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Researchers call for a new taxonomy of obstetric diseases – News from the School of Medicine

Researchers from the Perinatology Research Branch of the National Institutes of Health at Wayne State University School of Medicine have proposed the need for a new taxonomy of obstetric diseases that takes into account the results of biomarkers found during placental examinations rather than simply the symptoms that doctors now rely on.

Published in The American Journal of Obstetrics and Gynecology, “Towards a new taxonomy of obstetric diseases: improving the performance of maternal blood biomarkers for major obstetric syndromes when classified according to placental pathology” demonstrates that biomarker performance improves if placental pathology findings are considered.

Roberto Romero, MD, DMedSci,

“We found that classification of obstetric syndromes based on the presence or absence of placental lesions of maternal vascular malperfusion allowed biomarkers to be informative earlier in gestation and enhanced the strength of association between biomarkers. and clinical outcomes,” said Roberto Romero, MD. , DMedSci, chief of the perinatology research arm of the Eunice Kennedy Shriver National Institute of Child Health and Human Development and professor of molecular obstetrics and genetics in the School of Medicine. “We proposed that this new taxonomy of obstetrical disorders will facilitate the discovery and implementation of biomarkers as well as the prediction and prevention of these disorders.”

Maternal vascular malperfusion, or MVM, develops when normal healthy blood flow to the placenta is interrupted or impeded, which can form placental lesions. Lesions are indicative of a host of health problems, from preeclampsia to fetal death.

The lesions, the researchers found, translate into blood and placental biomarkers that can be used to distinguish and differentiate particular conditions, much earlier in gestation.

When obstetric syndromes are defined based on the combination of clinical signs and the presence or absence of placental lesions caused by MVM, specific maternal blood biomarkers become informative earlier in gestation, indicate a stronger magnitude of association with the development of individual syndromes and demonstrate an association with the development of preterm labor and premature preterm rupture of membranes, conditions that researchers did not previously believe to be predictive of such biomarkers.

“Current taxonomy of obstetrical disorders is largely based on symptoms and signs, which are inadequate descriptors of disease because they are nonspecific and, importantly, represent late manifestations of disease processes,” said Dr. Romero, lead author of the new study. Terms such as preterm labor, preterm premature rupture of membranes, preeclampsia, small for gestational age, or fetal death provide little insight into the underlying causes of these conditions. “A more rational approach to the prediction and prevention of obstetrical disorders should be based on understanding the causes and mechanisms responsible for pregnancy complications.”

Evidence from the study supports the generation of a new taxonomy of obstetric syndromes that would define specific conditions through the combination of clinical symptoms and biomarkers caused by placental damage. The new identification and naming system would improve the characterization of obstetric disorders by including information about disease mechanisms reflected in placental pathology, the researchers said.

This new homogeneous approach could facilitate the discovery and implementation of biomarkers and provide a framework for testing therapeutic interventions and prevention strategies.