V.F.Snegirev Archives of Obstetrics and GynecologyV.F.Snegirev Archives of Obstetrics and Gynecology2313-87262687-1386Eco-Vector3478510.17816/2313-8726-2020-7-2-97-101Research ArticlePlacental insufficiency and preeclampsia are associated with increased thrombin generationGribkovaIrina V.<p>MD, PhD</p>igribkova@yandex.ruhttps://orcid.org/0000-0001-5136-1752KorolevaNataliya S.tashakoroleva@gmail.comhttps://orcid.org/0000-0002-4525-9054MurashkoAndrey V.<p>MD, PhD, Professor</p>murashkoa@mail.ruhttps://orcid.org/0000-0003-0663-2909Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare DepartmentI.M. Sechenov First Moscow State Medical University (Sechenov University)1806202072971011806202018062020Copyright © 2020, Eco-Vector2020<p><strong>Introduction. </strong>An urgent problem of modern medicine is the risk of thrombosis in women during pregnancy, which can cause complications in both the mother and the fetus. Currently, a relationship between thrombosis and pregnancy complications is shown. However, there are practically no studies comparing the state of the hemostatic system in women with various pathologies of pregnancy.</p>
<p>Purpose of the study compare the status of the hemostatic system in pregnant women with various pregnancy complications.</p>
<p><strong>Material and methods</strong>. 32 pregnant women in the 3<sup>rd</sup> trimester were examined. All women were divided into groups with various complications of pregnancy: venous insufficiency (n = 7), thrombophilia (n = 11), placental insufficiency + preeclampsia (n = 4). The comparison group included women with a physiological course of pregnancy (n = 10). In the study groups pregnant women received low molecular weight heparin (LMWH). Women from the comparison group did not receive any anticoagulant therapy. A study of the status of the hemostasis system was performed using standard coagulation tests and the thrombin generation test (TGT).</p>
<p><strong>Results</strong>. The indicators of the standard coagulogram for each group were within the reference values. No statistically significant differences between the groups were detected for any indicator (paired Students t-test, ANOVA, p 0.05). A statistically significant increase in the parameter of TGT: endogenous thrombin potential (ETP) was shown, as well as a statistically significant decrease in the parameter of TGT: lag period (tlag) in pregnant women with placental insufficiency and preeclampsia compared with the comparison group (paired Students t-test, ANOVA, p 0.05).</p>
<p><strong>Conclusion</strong>. The parameters of the state of the hemostatic system in pregnant women with venous insufficiency and thrombophilia while taking a prophylactic dose of LMWH do not differ from each other and from the comparison group. ETP and the lag period of the group of pregnant women with placental insufficiency and preeclampsia significantly differ from the comparison group and other studied groups, showing a greater tendency to increased thrombosis.</p>pregnancy complicationsthrombin generation testplacental insufficiencypreeclampsiaосложнения беременноститест генерации тромбинаплацентарная недостаточностьпреэклампсия[Бицадзе В.О., Макацария А.Д., Хизроева Д.Х., Макацария Н.А., Яшенина Е.В., Казакова Л.А. Тромбофилия как важнейшее звено патогенеза осложнений беременности. Практическая медицина. 2012; 9(65): 24-31.][Грибкова И.В., Королева Н.С., Давыдовская М.В., Мурашко А.В. Повышенное образование тромбина — потенциальный маркер неблагоприятных исходов беременности. Акушерство и гинекология. 2018; 8: 92-7.][Момот А.П., Молчанова И.В., Семёнова Н.А., Романов В.В., Сердюк Г.В., Белозеров Д.Е. и др. Динамика показателей системы гемостаза у женщин при вынашивании беременности и после родов. Лабораторная служба. 2015; 4 (2): 3-11.][Мустафин И.Г., Курманбаев Т.Е., Шмидт А.А., Тимошкова Ю.Л., Атаянц К.М. «Глобальные» методы исследования системы гемостаза в современной акушерской практике. Казанский мед. журн. 2019; 100 (6): 958-65.][Галайко М.В., Рыбина О.В., Литвиненко М.С., Климов Ю.В., Альтшулер Б.Ю., Губкин А.В. Тромбофилия и беременность. Клиническая онкогематология. 2017;10(3): 409-22.][Липец Е.Н., Атауллаханов Ф.И., Пантелеев М.А. Интегральные лабораторные тесты гемостаза в диагностике гиперкоагуляции и оценке риска тромбоза. Онкогематология. 2015; 3(10): 67-85.][Николаева М.Г., Момот А.П., Зайнулина М.С., Момот К.А., Ясафова Н.Н. Гепаринопрофилактика гестационных осложнений у носительниц мутации фактора V Лейден (генотип GA). Акушерство, гинекология и репродукция. 2018; 12 (2): 21-31.][Mastrolia S.A., Mazor M., Loverro G., Klaitman V., Erez O. Placental vascular pathology and increased thrombin generation as mechanisms of disease in obstetrical syndromes. Peer J. 2014; 2: e653.][Simcox L.E., Ormesher L., Tower C., Greer I.A. Thrombophilia and Pregnancy Complications. Int. J. Mol. Sci. 2015; 16(12): 28418-28.][Bates S.M. Preventing thrombophilia-related complications of pregnancy: an update. Expert Rev. Hematol. 2013; 6(3): 287-300.][Hemker H.C., Giesen P., AlDieri R., Regnault V., de Smed E., Wagenvoord R., et al. The calibrated automated thrombogram (CAT): a universal routine test for hyper- and hypocoagulability. Pathophysiol. Haemost. Thromb. 2002; 32(5-6): 249-53.][Gribkova I.V., Lipets E.N., Rekhtina I.G., Bernakevich A.I., Ayusheev D.B., Ovsepyan R.A. et al. The modification of the thrombin generation test for the clinical assessment of dabigatran etexilate efficiency. Sci. Rep. 2016; 6: 29242.][Patel J.P., Patel R.K., Roberts L.N., Marsh M.S., Green B., Davies J.G., et al. Changes in thrombin generation and D-dimer concentrations in women injecting enoxaparin during pregnancy and the puerperium. BMC Pregnancy Childbirth. 2014;14: 384.][McLean K.C., Bernstein I.M., Brummel-Ziedins K.E. Tissue factor-dependent thrombin generation across pregnancy. Am. J. Obstet. Gynecol. 2012; 207(2):135.e1-6.][Lattová V., Procházka M., Procházková J., Ulehlová J., Slavík L., Lubušký M. et al. Preeclampsia and thrombin generation test. J. Čes. Gynek. 2013; (78): 466-72.]