Тромбоэластография в акушерской практике

Abstract

The study of changes in the hemostatic system in women with a complicated pregnancy is one of the promising tasks aimed at the prevention of thrombotic complications in obstetric practice. Objective. To develop treatment and prevention strategies for thrombotic complications in women staying in maternity units based on the study of hemostatic parameters using thromboelastography (TEG). Patients and methods. The pattern of coagulation disorders in the hemostatic system was examined in 343 pregnant women with obstetric complications (pre-eclampsia, placental abruption, fetal growth restriction, and preterm labor). In 220 women, hemostatic disorders were not corrected; in 123 women, the treatment strategy was determined by the results of laboratory and instrumental monitoring of the hemostatic system. Results. The area under the ROC curve (AUC) for maximum clot firmness (MA) [AUC = 0.9 (CI = 0.83–0.95), p < 0.001] was greater than for any of the blood coagulation parameters considered. The optimal classification threshold for the MA parameter is a cut-off point of 64.4. This threshold is characterized by sensitivity of 80.3% and specificity of 81.8%. Significant thresholds for thrombotic conditions are MA > 75 mm [AUC = 0.83 (95% CI 0.76–0.90)] and R < 2 min [AUC = 0.72 (95% CI 0.63–0.81)]. Conclusion. The introduction of treatment and prevention strategies based on thromboelastography in women staying in maternity units helps to avoid such complications as lower extremity thrombophlebitis, pelvic vein thrombosis, pulmonary embolism, and cerebral ischemia. Key words: pregnancy complications, prevention, thrombosis, thromboelastography