THROMBOPHILIA AND PREGNANCY: PREDICTION OF PERINATAL COMPLICATIONS AND OPTIMIZATION OF MANAGEMENT TACTICS

Objective. To study the role of endogenous intoxication syndrome (EIS) in the pathogenesis of thrombophilic complications during pregnancy and to provide a rationale for incorporation of a carbon hemosorption (CHS) technique into a complex of antithrombotic therapy. Subjects and methods. Ninety-six non-pregnant women with thrombophilia, 249 pregnant women with thrombophilia, 34 apparently healthy non-pregnant women, and 78 apparently healthy pregnant women were examined. The optical density of protein-free extracts of plasma and red blood cells was studied to detect low- and medium-weight molecules (LWM and MWM); the count of circulating endotheliocytes, the adhesive activity of platelets, and their aggregatory function were determined. Results. As compared with the controls, the thrombophilic patients showed significant endotoxicogram differences that were indicative of varying degree of EIS outside pregnancy and during its progression. EIS leads to the development of endothelial dysfunction attended by increases in the count of endotheliocytes and in the rate and degree of platelet aggregation. After CHS, there was a marked decrease in both the plasma and red blood cell levels of LWM and MWM and a significant reduction in integral coagulation index. Normalization of uteroplacental and fetoplacental blood flows was achieved in 76.4%. Conclusion. The detection of EIS and early signs of systemic endotheliosis may serve as an important diagnostic and prognostic criterion in the comprehensive evaluation of maternal and fetal status. The CHS shows a high efficiency in affecting the main components of the pathogenesis of thromboses, considerably improves the performance of the fetoplacental unit, and causes an increase in good perinatal outcomes.

thrombophilias, endogenous intoxication syndrome, pregnancy, carbon hemosorption