Download (2) Dr. A. Abadi (3)

Relation of Thrombophilia and intrauterine
fetal growth restriction
Dr. F Yassaei * (1) Dr. P. Taherzadeh Boroujeni (2) Dr. A. Abadi (3)
1. Assistant Professor Department of Obstetrics and Gynecology -
Taleghani Hospital - Medical shahid Beheshti university
2. Resident of obstetrics&gynecology - Taleghani Hospital - Medical
shahid Beheshti university
3. Department of Statistics and Epidemiology - shahid Beheshti Medical
Sciences university
Abstract
Background Objective: IUGR (Intrauterine Growth Restriction) is a situation
that infant mortality or disability and is accompanied during the whole life.
Pathogenesis of IUGR Organic and researchers dispute is one of the causes of this
study means challenging year thrombophilia with IUGR has been investigated.
Methods: In a case-control study in which delivery was to Taleghani Hospital 43
women with IUGR affected embryos as a group and 20 women with healthy
fetuses as controls were studied and evaluated in both groups Thrombophilia and
are compared.
Results: Thrombophilia in 13 women (30 / 2%) cases and 1 woman (5%) was
seen in the control group (0 / 027 = P valuen) (68 / 1 - 99%):% 95 =CI and odd
ratio = 8/23). Significant and independent relationship between Thrombophilia and
fetal environment and over the long femur bone was observed .. Among other
indixes with Thrombophilia significant relationship was seen.
Conclusion:
Data showed that the relationship between IUGR Thrombophilia and significant,
but to reach more definitive results further studies seem necessary.
key words: Thrombophilia - pregnancy - intrauterine fetal growth
* Author responsible for correspondence: doctor Fakhrolmoluk Yassaei - Tehran Velenjak - next shahid Beheshti University - Hospital Taleghani:
Email: dr [email protected]
Introduction
Intrauterine fetal growth (Intrauterine Growth Restriction) condition in which fetal
growth potential that it has had to reach before pregnancy based on age, size and
fetal weight was lower than normal (1). A definition, but that fetal weight
according to gestational age below the 10th percentile is placed (Small for
Gestational Age) SGA considered Are (2). Importance of fetal IUGR and SGA
experience is that the embryo and from newborns future delivery of their higher
risk of mortality and morbidity to the fetus and infants are normal weight (4-3).
Studies indicate that about 80% of cases with IUGR in which they can be lighter or
interventions before treatment done and about 20% of cases because genetic
cromosomal or present them in specific treatment is considered as the etiology of
IUGR (7-5).
Despite the identification of various causes of IUGR can be caused, new studies
show that in IUGR pathophysiology of some other cause that is the often less them
also has a role. Thrombophilia including factors that IUGR recently researchers
have been considered (10-8).
Thrombophilia phenomenon is creating and the pair caused vasculopathy Next
IUGR and pregnancy outcome makes the challenging (11). Thrombophilia
prevalence about o.7- 2 percent general population is estimated but is estimated
that intrauterine growth restriction in 35 percent of cases are due to Thrombophilia
(10-8). Although the pathophysiology and role in the incidence of IUGR
completely known.Thrombophilia are not. But its destructive effects on vascular
Placenta and impaired gas exchange and reduced blood oxygen carrying capacity
and impaired fetal growth materials required for the pathophysiology of a fetus
considered Thrombophilia am able (12-11) ..
The importance of challenging subject IUGR and accurate identification of factors
necessary factors in order to adopt strategies and the role of tinder before the
pathophysiology Thrombophilia IUGR, further studies on the relationship between
IUGR and Thrombophilia seems necessary. Accordingly, in the form of a clinical
study thesis course gynecology residency disease study conducted in this regard
and the relationship between the subject has been studied. Introduction to this
study for further studies and in the clinical trials and drug prevention and treatment
for IUGR using Thrombophilia methods are effective.
Materials and Methods
Study a variety of clinical studies and applied in the form of a case - control study
(Case - Control) is done.
This study in 1387(2008) and in Obstetrics and Gynecology, Taleghani Hospital,
Tehran has been done.
Population under study are words pregnant women who routinely evaluate the
status of her pregnancy are referred to Taleghani Hospital. Criteria for the study
group cases is:
1. Pregnant
2. Patients with fetal IUGR
3. With results of related experiments Thrombophilia
Exit criteria for the study group of cases, value is:
There any known factors other than Thtombophilia in create of IUGR include:
1 - factors, maternal
Chronic hypertension, cardiac diseases cyanosis, diabetes, Hemoglobinopathy,
autoimmune diseases, malnutrition energy - protein, smoking, drug abuse,
malformation uterine.
2 - placental factors:
Syndrome Twin-to-Twin transfusion abnormalities pair, pair head way, cord
abnormalities, multiple pregnancy.
3 - fetal factors:
Chromosomal abnormalities such as Trisomy 18, Down syndrome and TORCH
Criteria for the study of the control value is:
1. Pregnant
2. With normal fetal weight according to gestational age
3. With results of related experiments Thrombophilia
In this study, all mothers groups, which were under study criteria were evaluated
and in this particular group of statistical methods for sampling and sampling is not
used (sequential or census methods) for each individual group, a person as a
witness was considered that a randomly been studied after administrative
coordination necessary first clinical case of pregnancy, mothers who have been
with IUGR were determined and were studied. Data required, including maternal
age, gestational times, number of previous delivery, maternal height and weight,
the files were extracted. The results of fetal ultrasound, including weight,
environment abdomen, head circumference, femur length, diameter and height
Biparietal, Fundal and fluid index were amniotic and data required in the form of
data collection that the sample provided in Appendices has been to insert. The
results related tests, including Thrombophilia hyperhomosisteinemia - protein c, s.
.- factor 5 Leiden - Anti coagulant -. lupus anti coagulant - antithrombin III clinical
records were obtained in experiments where this was not done telephone was
declared to refer them to perform.
Then group the files of cases of pregnancy with IUGR mothers who had not faced
a randomly selected mothers in the next month related Thrombophilia tests were
performed.
After completion of the data and insert them in forms of data collection, data
compiled statistical software program and statistical analysis was performed.
Statistical analysis of data was done in several stages. Thrombophilia prevalence
ratio in the first group and control cases were compared with each other. Then the
group of two subgroups with and without Thrombophilia Thrombophilia were
divided, and sonographic parameters at several different dimensions and body size
were compared with embryos.
Variables in this study reported little mean and standard deviation and qualitative
variables for the frequency ratio is used. To compare the proportions and Fisher
exact test to compare
Mean T-test has been used. The relationship between variables and indices of fetal
Thrombophilia using logestic regression has been investigated. Statistical software
used in this study, SPSS-15 The significant 0 / 05 respectively.
Results
The results of this study has shown that number of 63 mothers were studied. 43
mothers who have suffered IUGR fetuses were 20 cases and as a mother who had
normal embryos as a control group were considered.
Our findings indicate that in 13 cases of Thrombophilia 43 (2 / 30%) in group 1
patients and 20 patients (5%) in the control group is diagnosed. Comparison of the
ratio using the exact test Fisher statistically significant difference indicates 0 / 0
27= P). Table 4-1 display the ratios above are presented.
Table 4-1 and compared according to the frequency or lack Thrombophilia
IUGR
Thrombophilia
Positive
Negative
Total
IUGR
Positive
Negative
Total
(30/ 3%) 13
(5%) 1
(22 / 2%) 14
(69/ 8%) 30
(95%) 19
(77 / 8%) 49
(100%) 43
(100%) 20
(100%) 63
The above ratios, the odds ratio for IUGR of People Thrombophilia 8 / 23 is the
non thrombophilia (68 / 1- 99%): 95% CI and 8 / 23 = odds).
As can be seen in Table 4-1 embryos in women having suffered IUGR 30/ 2%
patients are Thrombophilia. The fact that based on information from studies of
other researchers, the ratio averaged 35%, test One Sample Test difference
between test day which has shown no significant difference between the ratio
obtained in the our study and other studies (based on 35%) No (0 / 505 = P).
To evaluate the relationship Thrombophilia indices measure the status of mothers
with infants suffering from fetal IUGR mean indices in mothers with and without
Thrombophilia compared and the results are presented in Table 4-2.
Guessing 4-2 specific comparison group cases of fetal sonographic times
Status Trombophilia
Index studied
Thrombophilia
Mean (
P Value
SD)
Gestational age (weeks)
Fetal weight (g)
yes (13 = n)
34 /46+- 3/43
No (30 = n)
34/2+- 2/69
0/ 05>
0 / 
yes(13 = n)
1681 +- 547
No (30 = n)
Height fetus (cm)
1475 +- 385
0 / 
yes(13 = n)
38 / 1+- 3/6
No (30 = n)
Fetal head circumference (cm)
environment abdomen (cm)
Femoral bone length (mm)
34/ 9+- 3/3
yes (13 = n)
30/5+- 4/3
No (30 = n)
30/4+- 2/5
yes(13 = n)
29/2+- 5/6
No (30 = n)
28/5+- 3/2
yes (13 = n)
33/1+- 5/1
0 / 05<
0 /  *
0 / 0  *
50/5+- 8/8
No (30 = n)
Fundal length (cm)
0 / 
yes(13 = n)
31/6+- 4/1
No (30 = n)
Biparietal diameter (mm)
31/7+- 2/7
yes (13 = n)
81/8+- 2/8
No (30 = n)
80/4+- 5/1
0 / 
* Difference is significant (Independent Sample T Test)
Table 4-3 comparison of indices of maternal group cases according to
Status Thrombophilia
Index studied
Thrombophilia
Mean (
P Value
SD)
Maternal age (years)
0 / 
yes (13 = n)
26 / 2+- 4/7
No (30 = n)
Mother height (cm)
yes (13 = n)
27 / 4+- 5/1
157 / 8 +_ 4/1
0 / 
No (30 = n)
159 / 1+- 5/8
Mother weight (kg)
0 / 
yes (13 = n)
87 / 7 +- 6/6
No (30 = n)
Time of Pregnancy
Time of delivery
Symmetry
Index liquid amniotic
88 / 9+- 7/2
yes (13 = n)
1 / 92+-1/6
No (30 = n)
1/ 63+- 0/85
yes (13 = n)
1 / 32+- 0/61
No (30 = n)
0/68+- 0/53
yes (13 = n)
1/ 38+- 0/5
No (30 = n)
1 / 2+- 0/4
yes (13 = n)
5/ 1+- 2/96
No (30 = n)
4/86+- 1/7
Table 4-4 Types Thrombophilia frequency ratio is presented.
0 / 
0 / 
0/ 
0 / 
Table 4-4 Frequency and types than in all patients Thrombophilia
Type Thrombophilia
Protein
frequency
1
Ratio
7 / 1%
Cumulative percent
7 / 1%
S
Protein C
Factor V Leiden
Antithrombin III
Homosystein
Lups Auticoagulant
Anti Cardiolipin
Total
3
2
1
3
1
3
14
21 / 4%
14 / 3%
7 /1 %
21 / 4%
7 / 1%
21/ 4%
100%
28 / 6%
42/ 9%
50%
71 / 4%
78 / 6%
100%
Using logistic regression relationship between fetal head .freThrombophilia
independent of other indicators that showed there were Thrombophilia causes fetal
head to 4 / 284 unit decrease (001 / 0 
There is also due to Thrombophilia 17/456 femur length unit to be reduced
(0 / 001
Conclusion
As mentioned the most important hypothesis of this study the relationship between
IUGR and Thrombophilia
The aim has been to study this hypothesis is correct. Since this hypothesis has
come from several studies of the relationship between the two to talk about the
linkage. However, in some studies, there also has not been approved this year.
Theoretical terms, but also all possible pairs of tissue thrombosis in this
relationship is strengthened.
The results of this study indicate that patients with a range of Thrombophilia
Thrombophilia disorders are a way of Protein C, Protein S, V leiden Factor,
homocystein, Anticoagulant Lupus, Antithrombin III and Anti Cardiolipin study in
patients we have diagnosed. Most the prevalence of Protein C, Protein S, ystein
homoc, Anti Cardiolipin has been the lowest prevalence of Antithrombin III,
Lupus Anti coagulant is.
Our results indicate that the relationship between IUGR and significant
Thrombophilia exist
There are species that causes the probability Thrombophilia IUGR 23 / 8 against
the increase. This finding studies with findings Martinelli (12), Weiner (11),
Verspch (28), Alfirevic (29) standards. It is remarkable that the study of IUGR
only relation of Thrombophilia has been investigated, while other studies
Thrombophilia type also IUGR has been investigated. Our results therefore
Introduction for further studies to determine the type of relationship with
Thrombophilia of IUGR. Next study to reach these results have practical purposes,
because if recommended to be related tests in patients with Thrombophilia
embryos are affected IUGR, the routine is done, it is necessary to determine which
is the deficiency or more compounds IUGR are related, as the mothers in this
group of tests to be done.
Our findings indicate that most of the Thrombophilia and fetal biometry indicators
have a significant relationship. Because the matching (Matching) to mothers age,
gestational times, times of delivery, height and weight index, and liquid amniotic,
it was found that is due to Thrombophilia head and femoral bone length to be
reduced and other indicators under Thrombophilia effect has not been. In other
words created in the SGA fetus is Asymetrical type and it claims that the
Thrombophilia on the part of the variable effects of more opinions. But from there
to reach the more results, more accurate studies and Size higher sample is
necessary to achieve definitive results is subject to further studies. In this regard
can be studies to evaluate the relationship with Thrombophilia type indices can be
designed to determine fetal sonographic be Thrombophilia Which Game on indices
which has more effect.
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Appendix:
Questionnaire research project on the role of Thrombophilia on intrauterine fetal
growth
Name
Age
Total pregnancy
Gestational age at the time of delivery
Weigh
Fetal head size
Size around the abdomen embryos
Femur length size
Diameter biparietal
The result Thrombophilia