Прогнозирование и профилактика тромботических осложнений у беременных, перенесших новую коронавирусную инфекцию COVID-19

Abstract

Aim: The aim of the study was to optimize diagnostic, treatment and preventive measures in pregnant women who had a new coronavirus infection (NCI) COVID-19 during the gestation period. Design: Comparative study. Materials and methods. We studied the course of pregnancy, childbirth and perinatal outcomes in 60 women who had COVID-19 during this pregnancy, delivered in the conditions of the MONIAH. Patients were divided into two groups depending on the period of visit to the outpatient department of MORIAG. Group I consisted of 45 pregnant women who underwent NCI in the I–II trimesters with subsequent treatment and observation in the conditions of the polyclinic department of MONIAH, Group II — 15 pregnant women who had had NCI during gestation and applied to the polyclinic department before delivery. In the course of the work, in addition to the general clinical examination, an extended study of the hemostasis system was additionally carried out (during registration, before delivery and according to indications in order to control ongoing therapy), ultrasound and Doppler studies in dynamics, analysis of gestational and perinatal outcomes, the timing of the disease and course of the NCI. Results. During the first consultation, all participants in the study underwent ultrasound and an analysis of standard hemostasiological tests was performed. In pregnant women who received low molecular weight heparins, as well as in cases of placental insufficiency and/or structural changes in the placenta, thrombodynamics was studied (n = 21). Women of group II had a significantly lower APTT, a higher level of prothrombin in the blood, and they also had statistically significantly more signs of hemodynamic disturbances in the BMD. According to ultrasound findings, uteroplacental blood flow disorders were diagnosed in 13 patients; thrombodynamics test results demonstrate hypercoagulation in 17 women, while the data from the routine assessment of hemostasis did not go beyond the reference values. Structural changes in the placenta were found in 8 (53.4%) examined patients of group II, and a thrombodynamic test was performed in 5 of them. Hypercoagulation was detected in 4 (26.7%) patients in group II. In patients of group I, depending on the results obtained, correction of therapy was carried out, followed by ultrasound control of the structure of the placenta, as well as an assessment of the thrombodynamic test. Conclusion. Women who have undergone NCI during gestation, regardless of the clinical course and duration of infection with NCI, are characterized by hypercoagulable changes, however, standard hemostasiological tests do not fully reflect post-covid changes, in contrast to the thrombodynamic test in combination with careful placentometry, in which structural changes in the placenta and violations of intraplacental blood flow may indirectly indicate the presence of hypercoagulability. Rational anticoagulant and antiplatelet therapy under the control of indicators of the blood coagulation system and the structure of the placenta contributes to a significant reduction in the incidence of adverse obstetric and perinatal outcomes. Keywords: new coronavirus infection, pregnancy, placental insufficiency, doplerometry, thrombodynamic test.