Profilaktik tibbiyot va salomatlik
–
Профилактическая
медицина
и
здоровье
–
Preventive Medicine
and Health
Journal home page:
https://inscience.uz/index.php/preventive-medicine
The role of the development of thrombocytopathies in
pregnant women with pre-eclampsia and the principles of
their correction
Diyorakhon NASRETDINOVA
Andijan State Medical Institute
ARTICLE INFO
ABSTRACT
Article history:
Received October 2023
Received in revised form
10 November 2023
Accepted 25 November 2023
Available online
15 December 2023
One of the first places is occupied by obstetric bleeding, the
second is preeclampsia, and the third is extragenital diseases in
the structure of maternal mortality in the Republic of
Uzbekistan. At the same time, it should be taken into account
that in almost 80% of cases, bleeding is a consequence of
preeclampsia (PE), and from a scientific point of view, it can be
reasonably argued that I and II places should rightfully be for
PE, therefore, this pathology is an urgent problem both
scientifically and practical obstetrics.
2181-3663
/©
2023 in Science LLC.
https://doi.org/10.47689/2181-3663-vol2-iss6-pp5-7
This is an open-access article under the Attribution 4.0 International
(CC BY 4.0) license (
https://creativecommons.org/licenses/by/4.0/deed.ru
Keywords:
preeclampsia,
spontaneous bleeding,
thrombocytopathies,
clexane.
Preeklampsiyali homilador ayollarda trombotsitopatiyalar
rivojlanishining o‘ziga xosligi va ularni tuzatish tamoyillari
ANNOTATSIYA
Kalit so‘zlar
:
preeklampsi,
o
‘
z-o
‘
zidan qon ketish,
trombotsitopatiyalar,
klexane.
O‘zbekiston Respublikasida onalar o‘limi tarkibida birinchi
o‘rinda akusherlik qon ketishi, ikkinchi o‘rinda preeklampsiya,
uchinchi o‘rinda ekstragenital kasalliklar turadi. Shu bilan
birgadeyarli 80% qon ketish holati preeklampsi(PE)ning
natijasidir va ilmiy nuqtai nazardan, I va II o‘rinlar haqli
ravishda bo‘lishi kerakligi haqida asosli fikr yuritish
mumkinligini inobatga olish lozim. Shu sababli mazkur kasallik
ham ilmiy, ham amaliy akusherlikning dolzarb muammosidir.
1
Resident of the 3-
year master’s program of the Department of 1
-Obstetrics and Gynecology, Andijan State Medical
Institute. Andijan, Uzbekistan.
2
Doctor of Medical Sciences, Professor, Head of the Department 1-Obstetrics and Gynecology, Andijan State Medical
Institute. Andijan, Uzbekistan.
Profilaktik tibbiyot va salomatlik
–
Профилактическая медицина и здоровье
–
Preventive Medicine and Health
Issue
–
2
№
6 (2023) / ISSN 2181-3663
6
Роль развития тромбоцитопатии у беременных с
преэклампсией и принципы их коррекции
АННОТАЦИЯ
Ключевые слова:
преэклампсия,
спонтанные
кровотечения,
тромбоцитопатии,
клексан.
В структуре материнской смертности в Республике
Узбекистан одно из первых мест занимают акушерские
кровотечения, второе –
гестоз, третье –
экстрагенитальные
заболевания. При этом следует учитывать, что почти в 80%
случаев кровотечения являются следствием преэклампсии
(ПЭ) и с научной точки зрения можно обоснованно
утверждать, что I и II места по праву должны быть для ПЭ,
поэтому данная патология является актуальной проблемой
как в научном, так и в практическом акушерстве.
The causes of PE are multifactorial, complex and not fully understood. However,
according to modern concepts, the leading role belongs to endothelial damage, changes in
platelet function, changes in lipid metabolism, as well as immunological and genetic
factors. According to many studies, the predominant number of pregnant women with
preeclampsia have severe hypercoagulability with the development of DIC. The study of
the functional properties of platelets of pregnant women with PE showed that changes in
the adhesive-aggregation properties of platelets precede the involvement of the
procoagulant link of the hemostasis system in the development of DIC.
A certain role of hemocoagulation disorders in the pathogenesis of PE has now
been proven. However, many aspects of the development and progression of PE during
pregnancy are still far from being resolved. It has been established that during PE in
pregnant women, platelet activation develops, which leads not only to their disseminated
intravascular aggregation and damage to the walls of the vessel but also inevitably to
activation of blood coagulation and the development of DIC. Small doses of heparin,
antiplatelet agents, vitamin E antioxidant, and fresh frozen plasma are used To eliminate
these disorders in the complex therapy of such patients. The use of these drugs led to the
correction of disorders in the hemostasis system. At the same time, the frequency of
thrombohemorrhagic complications decreased by 2-3 times. However, in some cases, this
therapy does not provide a sufficient corrective effect, which is probably due to high
plasma heparin resistance in patients with DIC. The data accumulated to date suggest
that this condition is due to a sharp increase in the content of acute phase proteins (APF)
some of which have a high affinity for heparin and prevent its interaction with
antithrombin III II. It is possible to temporarily overcome the effect of BOF only by a
sharp increase in the dose of administered heparin, however, this is fraught with the risk
of bleeding and secondary depression of AT-III.
The
purpose of the research is
to study the platelet link of the hemostasis system
and determine their role in the development of thrombohemorrhagic complications in
preeclampsia and their prevention.
Research methods
are to assess the condition of women, the following will be
carried out: a thorough collection and analysis of anamnestic data, a general blood test, a
general urinalysis, a Nechiporenko urinalysis, a general examination, a gynecological and
obstetric examination, blood biochemical parameters: total protein, bilirubin, urea,
Profilaktik tibbiyot va salomatlik
–
Профилактическая медицина и здоровье
–
Preventive Medicine and Health
Issue
–
2
№
6 (2023) / ISSN 2181-3663
7
creatinine, enzymes (AlT), indicators of hemostasis, dynamic cardiotocographic study
(CTG), the study of the state of the platelet, procoagulant and fibrinolytic components of
the hemostasis system.
Platelets are an important component of the hemostasis system: platelet adhesion
to the site of vessel injury, aggregation, secretion of coagulation factors, subsequent clot
retraction, spasm of small vessels, and the formation of a white platelet thrombus stop
bleeding in microcirculatory vessels with a diameter of up to 100 nm. Activation of the
coagulation system induces the formation of fibrin on the surface of activated platelets
and the formation of a full-fledged thrombus.
Clinical manifestations depend on the characteristics of qualitative and
quantitative defects in platelets
–
the severity of the hemorrhagic syndrome can vary
significantly and does not directly depend on the degree of the defect. With mild bleeding,
there may be a tendency to bruising with small and minor injuries, at the site of
compression with an elastic band; periodic non-abundant nosebleeds, family prolonged
menstruation in women, etc. In the case of the development of a massive hemorrhagic
syndrome, life-threatening blood loss may develop.
Conclusion:
We used a new approach to prevent obstetric bleeding against the
background of preeclampsia using low molecular weight heparin Clexane, which
contributes to the normalization of platelet function, the elimination of thrombophilic
conditions, and heparin resistance. As a result of the implementation of the principles
developed by us for managing women with PE, the frequency of obstetric bleeding will be
reduced, which will reduce maternal morbidity and mortality in women, as well as
reduce their disability as a result of preserving the main reproductive organ
–
the uterus.
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