Placenta Accreta Forecasting Using Serum Marker Values
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.