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ÏÐÎÒÈÂÎÒÐÎÌÁÎÒÈ×ÅÑÊÀß ÏÐÎÔÈËÀÊÒÈÊÀ ÏÎÂÒÎÐÍÛÕ ÏÐÅÝÊËÀÌÏÑÈÉ Ó ÆÅÍÙÈÍ Ñ ÒÐÎÌÁÎÔÈËÈÅÉ
Æóðàâëåâà Å.Â. Äàòà ïóáëèêàöèè íà ñàéòå: 2014-08-14 Äîñòóïíà òàêæå â ïå÷àòíîé âåðñèè æóðíàëà Ðåçþìå | Ïîëíûé òåêñò | Ñêà÷àòü â PDF
Öåëü èññëåäîâàíèÿ – îöåíêà ýôôåêòèâíîñòè ïðîòèâîòðîìáîòè÷åñêîé ïðîôèëàêòèêè ïîâòîðíûõ ÏÝ ó æåíùèí ñ òðîìáîôèëèåé. Ìàòåðèàë è ìåòîäû. Ïðîâåäåíî ïðîñïåêòèâíîå êëèíè÷åñêîå èññëåäîâàíèå ñ ó÷àñòèåì 66 ïàöèåíòîê ñ òðîìáîôèëèåé (ãåíåòè÷åñêîé, ïðèîáðåòåííîé èëè ñî÷åòàííîé) è ÏÝ â àíàìíåçå: 35 – îáðàòèâøèåñÿ è, ñîîòâåòñòâåííî, íàõîäÿùèåñÿ ïîä íàøèì íàáëþäåíèåì ñ ôåðòèëüíîãî öèêëà (ïîäãðóïïà Ia), è 31 – îáðàòèâøèåñÿ ê íàì óæå áóäó÷è áåðåìåííûìè (ñ 6 ïî 13 íåä. ãåñòàöèè) – IIa ïîäãðóïïà. Êîíòðîëüíóþ ãðóïïó ñîñòàâèëè 50 æåíùèí ñ íåîòÿãîùåííûì àêóøåðñêîãèíåêîëîãè÷åñêèì è òðîìáîòè÷åñêèì àíàìíåçîì. Òåðàïèÿ ïðîâîäèëàñü: ÍÌà (ýíîêñàïàðèí), âèòàìèíû ãðóïïû Â, àíòèîêñèäàíòû è ìèêðîíèçèðîâàííûé ïðîãåñòåðîí. Ðåçóëüòàòû èññëåäîâàíèÿ: ó ïàöèåíòîê, ïîëó÷àâøèõ òåðàïèþ ñ ôåðòèëüíîãî öèêëà, òå÷åíèå áåðåìåííîñòè, àêóøåðñêèå è ïåðèíàòàëüíûå èñõîäû áûëè ëó÷øå, ÷åì â ãðóïïå ïàöèåíòîê, òåðàïèÿ êîòîðûì áûëà íà÷àòà âî âðåìÿ áåðåìåííîñòè. Çàêëþ÷åíèå: äëÿ ïðåäîòâðàùåíèÿ ïîâòîðíîé ÏÝ ïðè ïîñëåäóþùåé áåðåìåííîñòè íåîáõîäèìî íà÷èíàòü òåðàïèþ ñ ôåðòèëüíîãî öèêëà, ïðîäîëæàÿ âî âðåìÿ áåðåìåííîñòè, ðîäîâ è â ïîñëåðîäîâîì ïåðèîäå. Òåðàïèÿ äîëæíà âêëþ÷àòü ÍÌÃ, âèòàìèíû ãðóïïû Â, àíòèîêñèäàíòû è ìèêðîíèçèðîâàííûé ïðîãåñòåðîí.
ANTITHROMBOTIC PROPHYLAXIS REPEATED PREECLAMPSIA IN PATIENTS WITH THROMBOPHILIA Zhuravleva E.V.
First Moscow State Medical Sechenov University of the Ministry of Health Russian Federation
Abstract. Objective. To evaluate the efficiency of antithrombotic therapy to prevent repeated preeclampsia in patients with thrombophilia. Subject and methods. A prospective clinical study was conducted 66 patients with thrombophilia (genetic, acquired or concomitant) and with history of preeclampsia: 35 patients addressed and were followed since fertile cycle (subgroup Ia) and 31 patients addressed during pregnancy and were followed since 6-13 weeks of gestation – IIa subgroup. Control group – 50 patients without both obstetrics and gynecology and thrombotic complications in history. Therapy included LMWG (klexan), B vitamins, antioxidants and micronized progesterone. Results. The all period of pregnancy, obstetric and perinatal outcomes were better in patients receiving therapy since fertile cycle compared with group of patients whose therapy was initiated during pregnancy.Conclusion. To prevent re-PE at a subsequent pregnancy, the therapy should be start since fertile cycle, continuing during pregnancy, childbirth and the postpartum period. Therapy should include LMWH, B vitamins, antioxidants and micronized progesterone.
Key words: preeclampsia, antithrombotic therapy, LMWG, thrombophilia.
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