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Use of plasmapheresis in treatment of patients with unfavorable anamnestic pregnancy outcomes coupled to antiphospholipid antibodies

https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.105

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Abstract

Aim: to evaluate efficacy of plasmapheresis combined with low molecular weight heparins (LMWH) and acetylsalicylic acid (ASA).

Materials and Methods. 327 plasmapheresis sessions were performed for 75 patients: 17 (22.6 %) patients during preparation for pregnancy, 11 (19.0 %) pregnant women in the first trimester, 33 (56.9 %) pregnant women in the second trimester, and 34 (58.6 %) pregnant women in the third trimester. Study inclusion criteria were as follows: high titers of antiphospholipid antibodies (APA) as well as included non-inclusion criteria in pregnant women with miscarriages and unfavorable anamnestic pregnancy outcome. 36 (62.1 %) women had pregnancy loss in anamnesis. All patients received low-dose ASA and LMWH therapy; 15 (25.86 %) pregnant women also received courses of intravenous immunoglobulins in the first and second trimesters.
Results. 47 pregnant women had delivery, whereas 10 of women had pregnancy in progress. Term delivery was in 40 (85.1 %) patients, so that 23 (48.9 %) pregnant women had delivery per vias naturales. The average weight of the fetus was 3364.00 ± 393.76 g, height - 52.13 ± 1.82 cm. In 100 % cases, Apgar score was 8 points. 24 (51.1%) pregnant women had delivery via cesarean section. The average blood loss comprised 528.64 ± 166.10 ml. The average fetal weight in group after surgical delivery was 2982.14 ± 582.88 g, average height - 49.14 ± 4.09 cm, the Apgar score - 7.69 ± 0.47 points. Preterm births were observed in 7 (14.9%) cases, all via cesarean section. In 1 case, early fetal death was at gestational age of 8/9 weeks; according to the karyotyping data, a fetal chromosomal abnormality was detected. No severe obstetric complications were observed.
Conclusions. Combining plasmapheresis with low dose LMWH and ASA therapy demonstrated high efficacy in treating obstetric APS manifested as high percentage of favorable pregnancy outcomes and low number of obstetric complications.

 

About the Authors

D. R. Eremeeva
Pavlov First Saint Petersburg State Medical University, Health Ministry of Russian Federation; Snegirev Maternity Hospital № 6
Russian Federation

Dina R. Eremeeva - MD, PhD, Assistant, Department of Obstetrics, Gynecology and Reproductive Medicine, Pavlov First Saint Petersburg State Medical University; Deputy of Head Physician, Snegirev Maternity Hospital № 6.
6/8 Lev Tolstoy Str., Saint Petersburg 197022; 5 Mayakovskogo Str., Saint Petersburg 192014.



M. S. Zainulina
Pavlov First Saint Petersburg State Medical University, Health Ministry of Russian Federation; Snegirev Maternity Hospital № 6
Russian Federation

Marina S. Zainulina - MD, Dr Sci Med, Professor, Department of Obstetrics, Gynecology and Reproductive Medicine, Pavlov First Saint Petersburg State Medical University; Head Physician, Snegirev Maternity Hospital № 6.
6/8 Lev Tolstoy Str., Saint Petersburg 197022; 5 Mayakovskogo Str., Saint Petersburg 192014.
Scopus Author ID: 37076359000
Researcher ID: B-5746-2018



Yu. S. Dolgova
Pavlov First Saint Petersburg State Medical University, Health Ministry of Russian Federation; Snegirev Maternity Hospital № 6
Russian Federation

Yulia S. Dolgova - MD, Senior Assistant, Department of Obstetrics, Gynecology and Reproductive Medicine, Pavlov First Saint Petersburg State Medical University; Obstetrician-Gynecologist, Obstetric Department of Pregnancy Pathology, Snegirev Maternity Hospital № 6.
6/8 Lev Tolstoy Str., Saint Petersburg 197022; 5 Mayakovskogo Str., Saint Petersburg 192014.



R. A. Shakhaliev
Pavlov First Saint Petersburg State Medical University, Health Ministry of Russian Federation
Russian Federation

Rustam A. Shakhaliev - MD, Clinical Resident, Department of Obstetrics, Gynecology and Reproductive Medicine, Pavlov First Saint Petersburg State Medical University.
6/8 Lev Tolstoy Str., Saint Petersburg 197022.



O. A. Silvanovich
Saint Petersburg State Pediatric Medical University, Health Ministry of Russian Federation
Russian Federation

Olga A. Silvanovich - Student, Saint Petersburg State Pediatric Medical University.
2 Litovskaya Str., Saint Petersburg 194100.



L. A. Pavlova
Saint Petersburg State Pediatric Medical University, Health Ministry of Russian Federation
Russian Federation

Lada A. Pavlova - Student, Saint Petersburg State Pediatric Medical University.
2 Litovskaya Str., Saint Petersburg 194100.



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For citation:


Eremeeva D.R., Zainulina M.S., Dolgova Yu.S., Shakhaliev R.A., Silvanovich O.A., Pavlova L.A. Use of plasmapheresis in treatment of patients with unfavorable anamnestic pregnancy outcomes coupled to antiphospholipid antibodies. Obstetrics, Gynecology and Reproduction. 2021;15(1):22-31. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.105

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