Использование плазмафереза в лечении пациенток с неблагоприятными исходами беременностей в анамнезе и наличием антифосфолипидных антител

Цель исследования: оценить эффективность применения плазмафереза в комбинации с терапией низкомолекулярными гепаринами (НМГ) и ацетилсалициловой кислотой (АСК) у женщин с высокими титрами антифосфолипидных антител (АФА) и повторными акушерскими потерями.
Материалы и методы. Проведено 327 сеансов плазмафереза 75 пациенткам: на этапе подготовки к беременности -17 (22,6 %) женщинам, в I триместре - 11 (19,0 %) беременным, во II триместре - 33 (56,9 %) беременным, в III триместре - 34 (58,6 %) беременным. Критерием включения в исследование явилось наличие высоких титров как критериальных, так и некритериальных АФА у беременных с потерями и неблагоприятными исходами беременности в анамнезе. У 36 (62,1 %) женщин имелись потери беременности в анамнезе. Все пациентки получали терапию низкими дозами АСК и НМГ, 15 (25,86 %) беременных также получали курсы внутривенных иммуноглобулинов в I и II триместрах.
Результаты. Родоразрешено 47 беременных, у 10 беременность на данный момент прогрессирует. Роды в срок прошли у 40 (85,1 %) пациенток, у 23 (48,9 %) беременных роды прошли через естественные родовые пути. Средний вес плода составил 3364,00 ± 393,76 г, рост - 52,13 ± 1,82 см. Оценка по шкале Апгар в 100 % случаев составила 8 баллов. Путем операции кесарева сечения родоразрешены 24 (51,1 %) беременные. Средняя кровопотеря при оперативном родоразре-шении составила 528,64 ± 166,10 мл. Средний вес плода в группе родоразрешенных оперативным путем составил 2982,14 ± 582,88 г, средний рост - 49,14 ± 4,09 см, оценка по шкале Апгар - 7,69 ± 0,47 балла. Преждевременные роды произошли в 7 (14,9 %) случаях, все - путем операции кесарева сечения. В одном случае беременность замерла при сроке 8/9 нед; по результатам кариотипирования абортного материала обнаружена хромосомная аномалия плода. Тяжелых акушерских осложнений не наблюдалось ни в одном случае.
Заключение. Комбинация плазмафереза с НМГ и АСК показала высокую эффективность в лечении акушерского антифос-фолипидного синдрома - высокий процент благоприятных исходов беременности, отсутствие тяжелых акушерских осложнений.

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