Some aspects of the pathogenesis of venous thromboembolism in pregnant women
DOI:
https://doi.org/10.24144/2415-8127.2020.61.85-88Keywords:
varicose disease of the lower extremities, placental dysfunction, functional state of the fetoplacental complex, prognosis, treatment.Abstract
Nowadays, the issue of adverse influence of extragenital pathology of vascular genesis with the development of systemic disorders of hemostasis, thrombophilic conditions, and changes in hemodynamics in the fetoplacental complex in pregnant women is one of the most topical problems of modern obstetrics. The aim of the study was to reduce obstetric and perinatal complications in pregnant women with varicose veins of the lower extremities. Based on the study of medical records, a retrospective analysis was performed, it was determined that varicose disease of the lower extremities in pregnant women is manifested in 32.7%, with an increase of clinical manifestations before the third trimester up to 69.1%. Leading factors include maternal and paternal heredity (OR=6.9), placental dysfunction in previous pregnancies (OR=6.3), endocrine-metabolic disorders (OR=2.5), overweight (OR=4.8), thrombotic conditions (OR=10.8). There were examined 120 women with varicose lower limb disease who were divided into the main group, with the appointment of elastic compression, a mixture of bioflavonoids, a donor of nitric oxide and therapy aimed at the correction of hemostasiological indices, and a comparison group where pregnancy monitoring was performed according to the generally accepted standards. On the eve of delivery, the activation of the anticoagulant system and predictors of thrombotic complications, such as hyperfibrinogenemia, decrease of platelet number and impairment oftheir aggregation capacity, decrease of antithrombin III level 1.4-fold and increase 1.7-fold of D-dimers. With the progression of pregnancy, the hormonal parameters changed: hyperfunction in 38.3%, dysfunction in 11.7%, imbalance of estriol and cortisol in 50.0% of observations. The use of therapeutic-prophylactic measures allowed us toreduce the proportion of preterm births 2.2-fold; preeclampsia, placental dysfunction and fetal distress – 2.0-fold; fetal growth retardation – 1.8-fold, decrease of post-hypoxic encephalopathy – 2.0-fold.
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