akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2024.479akusherstvo-2170Research ArticleОRIGINAL ARTICLESОРИГИНАЛЬНЫЕ СТАТЬИAssessing the effectiveness of preventing placenta-associated complications in patients with burdened obstetric history and circulating antiphospholipid antibodiesОценка эффективности профилактики плацента-ассоциированных осложнений у пациенток с отягощенным акушерским анамнезом и циркуляцией антифосфолипидных антителhttps://orcid.org/0000-0003-4512-9599ЕремееваД. Р.EremeevaD. R.

Еремеева Дина Рустемовна - к.м.н.

197022 Санкт-Петербург, ул. Льва Толстого, д. 6/8; 192014 Санкт-Петербург, ул. Маяковского, д. 5

Dina R. Eremeeva - MD, PhD.

6/8 Lev Tolstoy Str., Saint Petersburg 197022; 5 Mayakovskogo Str., Saint Petersburg 192014

dina-bikmullina@yandex.ruhttps://orcid.org/0000-0002-2622-5000ЗайнулинаМ. С.ZainulinaM. S.

Зайнулина Марина Сабировна - д.м.н., проф.

197022 Санкт-Петербург, ул. Льва Толстого, д. 6/8; 192014 Санкт-Петербург, ул. Маяковского, д. 5

Scopus Author ID 37076359000; WoS ResearcherID B-5746-2018

Marina S. Zainulina - MD, Dr Sci Med, Prof.

6/8 Lev Tolstoy Str., Saint Petersburg 197022; 5 Mayakovskogo Str., Saint Petersburg 192014

Scopus Author ID 37076359000; WoS ResearcherID B-5746-2018

ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской Федерации; СПб ГБУЗ «Родильный дом № 6 имени профессора В.Ф. Снегирева»РоссияPavlov First Saint Petersburg State Medical University, Health Ministry of Russian Federation; Snegirev Maternity Hospital No. 6Russian Federation202412092024184475491Copyright © Eremeeva D.R., Zainulina M.S., 20242024Еремеева Д.Р., Зайнулина М.С.Eremeeva D.R., Zainulina M.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/2170Introduction

Introduction. The role of antiphospholipid antibody (APA) carriage in the pathogenesis of pregnancy failure is one of the most recently debated issues. To date, no unified therapeutic approach to immunotherapy of antiphospholipid syndrome (APS) in pregnancy exists. Intravenous immunoglobulins (IVIG) have become the drugs of choice to treat this pathology in pregnant women.

Aim

Aim: to evaluate an effectiveness of preventing placenta-associated complications (PACs) in patients with recurrent miscarriage and circulating APAs.

Materials and Methods

Materials and Methods. A prospective study was conducted to analyze the course of pregnancy and outcomes in 150 patients who had diagnostic APA titers and aggravated obstetric and gynecological anamnesis. All pregnant women received therapy with low-dose aspirin (LDA) and low molecular weight heparin (LMWHs). In addition to combining LMWHs and LDA, 126 (84.0 %) pregnant women received IVIG courses administered at gestational age of 6-8, 12-14, and 22-24 weeks.

Results

Results. Based on the data obtained, gestational complications such as chronic placental insufficiency, hemodynamic disorders, fetal growth retardation, gestational arterial hypertension, moderate preeclampsia (PE) were significantly more frequent in patients receiving no IVIG during pregnancy. It should be noted that development of severe obstetric complications, such as severe PE, premature detachment of a normally located placenta, massive blood loss, and antenatal fetal death were not observed in any case. No patient developed venous thromboembolism during pregnancy and in the postpartum period. Comparing relative expression area of annexin V, CD 34+, KiSS-peptine and its receptors (KiSS1R), there were revealed significant differences. The relative expression area for anticoagulant protein annexin V was 2.3-fold higher in IVIG-treated patients in pregnancy; endothelial marker CD34+ - 4-fold higher, KiSS-peptine - 2.3-fold higher, and KiSS1R - 5.4-fold higher in placenta from women treated with IVIG starting from early pregnancy stage.

Conclusion

Conclusion. In order to assess the effectiveness of PAC prevention in patients with habitual miscarriage and circulating APAs, it is possible to estimate relative expression area for placental anticoagulant protein annexin V, endothelial marker CD 34+, KiSS-peptine and KiSS1R.

Введение

Введение. Роль носительства антифосфолипидных антител (АФА) в патогенезе невынашивания беременности является одной из наиболее обсуждаемых в последние годы проблем. На сегодняшний день не существует единого терапевтического подхода к иммунотерапии антифосфолипидного синдрома (АФС) при беременности. Внутривенные иммуноглобулины (ВВИГ) стали препаратами выбора при лечении данной патологии у беременных.

Цель

Цель: оценить эффективность профилактики плацента-ассоциированных осложнений (ПАО) у пациенток с привычным невынашиванием и циркуляцией АФА.

Материалы и методы

Материалы и методы. Проведено проспективное исследование, проанализированы течение беременности и исходы у 150 пациенток, имевших диагностические титры АФА и отягощенный акушерско-гинекологический анамнез. Все беременные получали терапию ацетилсалициловой кислотой (АСК) в дозе 100-150 мг и низкомолекулярными гепаринами (НМГ). Помимо комбинации НМГ и АСК, 126 (84,0 %) беременных получали курсы ВВИГ, которые проводились в сроках 6-8, 12-14, а также в 22-24 нед беременности.

Результаты

Результаты. Такие осложнения гестации, как хроническая плацентарная недостаточность, нарушения гемодинамики, задержка роста плода, гестационная артериальная гипертензия, умеренная преэклампсия (ПЭ) достоверно чаще встречались у пациенток, которые не получали ВВИГ при беременности. Стоит отметить, что развитие тяжелых акушерских осложнений, таких как тяжелая ПЭ, преждевременная отслойка нормально расположенной плаценты, массивная кровопотеря, антенатальная гибель плода не наблюдались ни в одном случае. Ни у одной пациентки не развились венозные тромбоэмболические осложнения при беременности и в послеродовом периоде. В результате сравнения относительной площади экспрессии аннексина V, CD 34+, кисспептина (англ. KiSS-peptine) и его рецепторов KiSS1R были выявлены статистически значимые различия. Относительная площадь экспрессии антикоагулянтного протеина аннексина V была в 2,3 раза выше у пациенток, получавших ВВИГ при беременности; эндотелиального маркера CD34+ - в 4 раза выше, KiSS-peptine - в 2,3 раза, а его рецепторов KiSS1R - в 5,4 раза выше в плацентах женщин, которым проводилась терапия ВВИГ с ранних сроков беременности.

Заключение

Заключение. С целью оценки эффективности профилактики ПАО у пациенток с привычным невынашиванием и циркуляцией АФА можно использовать определение относительной площади экспрессии антикоагулянтного протеина аннексина V, эндотелиального маркера CD 34+, KiSS-peptine и его рецепторов KiSS1R в плаценте.

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The authors declare that there are no conflicts of interest present.