Evaluation of Thrombomodulin in Predicting Thrombotic Complications in Early Reproductive Pregnancy Losses

Objective: The aim of the study was to evaluate the prognostic relationship of thrombomodulin with ischemic/thrombotic histopathological changes in spontaneous abortions in early pregnancy. Design and method: The study included 90 women of reproductive age who sought medical care at a hospital. Of these, 25 women sought reproductive loss before 12 weeks of pregnancy and 65 women sought voluntary termination of pregnancy. To all womens anamnesis was collected, an electronic health passport was analyzed to exclude extragenital pathology and form study groups. After blood was collected using an automated hematology analyzer to assess the thrombomodulin level. The determination was carried out by the chromatogenic enzyme immunoassay method using IVD kits and using robotic ELISA systems Evolis and Tecan. Histopathological examination of uterine cavity scrapings revealed ischemic findings and/or vasculogenesis disorders (n = 25), which were manifested early vascular karyorrhexis, parabasal infarctions and hemorrhages into the basal plate with parabasal necrosis, severe chorionic villus hypoplasia and avascular villi (grade III) according to the Hakvoort RA classification. Results: The thrombomodulin level was significantly higher in the group with ischemic findings and/or vasculogenesis disorders compared to the group without pathology (p<0.001). The median thrombomodulin level in the examined subjects was 8.360, interquartile range (Q1–Q3) 7.120–9.030. In 16% of the samples, signs of early vascular karyorrhexis and intervillous hemorrhage were detected. In 28% of the samples, parabasal infarcts and hemorrhages into the basal lamina were detected. Vascularization in 60% of the samples examined ranged from severe hypoplasia (66.7%) to avascularity (33.3%). This study found an association between high thrombomodulin levels and histological vascular ischemic lesions. This demonstrates the importance of thrombomodulin assessment as a key marker for predicting reproductive loss in women in early pregnancy. Conclusions: The thrombomodulin level should be considered as a marker of ischemic damage and defective vasculogenesis due to microthrombosis in the uterine vascular system. Monitoring the levels of these markers can help identify women at high risk for targeted screening and correction of risk factors that influence adverse early pregnancy outcomes.