CLINICAL CASE OF EARLY-ONSET FETAL GROWTH RESTRICTION ASSOCIATED WITH HUMAN PAPILLOMAVIRUS-RELATED PLACENTAL LESION

Fetal growth restriction (FGR) is the second leading cause of perinatal mortality worldwide. Impaired uteroplacental perfusion represents a key mechanism in the pathogenesis of FGR. In recent years, increasing attention has been directed toward the role of infectious agents in the development of placental insufficiency, including human papillomavirus (HPV). HPV has been shown to impair trophoblast differentiation, adhesion, and invasion and to induce inflammatory and thrombotic changes in placental tissue. A major challenge in the management of pregnancies complicated by FGR is the objective assessment of fetal well-being and the evidence-based determination of the optimal timing and mode of delivery. This article presents a clinical case of early-onset FGR associated with HPV infection of placental tissue in a patient initially classified as being at low risk for obstetric complications. Key aspects of pregnancy management are demonstrated, including the use of telemedicine technologies and serial monitoring of angiogenic markers of placental dysfunction, namely soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and their ratio. An increase in the sFlt-1/PlGF ratio was shown to correlate with worsening of Doppler flow parameters and progression of FGR in the absence of clinical signs of preeclampsia. Remote fetal cardiotocographic monitoring enabled timely detection of critical fetal deterioration, appropriate delivery planning, and resulted in a favorable perinatal outcome. Molecular genetic analysis of placental tissue revealed the presence of HPV DNA types 51 and 66, supporting the consideration of HPV infection as a potential contributing factor to placental dysfunction in this clinical case. These findings emphasize the importance of a dynamic and personalized approach to the management of pregnancies complicated by FGR and highlight the need for further research into the role of HPV infection in adverse pregnancy outcomes.