Стан імунної та гемокоагуляційної систем у динаміці вагітності після ДРТ у жінок з інфекціями, що передаються статевим шляхом, в анамнезі

Abstract

Purpose - to analyze the dynamics of laboratory parameters of functioning of the immune and haemocoagulation systems in pregnant women with a history of sexually transmitted infections (STIs) after pregravid preparation before cycles of assisted reproductive technologies (ART). Materials and methods. The functioning analysis of the immune and hemocoagulation systems of 200 pregnant women with a history of STIs after ART has been conducted. Group I (main) consisted of 100 pregnant women with pregravid preparation before the ART cycle, obstetric and perinatal support and delivery in accordance with the medical and organizational algorithms developed by our team, prognostic methods and treatment and preventive schemes; Group II (main) - 100 pregnant women who were treated using generally accepted prognostic, therapeutic and preventive measures. The control group is 100 practically healthy pregnant women with a favorable reproductive history and an uncomplicated course of pregnancy. The women underwent an in-depth immunological examination. Statistical processing of research results was carried out with the use of programs «Microsoft Excel 5.0» and «Statistica 8.0». Results. It is demonstrated a significant decrease (p<0.05) in lymphocyte levels with properties of natural killers (CD56+) during the gestational period in pregnant women of Group I against Group II; the level of total hemolytic activity of the classical complement activation pathway (CH50) in Group I of pregnant women increased steadily with increasing gestational age; at the end of the II trimester, there was a significant decrease in CH50; in the III trimester of pregnancy, the level of CH50 in Group II was 123±6.7, but in the Group I this figure remained higher. Throughout the II and III trimesters of gestation, there was a probable decrease (p<0.05) of the immunoregulatory coefficient in Group I of pregnant women, due to adequate correction of derivative immunological disorders, compared with pregnant women of Group II. During the residual formation of the placental barrier in Group I pregnant women the active partial thromboplastin time increased significantly during the gestational period and differed significantly from the indicators of Group II; there was a general decrease in the active recalcification time during the II and III trimesters of pregnancy in women of the Group I; a gradual decrease in the level of fibrin and fibrinogen degradation products, unlike the analogous indicator in the Group II, which showed a gradual increase. The level of stable thromboxane metabolite (TxB2) in the II trimester decreased twofold and was lower than in Group II; the level of stable prostacyclin metabolite (6-keto-PGF1α) increased in the III trimester. This led to an increase of PgI2/TxA2 balance in Group I, which corresponded to the physiological requirements of systemic and organ hemodynamics during pregnancy. Conclusions. Development and implementation of effective pregravid preparation before ART cycles in women with a history of STIs and medical correction during pregnancy helps to increase an adaptive compensatory and an adaptive potential in the immune and haemocoagulatory homeostasis of the mother and perinatal protection of the fetus. The study was carried out in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethics Committee of the institution specified in the article. The study received informed consent from the women. No conflict of interests was declared by the author.