POSSIBILITIES OF PREDICTING AND PREVENTING COMPLICATIONS IN COMBINED IMPAIRMENTS IN THE COAGULANT AND ANTICOAGULANT COMPONENTS OF THE HEMOSTATIC SYSTEM IN OBSTETRIC PRACTICE

In clinical practice one has to encounter the situations when different congenital hemostatic defects threatened by hemorrhages are concurrent with one or another of the congenital or acquired predictors of thrombophilia. The paper describes a clinical case of the course of pregnancy, labor, or postpartum in women with combined congenital hemostatic disease and a history of late postpartum hemorrhage. The non-pregnant women showed a decrease in the level of factor XII to 20% (normal range, 75—125%) and factor IX to 50% (normal range, 75—125%) and an increase of factor VII to 145% (normal range, 75—125%). During pregnancy, there were adaptive changes in the hemostatic system: the level of factor XII increased up to 50% (normal range, 100—200%), factor IX up to 95% (normal range, 100—150%), and factor VII up to 190% (normal range, 150—250%). The total recordings of hemostasiograms corresponded to the normal gestational values during pregnancy. Fresh frozen plasma was intravenously injected in a volume of 500 ml in the first stage of labor to prevent postpartum hemorrhage. Blood loss during childbirth was 350 ml. The postpartum period was uncomplicated as long as 16 days. The hemostasiogram recordings over time were consistent with insignificant hypocoagulation with no signs of thrombinemia and hyperfibrinolysis.

thrombosis, hemorrhages, pregnancy, labor, postpartum period