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Hemostasis in pregnant, parturient and puerperal women with preeclampsia

https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.168

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Abstract

Introduction. Preeclampsia (PE) is a specific complication of pregnancy holding a lead place in maternal and perinatal morbidity and mortality worldwide. The development of PE in the maternal body is accompanied by severe hypercoagulation, disturbed anticoagulation and fibrinolytic systems. As a result, vascular microthrombosis in diverse organs with developing endothelial dysfunction, impaired utero-placental blood circulation emerge that leads to adverse perinatal outcomes.

Aim: to study status of coagulation arm in pregnant women with moderate and severe PE, after delivery by cesarean section, to optimize management of the postoperative period.

Materials and Methods. There were enrolled 50 pregnant women with PE: 16 with moderate and 34 with severe PE after surgical delivery. A status of coagulation arm was examined by evaluating major parameters in coagulogram (fibrinogen, activated partial thromboplastin time, prothrombin, international normalized ratio) as well as assay for early diagnostics of blood clotting disorders to reveal bleeding and thrombosis risks.

Results. It was found that prior to surgery patients with severe PE had significantly increased clot growth rate (V) by 1.09-fold (p = 0.001), relative clot density (D) by 1.15-fold (p = 0.001), and time of spontaneous clot appearance (Tsp) was accelerated by 2-fold (p = 0.001) compared to moderate PE. After surgical delivery, patients from both groups had changes evidencing about activated coagulation system: increased V, D, as well as the Tsp. Upon that, all such parameters in patients with severe PE were significantly elevated: the V – by 1.25-fold (p = 0.005); the D – by 1.1-fold (p = 0.02); the Tsp was accelerated by 2-fold (p = 0.03) compared to patients with moderate PE. All parameters in both groups tended to normalize on day 5 after surgical delivery, but patients with severe PE were shown to have significantly increased the V – by 1.5-fold (p = 0.001); the D – by 1.14-fold (p = 0.001); the clot size – by 1.14-fold (p = 0.001); the Tsp – accelerated by 41 % (p = 0.001) compared to patients with moderate PE.

Conclusion. Thus, patients with moderate and severe PE after surgical delivery by cesarean section were featured with markedly activated coagulation hemostasis, which may justify a prolonged use of low-molecular-weight heparins in the postoperative period, especially in patients with PE.

About the Authors

M. G. Mustafin
Kazan State Medical University, Health Ministry of Russian Federation
Russian Federation

Ilshat G. Mustafin – MD, Dr Sci Med, Professor, Department of Biochemistry and Clinical Laboratory Diagnostics

49 Butlerova Str., Kazan 420012, Russia



E. Yu. Yupatov
Kazan State Medical Academy – branch of Russian Medical Academy of Continuing Professional Education, Health Ministry of Russian Federation
Russian Federation

Evgenii Yu. Yupatov – MD, PhD, Associate Professor, Head of the Department of Obstetrics and Gynecology

36 Butlerova Str., Kazan 420015, Russia

Scopus Author ID: 57201192778



T. E. Kurmanbaev
S.M. Kirov Military Medical Academy, Ministry of Defense of Russian Federation
Russian Federation

Timur E. Kurmanbaev – MD, PhD, Faculty Member, Department of Obstetrics and Gynecology

6 Klinicheskaya Str., Saint Petersburg 194044, Russia



R. M. Nibiullina
Kazan State Medical University, Health Ministry of Russian Federation
Russian Federation

Rosa M. Nabiullina – MD, PhD, Associate Professor, Head of the Department of Biochemistry and Clinical Laboratory Diagnostics

49 Butlerova Str., Kazan 420012, Russia



Yu. L. Timoshkova
S.M. Kirov Military Medical Academy, Ministry of Defense of Russian Federation
Russian Federation

Yulia L. Timoshkova – MD, PhD, Senior Lecturer, Department of Obstetrics and Gynecology

6 Klinicheskaya Str., Saint Petersburg 194044, Russia



A. A. Shmidt
S.M. Kirov Military Medical Academy, Ministry of Defense of Russian Federation
Russian Federation

Andrey A. Smidt – MD, PhD, Associate Professor, Colonel of Medical Service, Head of the Department of Obstetrics and Gynecology

6 Klinicheskaya Str., Saint Petersburg 194044, Russia



N. V. Yakovlev
AVA-Kazan JSC
Russian Federation

Nikita V. Yakovlev – MD, PhD, Associate Professor, Obstetrician-Gynecologist

19/15 Profsoyuznaya Str., Kazan 420111, Russia



References

1. Hypertensive disorders during pregnancy, childbirth and the postpartum period. Preeclampsia. Eclampsia. Clinical guidelines (Treatment protocol). [Gipertenzionnye rasstrojstva vo vremya beremennosti, v rodah i poslerodovom periode. Preeklampsiya. Eklampsiya. Klinicheskie rekomendacii (Protokol lecheniya)]. Moskva, 2016. 73 s. (In Russ.). Available at: http://www.uzo.kurgan-med.ru/files/downloads/3483.pdf. [Accessed: 15.07.2020].

2. Mayer-Pickel K., Kolovetsiou-Kreiner V., Stern C. et al. Effect of low-dose aspirin on soluble fms-like tyrosine kinase 1/placental growth factor (sflt-1/plgf ratio) in pregnancies at high risk for the development of preeclampsia. J Clin Med. 2019;8(9):1429. https://doi.org/10.3390/jcm8091429.

3. Nikolaeva N.G., Momot A.P., Serdyuk G.V. et al. APC-resistance associated with factor V Leiden gene mutation (genotype GA): clinical occurrence in pregnancy. [APS-rezistentnost', svyazannaya s mutaciej gena faktor V Lejden (genotip GA): klinicheskaya realizaciya pri beremennosti. Tromboz, gemostaz i reologiya. 2018;(1):47–54. (In Russ.). https://doi.org/10.25555/THR.2018.1.0823.

4. Oladosu-olayiwola O., Olawumi H., Babatunde A. et al. Fibrinolytic proteins of normal pregnancy and pre-eclamptic patients in North West Nigeria. African Health Sciences. 2018;18(3):576–83. https://doi.org/10.4314/ahs.v18i3.15.

5. Makatsaria A.D., Bitsadze V.O., Smirnova L.M. et al. Thrombohemorrhagic complications in obstetric and gynecological practice: a guide for doctors. [Trombogemorragicheskie oslozhneniya v akushersko-ginekologicheskoj praktike: rukovodstvo dlya vrachej]. Moskva: MIA, 2011. 1056 s. (In Russ.).

6. Makatsariya A.D., Bitsadze V.O., Akinshina S.V., Andreeva M.D. The pathogenesis and prevention of complications of pregnancy conditioned by thrombotic microangiopathy. [Patogenez i profilaktika oslozhnenij beremennosti, obuslovlennyh tromboticheskoj mikroangiopatiej]. Voprosy ginekologii, akusherstva i perinatologii. 2013;12(6):63–73. (In Russ.).

7. Byshevsky A.Sh., Polyakova V.A., Rudzevich A.Yu. Hemostasis in physiological pregnancy, pregnancy with arterial hypertension and preeclampsia. [Gemostaz pri fiziologicheskoj beremennosti, beremennosti s arterial'noj gipertenziej i preeklampsiej. Tromboz, gemostaz i reologiya. 2010;(4):13–30. (In Russ.).

8. Zhu J., Zhang J., Jack N. M. et al. Angiogenic factors during pregnancy in Asian women with elevated blood pressure in early pregnancy and the risk of preeclampsia: a longitudinal cohort study. BMJ Open. 2019;9(11):e032237. https://doi.org/10.1136/bmjopen-2019-032237.

9. Schatz F., Guzeloglu-Kayisli J., Arlier S. et al. The role of decidual cells in uterine hemostasis, menstruation, inflammation, adverse pregnancy outcomes and abnormal uterine bleeding. Hum Reprod Update. 2016;22(4):497–515. https://doi.org/10.1093/humupd/dmw004.

10. Leaños-Miranda A., Méndez-Aguilar F., Ramírez-Valenzuela K.L. et al. Circulating angiogenic factors are related to the severity of gestational hypertension and preeclampsia, and their adverse outcomes. Medicine. 2017;96(4):e6005. https://doi.org/10.1097/MD.0000000000006005.

11. Ivanets T.Yu., Alekseeva M.L., Loginova N.S. et al. The placental growth factor and fms-similar tyrosine kinase-1 as markers of preeclampsia in dynamics of pregnancy. [Placentarnyj faktor rosta i fms-podobnaya tirozinkinaza-1 kak markery preeklampsii v dinamike beremennosti]. Klinicheskaya laboratornaya diagnostika. 2013;(8):14–7. (In Russ.).

12. Tannetta D.S., Hunt K., Jones C.I. et al. Syncytiotrophoblast extracellular vesicles from preeclampsia placentas differentially affect platelet function. PLoS One. 2015;10(11):e0142538. https://doi.org/10.1371/journal.pone.0142538. 13. Prochazkova J., Slavik L., Ulehlova J., Prochazka M. The role of tissue factor in normal pregnancy and in the development of preeclampsia: A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015;159(2):192–6. https://doi.org/10.5507/bp.2014.061.

13. Prevention of venous thromboembolic complications. Clinical guidelines (Protocol). [Profilaktika venoznyh tromboembolicheskih oslozhnenij. Klinicheskie rekomendacii (Protokol)]. Moskva, 2014. 34 s. (In Russ.). Available at: https://mosgorzdrav.ru/uploads/imperavi/ru-RU/025_2014.pdf. [Accessed: 15.07.2020].

14. Panteleev M.A., Vasiliev S.A., Sinauridze E.I. et al. Practical coagulology. Ed. A.I. Vorobyov. [Prakticheskaya koagulologiya. Pod red. A.I. Vorob'eva]. Moskva: Prakticheskaya medicina, 2012. 192 s. (In Russ.).

15. Erez O., Romero R., Vaisbuch E. et al. The pattern and magnitude of “in vivo thrombin generation” differ in women with preeclampsia and in those with SGA fetuses without preeclampsia. J Matern Fetal Neonatal Med. 2018;31(13):1671–80. https://doi.org/10.1080/14767058.2017.1323327.

16. Lattova V., Prochazka M., Prochazková J. et al. Preeclampsia and thrombin generation test. Ceska Gynekol. 2013;78(5):466–72.

17. Zaporozhan V.N., Tyutrin I.I., Udut V.V. et al. RASC system in pregnant women with preeclampsia according to the "global test" of low-frequency piezothromboelastography. [Sostoyanie sistemy RASK u beremennyh s preeklampsiej po dannym «global'nogo testa» nizkochastotnoj p'ezotromboelastografii]. Klіnіchna anestezіologіya ta іntensivna terapіya. 2014;(1):5–14.


For citation:


Mustafin M.G., Yupatov E.Yu., Kurmanbaev T.E., Nibiullina R.M., Timoshkova Yu.L., Shmidt A.A., Yakovlev N.V. Hemostasis in pregnant, parturient and puerperal women with preeclampsia. Obstetrics, Gynecology and Reproduction. 2020;14(4):469-478. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.168

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ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)