CLINICAL MANAGEMENT OF DISORDERS HEMOSTASIS-RELATED WITH OBSTETRIC COMPLICATIONS

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Abstract


Background: The aim of the study was the reduction of adverse pregnancy outcomes in women with gestational and genetically determined changes in the hemostatic system. Patients and methods: The study group comprised 98 patients with obstetric complications on the background of changes in the parameters of coagulation screening. In 63 pregnant women, hemostatic disorders were not corrected, in 35 patients medical tactic defined clinical situation and the results of laboratory and instrumental studies of the hemostatic system. Results: Hereditary thrombophilia detected in 85% of patients with obstetric complications. Carriage of the rare allele of MTHFR-677 2-fold increased risk of adverse pregnancy outcomes; heterozygous carriers of polymorphism PAI-1 — 1,5 times more. The prognostic parameters thrombelastographic (sensitivity 80%, specificity 82%) were higher than in laboratory tests. To determine the most predictive of adverse pregnancy outcome has a density of fibrin clot — the maximum amplitude. Conclusions: In women with obstetric complications associated with disturbances in the hemostatic system, medical diagnostic tactics using thrombelastographic evaluates all stages of coagulation and fibrinolysis, allows you to select a reasonable pathogenetic anticoagulant therapy and reduce the number of adverse pregnancy outcomes.


S. V. Barinov

Omsk State Medical Academy

Author for correspondence.
Email: barinov_omsk@mail.ru

Russian Federation PhD, professor, Head of the Department of Obstetrics and Gynecology № 2 of Omsk State Medical Academy

V. T. Dolgikh

Omsk State Medical Academy, Russian Federation

Email: prof_dolgih@mail.ru

Russian Federation Honoured Scientist of RF, PhD, professor, Head of the Pathophysiology with course of clinical pathophysiology of Omsk State Medical Academy.  Address: 12, Lenin Street, Omsk, RF, 644043; tel.: +7 (3821) 24-06-58

I. V. Medyannikov

Omsk State Medical Academy, Russian Federation

Email: medyannikova_i@mail.ru

Russian Federation

MD, assistant of the Department of Obstetrics and Gynecology № 2 of Omsk State Medical Academy. Address: 12, Lenin Street, Omsk, RF, 644043; tel.: +7 (3812) 35-91-94

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