introduction. Intrauterine hematomas commonly found in routine ultrasound examinations represent one of causes resulting in early pregnancy loss. The most common is retrochorial hematoma resulting from fetal egg detachment from the uterine wall. Retrochorial hematoma often leads to pregnancy complications and affects gestational process.Aim: to develop a personalized approach to the diagnosis, prevention and management of pregnancy with retrochorial hematomas in the early stages.Materials and methods. A prospective examination of 70 females, aged 22 to 37 years old, with retrochorial hematoma was performed at gestational age ranging from 5 to 12 weeks. Here, we examined serum level for lupus anticoagulant, antiphospholipid antibodies (AFA), antibodies to cardiolipin, fi2-glycoprotein I, to annexin V and prothrombin, and ADAMTS-13. All women were examined for genetic mutations linked to high thrombogenic risk and low thrombogenic risk polymorphisms. Patients were also examined for urinary tract infections.Results. It was found that 43 (61 %) females had aggravated obstetric anamnesis (non-developing pregnancy, spontaneous miscarriage in early stages, antenatal fetal death), whereas 13 (18.5 %) subjects had burdened familial thrombotic history (heart attack, stroke, and thrombosis occurred before the age of 55 years in first-line relatives). In addition, 22 (31.4 %) females were found to have genetic and acquired forms of thrombophilia; 6 (8.5 %) were detected to have circulatory ADAMTS-13 inhibitor; 5 females were confirmed to have decreased blood coagulation factor activity; and 38 (54.2 %) had vaginal dysbiosis.Conclusion. Our work demonstrates that a personified and pathogenetically differentiated algorithm for diagnostics and management of pregnant women with chorionic detachments in early stages allows to lower frequency of early abortions and increases the therapeutic effectiveness

Disseminated intravascular coagulation in perinatal medicine

Introduction. Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by intravascular activation of blood clotting without specific localization and arising from various causes. DIC is the most complex and high-priority problem in contemporary clinical medicine including obstetrics and perinatology. DIC significance is related to its peak perinatal mortality, as well as a large rate of complications during childbirth and postpartum period.Aim: to conduct comprehensive data assessment related to DIC pathogenesis and management in pregnant women and newborns.Materials and methods. A search for DIC-related publications within the past 10 years was conducted in international research databases: Scientific Electronic Library Online eLibrary, Google Scholar, ScienceDirect, Cochrane Library, PubMed/Medline. The data regarding DIC diagnostic criteria and markers, as well as current approach to its treatment are presented.Results. DIC may be considered as one of the causes resulting in massive obstetric bleeding. The majority of pregnancy-related complications is manifested as preeclampsia, premature detachment of normally situated placenta and anaphylactoid syndrome of pregnancy. Any massive bleeding should be perceived as hemorrhage resulting from the DIC progression.Conclusion. Knowledge of the DIC pathogenetic mechanisms is necessary for conducting a differential diagnosis and applying timely treatment