Антифібринолітична терапія у клініці невиношування вагітності – аспекти лікувальної тактики

Abstract

The objective: to evaluate the efficacy of tranexamic acid (Tranexam drug) accompanied by pregnancy with a partial detachment of a normally located placenta in the second trimester of pregnancy in women with a history of obstetrical gynecological anamnesis. Patients and methods. Under observation were 75 patients with complicated retrochorial hematoma at first trimester of pregnancy, re-hospitalized at the time of 18–21 weeks with signs of premature placental abruption. The blind method of the patient was randomized into two groups (baseline and comparison), which differed in the type of haemostatic therapy. Clinical groups were formed by age (26.5±0.8 and 27.4±1.1 years, respectively), parity, gestational age, somatic and obstetric-gynecological history, localization and approximate sizes of retroplacental hematomas were comparable. Patients from both groups received sublingual micronized progesterone at a dose of 200 mg, anti-anemia and symptomatic therapy according to indications. In the main group, 45 pregnant women received a haemostatic therapy with the drug Tranexam (Stada): 750 mg at a single dose at a single dose of 1500 mg for 5 to 7 days before bleeding stopped. 30 patients, who underwent haemostatic therapy with sodium etamzilate in a complex of therapeutic measures, made a comparison group. The duration of hemorrhage from the genital tract, the regression of the retrohorial hematoma, the length of stay in the hospital, the prolongation and the consequences of pregnancy were estimated. Results. Clinically, a decrease in the intensity of bleeding with Tranexam was observed 24.6±2.1 hours after the initial dose, bleeding duration averaged 3.5±0.3 days, whereas in the group taking sodium etamzilate, the bleeding time was significantly longer – 4.9±0.2 days (p<0.05). These data correlated with ultrasound data confirming the absence of progression of retrochorial hematomas from the second day with the use of Tranexam in 34 (75.6%) of the women in the main group, whereas in the comparison group, similar changes occurred at the same time in only 10 (33.3%) of patients (p<0.5). The faster stopping of bleeding and, as a consequence, the organization and resorption of hematomas in the region of placental detachment in a shorter period affected the effects of pregnancy (the frequency of preterm labor in the comparison group occurred 2.2 times more often than in the main group). Conclusion. Taking into account the peculiarities of the physiological mechanisms of the functioning of the fibrinolytic system during the gestation period and the significance of their disturbances in the genesis of early and late gestational bleeding allows us to choose the most effective therapeutic tactics. Tranexam in effective daily doses with course duration of treatment of 5–7 days gives a pronounced haemostatic effect, does not cause side effects, and allows successfully prolonging the pregnancy and reducing the frequency of late gestational complications. Inclusion in the treatment complex of patients with recurrence of retroplacentar hematomas and formation of partial placental detachment in the second trimester of gestation of the preparation of antifibrinolytic action to Tranexam is an effective means not only to stop bleeding, but also to preserve pregnancy, prevent the formation of placental insufficiency and ensure favorable pregnancy outcomes. Accumulated experience allows attributing Tranexam to the drugs of the first choice in the clinic for miscarriage and recommending it for widespread use in practice. Key words: retroplacentar hematoma, pregnancy, antifibrinolytic therapy, Tranexam.