Volume 14, no. 1
Pages 88-95

   Objective: to study the hemostasis system indices and systemic inflammatory response in pregnant women with moderate and severe preeclampsia. In the study “case-control” there were 14 women without preeclampsia (control group), 16 women with moderate preeclampsia and 14 – with severe one. We have studied hemostasis indices (D-dimer, prothrombin index, antithrombin III, activated partial thromboplastin time, fibrinogen, XIIa-dependent and euglobulin fibrinolysis, soluble fibrin-monomeric complex, thrombocyte aggregation with ADP, adrenalin, collagen) and systemic inflammation (hsCRP, endotoxin). In moderate preeclampsia we registered decrease in thrombocyte count (180.00 ± 5.15×109/l) and increase in their induced aggregation (with ADP – 5 73.52 ± 1.35 %, АDP – 0.5 4.47 ± 0.11 %, adrenalin – 70.89 ± 1.10 %, collagen – 82.73 ± 1.71 %), we also revealed the hemostasis activation markers (D-dimer increasing – 1971.88 ± 391.99 ng/ml, fibrinogen increasing – 6.68 ± 0.26 g/l, antithrombin III activity decreasing – 97.96 ± 4.00 %) and the markers of systemic inflammation (rising of hsCRP – 6.42 ± 0.85 mg/l, endotoxin – 8.46 ± 0.67 EU/ml). Compared with moderate preeclampsia the severe one is characterized by more expressed thrombocyte count (155.57 ± 6.45×109/l) with thrombocyte disaggregation predisposition (increasing of aggregation with adrenalin – 73.95 ± 2.92 %, decreasing – with ADP 0.5 – 2.52 ± 0.16 %), significant hypercoagulation shifts (increase of D-dimer – 1653.71 ± 234.52 ng/ml, soluble fibrin-monomeric complex – 

15.39 ± 1.10 mg%, fibrinogen – 6.57 ± 0.15 g/l, decreasing of antithrombin III activity – 91.74 ± 4.29 %, retardation of euglobulin and XIIа-dependent fibrinolysis 298.36 ± 12.17 min and 18.19 ± 1.77 min accordingly) and rising of inflammatory response markers (hsCRP 8.02 ± 1.02 mg/l, endotoxin 9.52 ± 0.81 EU/ml). We found out positive correlation relationships of hsCRP-level and endotoxin with coagulation hemostasis indices (D-dimer, soluble fibrin-monomeric complex, fibrinogen), vascular-thrombocytic hemostasis (thrombocyte count, thrombocyte aggregation with ADP), anticoagulative system (XIIa-dependent fibrinolysis) and negative correlation relationships with antithrombin III activity. Systemic inflammation markers (hsCRP, endotoxin) and hemostasis system indices (D-dimer, soluble fibrin-monomeric complex, fibrinogen, thrombocyte count, thrombocyte aggregation with ADP, XIIa-dependent fibrinolysis, antithrombin III) may be used as the criteria of preeclampsia severity. Keywords: preeclampsia, systemic inflammation indices, hemostasis system. 

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References

1.Dolgushina V.F., Chulkov V.S., Vereina N.K., Sinitsyn S.P. [Obstetric Complications in Various Forms Arterial Hypertension in Pregnant Women]. Akusherstvo i ginekologiya [Obstetrics and Gynecology], 2013, no. 10, pp. 33–39 (in Russian).

2.Vereina N.K., Sinitsyn S.P., Chulkov V.S. [Dynamics of Hemostasis During Physiological Pregnancy]. Klinicheskaya laboratornaya diagnostika [Clinical Laboratory Diagnostics], 2012, no. 2, pp. 43–45 (in Russian).

3.Vereina N.K., Chulkov V.S. [Hemostatic Condition in Women with Chronic Hypertension in Different Trimesters of Pregnancy]. Regionarnoe krovoobrashchenie i mikrotsirkulyatsiya [Regional Circulation and Microcirculation], 2011, vol. 10, no. 4(40), pp. 28–33 (in Russian).

4.Nauchnyy tsentr akusherstva, ginekologii i perinatologii im. V.I. Kulakova. [Health Ministry of Russia. Institute for Family Health. The “Mother and Child”. Hypertension During Pregnancy. Preeclampsia. Eclampsia. Clinical protocol]. Moscow, 2012. 44 p.

 

5.Dzhoboeva E.M., Dobrokhotova Yu.E. Disfunktsiya endoteliya i sistema gemostaza u beremennykh iz grupp vysokogo riska. Sistemnyy podkhod k diagnostike i terapii (klinicheskie rekomendatsii) [Endothelial Dysfunction and Hemostasis System in Pregnant Women at High Risk. Systematic Approach to Diagnosis and Therapy (Clinical Guidelines)]. Moscow, Limited Liability Company Teler Publ., 2013. 128 p.

6.Makarov O.V., Kerchelaeva S.B., Ozolinya L.A. Priobretennye i nasledstvennye faktory trombofilii v razvitii oslozhneniy beremennosti [Acquired and Inherited Thrombophilia Factors in the Development of Pregnancy Complications]. Moscow, Medical Publ., 2006. 120 p.

7.Makatsaria A.D. Trombogemorragicheskie oslozhneniya akushersko-ginekologicheskoy praktike: Rukovodstvo dlya vrachey [Thrombohemorrhagic Complications Obstetric Practice: a Guide for Physicians]. Moscow, Medical Information Agency Publ., 2011. 1056 p.

8.Medvedev B.I., Syundyukova E.G., Sashenkov S.L. [Clinical-biochemical Predictors of Preeclampsia Development]. Akusherstvo i ginekologiya [Obstetrics and Gynecology], 2013, no. 5, pp. 30–35 (in Russian).

9.Serov V.N., Sukhikh G.T., Baranov I.I., Pyregov A.V. Neotlozhnye Sostoyaniya v Akusherstve: Rukovodstvo dlya Vrachey [Threatening Conditions in Obstetrics: a Guide for Physicians]. Moscow, GEOTAR Media Publ., 2011. 784 p.

10.Chulkov V.S., Sinitsyn S.P., Vereina N.K., Urazova N.V. [Features of the Structure, History and Preg-nancy Outcomes in Hypertension]. Ekologiya cheloveka [Human Ecology]. 2009, no. 10, pp. 49–54 (in Russian).

11.Sukhikh G.T., Murashko L.E. Preeklampsiya: rukovodstvo [Preeclampsia: Manual]. Moscow, GEOTAR Media Publ., 2010, 576 p.

12.Repina M.A., Korzo T.M., Papayan L.P. [Correction of Hemostatic Disorders in Pregnancy Complicated by Preeclampsia]. Akusherstvo i ginekologiya [Obstetrics and Gynecology], 1998, no. 5, pp. 39–46 (in Russian).

13.Syundyukova E.G. [Polymorphism of PAI-1 675 4G/5G and Markers of Systemic Inflammatory Re-sponse in Preеclampsia]. Vrach-aspirant [Doctor-graduate Student], 2014, no. 12(62), pp. 299–305 (in Russian).

14.Chulkov V.S., Sinitsyn S.P., Vereina N.K. [The Clinical Course of Pregnancy, the State of Hemostasisand Endothelial Function in Patients with Hypertension and Risk Factors Thrombogenic Complications]. Rossiyskiy vestnik akushera-ginekologa [Russian Bulletin Obstetrician], 2010, no. 3, pp. 9–12 (in Russian).

15.Chulkov V.S., Sinitsyn S.P., Vereina N.K. [During Pregnancy and Childbirth, Hemostasis in Womenwith Overweight and Obesity]. Akusherstvo i ginekologiya [Obstetrics and Gynecology], 2011, no. 1, pp. 22–26 (in Russian).

16.Shmakov R.G., Savushkin A.V, Sidel'nikova V.M. [Comparative Evaluation of Adaptive Changes in theHemostatic System and the Morphological and Functional Characteristics of Platelets During Pregnancy]. Akusherstvo i ginekologiya [Obstetrics and Gynecology], 2003, no. 3, pp. 17–21 (in Russian).

17.Yurchenko L.N., Chereshnev V.A., Gusev E.Yu. Sistemnoe vospalenie i sistema gemostaza v akusherskoy patologii [Systemic Inflammation and Hemostasis System in Obstetric Pathology]. Ekaterinburg, Ural branch of the Russian academy of sciences Publ., 2004, pp. 17–72.

18.Xiong Y., Zhou S.F., Zhou R., Yang D., Xu Z.F., Lou Y.T., Guo Q.S., Hu R., Peng T., Ma D., Li X.T.Alternations of Maternal and Cord Plasma Hemostasis in Preeclampsia before and after Delivery. Hypertens Pregnancy, 2011, no. 30(3), pp. 347–358.

19.Peisajovich A., Marnell L., Mold C., Du Clos T.W. C-Reactive Protein at the Interface between InnateImmunity and Inflammation. Expert. Rev. Clin. Immunol. 2008, no. 4(3), pp. 379–390.

 

20.Menzies J., Magee L.A., Macnab Y.C., Ansermino J.M., Li J., Douglas M.J., Gruslin A., Kyle P., Lee S.K.,Moore M.P., Moutquin J.M., Smith G.N., Walker J.J., Walley K.R., Russell J.A., von Dadelszen P. Current CHS and NHBPEP Criteria for Severe Preeclampsia Do Not Uniformly Predict Adverse Maternal or Perinatal Outcomes. Hypertension in Pregnancy, 2007, no. 26(4), pp. 447–462.

1.Demir C., Dilek I. Natural Coagulation Inhibitors and Active Protein c Resistance in Preeclampsia. Clinics(Sao Paulo), 2010, no. 65(11), pp. 1119–1122.

2.Devaraj S., Singh U., Jialal I. The Evolving Role of C-Reactive Protein in Atherothrombosis. Clin.Chem., 2009, no. 55(2), pp. 229–238.

3.Pijnenborg R., Vercruysse L., Hanssens M., Brosens I. Endovascular Trophoblast and Preeclampsia:A reassessment. Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health., 2011, vol. 1, iss. 1, pp. 66–71.

4.Portelinha A., Cerdeira A.S., Belo L., Braga J., Tejera E., Pinto A., Pinto F., Areias M.J., Patrício B., Re-belo I. Haemostatic Factors in Women with History of Preeclampsia. Thromb. Res., 2009, no. 124(1), pp. 52–56.

5.Dusse L.M., Alpoim P.N., Lwaleed B.A., de Sousa L.P., Carvalho Md., Gomes K.B. Is There a Link be-tween Endothelial Dysfunction, Coagulation Activation and Nitric Oxide Synthesis in Preeclampsia? 2013, no. 415, pp. 226–229.

 

6.Kazmi R.S., Cooper A.J., Lwaleed B.A. Platelet Function in Preeclampsia. Semin. Thromb. Hemost.2011, no. 37(2), pp. 131–136.