The state of the fibrinolytic system in HIV-infected pregnant women and parturient women with thrombohemorrhagic risk factors

Authors

DOI:

https://doi.org/10.18370/2309-4117.2020.51.47-50

Keywords:

HIV infection, thrombogemorrhagic complications, fibrinolysis system, antiretroviral therapy, pregnancy, childbirth

Abstract

Purpose of the study: to explore the status of the fibrinolytic system in HIV-infected pregnant women and parturient women.

Materials and methods. 120 HIV-positive pregnant women with risk factors of thrombohemorrhagic complications were examined. The main group included: IA-O subgroup – 10 patients with HIV-infection stage I who received high-activity antiretroviral therapy before this pregnancy, IB-O subgroup – 20 patients with HIV-infection stage I who started high-activity antiretroviral therapy during this pregnancy, II-O – 21 pregnant women with HIV infection II clinical stage, III-O subgroup – 24 women with HIV-infection III clinical stage. Comparison group consisted of 45 patients with HIV infection without thrombohemorrhagic complications; control group consisted of 40 pregnant women and parturient women without HIV. D-dimer, soluble fibrin-monomer complexes, antithrombin III and XIIa-dependent fibrinolysis time were evaluated.

Study results. In II-O and III-O subgroups there were changes of fibrinolytic system state in 18–22 weeks of pregnancy – increased D-dimer and soluble fibrin-monomer complexes, XIIa-dependent fibrinolysis time prolongation and antithrombin III decreased. With pregnancy progression the main group with HIV stage III showed a significant increase of soluble fibrin-monomer complexes and D-dimer with a tendency to XIIa-dependent fibrinolysis time reduction and antithrombin III decreasing. In all women of the main group there were thrombosis signs. In subgroup III-O there were laboratory signs of fibrinolysis activation (shortening the time of XIIa-dependent fibrinolysis) and a tendency to antithrombin III decrease. Parturient women who started taking high-activity antiretroviral therapy during this pregnancy show a slowing of the fibrinolysis processes (shortening of XIIa-dependent fibrinolysis) and a tendency to antithrombin III decrease. In IB-O subgroup there was a further suppression of fibrinolysis (prolonging the time of XIIa-dependent fibrinolysis).

Conclusions. Changes in the fibrinolytic system toward suppression of the fibrinolysis process during pregnancy and it activation during labor are significantly present in HIV-infected pregnant women and in women with risk factors for thrombogemorrhagic complications.

Author Biographies

С. Є. Савченко, P.L. Shupyk NMAPE of the MoH of Ukraine, Kyiv

MD, professor, Department of Obstetrics, Gynecology and Reproductology

О. І. Гервазюк, P.L. Shupyk NMAPE of the MoH of Ukraine Kyiv City Center of Reproductive and Perinatal Medicine, Kyiv

PhD, senior researcher, Department of Obstetrics, Gynecology and Reproductology

Obstetrician gynecologist

Л. М. Онищик, P.L. Shupyk NMAPE of the MoH of Ukraine Kyiv City Center of Reproductive and Perinatal Medicine, Kyiv

Postgraduate student, Department of Obstetrics, Gynecology and Reproductology

Obstetrician gynecologist

Ю. С. Мудра, P.L. Shupyk NMAPE of the MoH of Ukraine Kyiv City Center of Reproductive and Perinatal Medicine, Kyiv

Postgraduate student, Department of Obstetrics, Gynecology and Reproductology

Obstetrician gynecologist

Г. Б. Бойко, P.L. Shupyk NMAPE of the MoH of Ukraine Kyiv City Center of Reproductive and Perinatal Medicine, Kyiv

PhD, assistant of Department of Obstetrics, Gynecology and Reproductology

Obstetrician gynecologist

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Published

2020-03-25

Issue

Section

Pregnancy and childbirth