Зміни в гемокоагуляційній системі після прегравідарної підготовки перед програмою ДРТ у вагітних з інфекціями, що передаються статевим шляхом, в анамнезі

Abstract

Purpose - to analyze the dynamics of laboratory parameters of haemocoagulation system functioning after pregravid preparation before assisted reproductive technologies (ART) cycles in pregnant women with a history of sexually transmitted infections (STIs). Materials and methods. The functioning of the haemocoagulation system after the ART program in women with infertility and a history of STIs was analyzed: the Group 1 - 56 pregnant women received the treatment and preventive measures proposed by us in the pregravid period; the Group 2 - 55 pregnant women received conventional treatment and preventive measures. The state of the hemostasis system was assessed by the following indicators: fibrinogen concentration, activated recalcification time, activated partial thromboplastin time (APTT), integrative «index of thrombodynamic potential» (ITP), concentration of fibrin and fibrinogen degradation products (FDP) and the level of more stable but less biologically active metabolites of prostacyclin (6-keto-PGF1α) and thromboxane (T×B2). The statistical processing of the study results was performed using standard software «Microsoft Excel 5.0» and «Statistica 8.0». Results. During the period of final formation of the placental barrier in pregnant women of the Group 1, the APTT slowly lengthened (31.3±1.6 s - in the trimester ІІ; 34.3±2.9 s - in the trimester III) with increasing gestational age and significantly differed from the indicators in the Group 2 (27.6±3.0 s and 30.2±1.7 s, respectively; p<0.05); activated recalcification time slowly decreased during the trimesters II and III of gestation in pregnant women of the Group 1 (63.1±2.8 s and 59.3±2.8 s, respectively); gradually decreased the level of FDP (5.8±0.27×10-2 g/l and 5.1±0.22×10-2 g/l), in contrast to the level of FDP in the Group 2, in which this indicator gradually increased (9.4±0.17×10-2 g/l and 11.6±0.27×10-2 g/l); (p<0.01). The level of stable T×B2 in the trimester II decreased by 2 times and was lower (p<0.05) than in the Group 2; the level of stable 6-keto-PGF1α increased in the trimester III (p<0.05). This resulted in an increase in the PgI2/T×A2 balance in the Group 1 from 0.34±0.02 to 1.16±0.03, which corresponded to the physiological needs of systemic and organ hemodynamics during pregnancy. Conclusions. The development and implementation of effective pregravid preparation before ART cycles in women with a history of STIs and medical correction during pregnancy contribute to the increase of the adaptive compensatory and adaptive potential of maternal haemocoagulation homeostasis and perinatal fetal care. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.