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Procena ishoda trudnoća komplikovanih urođenim trombofilijama

Evaluation of pregnancy outcome complicated by inherited thrombophylias

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Author
Maglić, Dragana N.
Mentor
Miković, Željko
Committee members
Bogdanović-Pristov, Jelena
Plećaš, Darko
Hajrić-Egić, Amira
Grujić, Zorica
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Abstract
UVOD: Trudnice sa urođenom trombofilijom imaju veći rizik za razvoj venskih tromboembolijskih komplikacija, spontanih i habitualnih pobačaja, peeklampsije, intrauterusnog zastoja u rastu ploda i abrupcije posteljice. Etiopatogeneza obstetričkih komplikacija kod trombofilije nije jasno definisana, što je i jedan od razloga povremenih neuspeha terapije. Ključni faktor za normalan razvoj trudnoće je kontakt između fetalne i maternalne cirkulacije, kao i ravnoteža između koagulacije i fibrinolize u posteljici na nivou hemohorionske membrane. Najčešće se govori o trombozi fetoplacentne cirkulacije kao uzroku obstetričkih komplikacija kod trudnica sa urođnom trombofilijom. S obzirom na značajan broj neuspelih trudnoća i uz primenjenu antikoagulantnu terapiju, evidentno je da postoje i drugi uzroci opstetričkih komplikacija u trudnoćama sa naslednom trombofilijom. Obstetričke komplikacije tokom drugog i trećeg trimestra kod trudnica sa trombofilijom su slične komplikacijama preeklampsije. Kod... trudnica sa preeklampsijom je dokazan porast koncentracije reaktivnih kiseoničkih vrsta kao i smanjena aktivnost enzima zaštite od oksidacionih oštećenja, što za posledicu ima endotelijalnu disfunkciju, neadekvatnu invaziju trofoblasta i hipoperfuziju posteljice što pojačava oksidativni stres. Hipoteza studije bi bila, da je u trudnoćama sa naslednom trombofilijom oksidativni stres uzrok komplikacija. CILJ RADA: Uticaj primene LMWH kod pacijentkinja sa opterećenom akušerskom anamnezom i dokazanom urođenom trombofilijom na broj živorođene dece i pojavu komplikacija u trudnoći (spontani pobačaj, intrauterusna smrt ploda, abrupcija posteljice, PE, IUGR, VTE). Ispitati i uporedi aktivnost antioksidativnog enzimskog zaštitnog sistema u krvi trudnica obolelih od trombofilije i zdravih trudnica nakon porodjaja. METODOLOGIJA: Longitudinalnom studijom je obuhvaćeno 60 trudnica koje su bile hospitalizovane i kontrolisane u GAK “Narodni Front” u Beogradu u toku 2013 godine, a kod kojih je dijagnoza urođene trombofilije postavljena pre ispitivane trudnoće. Svim trudnicama uključenim u ispitivanje prvi put je ordinirana antikoagulantna terapija u vidu nisko molekularnog heparina...

BACKGROUND: Pregnant women with inherited trombophylia have a higher risk for developing venous embolic complications, spontaneous and habitual miscarriages, preeclamspia, IUGR, and placental abruption. Genesis of obstetric complications is not clearly defined, and as such may present one of the reasons for therapy failure. The key for the development of a normal pregnancy is the contact between the fetal and maternal circulation, as is the balance between coagulation and fibrinolysis in the placenta at the chorionic membrane level, Usualy we target fetoplacental thrombosis, as the main cause for obstetrical complication in pregnant women with congenital thrombophilia. Considering the number of unsuccesfull pregnancies, even when using anticoagulant therapy, it becomes evident that other causes exist for obstetric complications in pregnancies with inherited trombophylia. Obstetric complications during the second and third trimester, in pregnancies with inherited thrombophilia are simil...air to eclamptic complications, An elevated level of reactive oxygen is found in pregnant patients with preeclampsia, and an impaired enzyme protection from oxidative damage, which effect in endothelial dysfunction, less than adequate trophoblast invasion and a hypoperfussion of the placenta, which all increase oxidative stress. THE GOALS: To examine the influence of LMWH application in patients with inherited trombophylia on the number of live born children and number of manifest complkications in pregnancy (spontaneous abortion, intrauterine fetal death, placental abruption, PE, IUGR, VTE). To investigate the activity of enzyme antioxidative protection system in patients with trombophylia and to compare with healthy patients after live birth. METHODS: Through this longitudinal study 60 gravide patients were followed. These patients were hospitalized and/or controlled in GAK “Narodni Front” in Beograd during 2013., with a diagnosis of inherited trombophylia prior to pregnancy. For all of the patients this was the first administration of low molecular heparin. All examinations and blood sampling was performed during planed hospitalizations: in first, second, third trimester, prior to childbirth and two days after delivery.

Faculty:
Универзитет у Београду, Медицински факултет
Date:
27-09-2016
Keywords:
Urođena trombofilija / Inherited thrombophylia / LMWH / IUGR / PE / pobačaj / FMU / abrupcija posteljice / oksidativni stres / LMWH / IUGR / PE / abortion / FMU / placental abruption / oxydative stress
[ Google Scholar ]
Handle
https://hdl.handle.net/21.15107/rcub_nardus_7348
URI
https://nardus.mpn.gov.rs/handle/123456789/7348
http://eteze.bg.ac.rs/application/showtheses?thesesId=4374
https://fedorabg.bg.ac.rs/fedora/get/o:14257/bdef:Content/download
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