Management of the pre-eclamptic women from the point of obstetrical hemostaseology

О. В. Грищенко, І. В. Лахно

Abstract


Pre-eclampsia is a disease caused the hypertension and the internal organs mulfunction in the II half of pregnancy. The coagulopathic events found in women with preeclampsia makes an emphasis not only on the increased risk of the thrombosis but also on the possible hypocoagulation. The elevated protease level has an obvious impact on the increased fibrinolytic activity.

The aim of study was to investigate the clinical efficacy of Tranexam for the prevention of the intra- and postpartum bleeding in women with pre-eclampsia. Totally, 92 pregnant women were examined. The main group (III) included 34 pregnant women with pre-eclampsia whom additionally to antihypertensive drugs at the same time with the onset of the activities for labor induction Tranexam was administered: 2 tablets (500 mg) three times a day orally. There were 32 patients with pre-eclampsia treated with conventional therapy in group II (comparison). 26 women in the III trimester of healthy pregnancy were enrolled in the control group (I).

The survey has revealed an increased hemostatic activity with the development of the thrombotic coagulopathy and the reduced level of endogenous anticoagulants in pre-eclamptic patients. Detected characteristics of women with preeclampsia may have been associated with congenital or acquired thrombophilia, systemic inflammatory response syndrome and oxidative stress. Complex therapy of women with pre-eclampsia not only supported the rheological properties of blood, but was aimed at the prevention of eclampsia, premature detachment of normally situated placenta and antenatal fetal death. The treatment helped to prevent thrombotic complications and maintain microcirculation processes. But the usage of the anticoagulants has not been able to counteract the systemic disorder associated with endothelial dysfunction, “humoral protease explosion”, oxidative stress and hepatic failure.

The prophylactic application of Tranexam in women with pre-eclampsia decreased the risk of bleeding in the intra- and postpartum period more than 4 times. Therefore, the preventive use of oral tranexamic acid formulations has every reason for the widespread introduction in obstetric clinical practice.


Keywords


pre-eclampsia; obstetric hemorrhage; Tranexam

References


Daneva, A.M., Hadži-Lega, M., Stefanovic, M. “Correlation of the system of cytokines in moderate and severe preeclampsia.” Clin Exp Obstet Gynecol 43.2 (2016): 220–4.

D’Angelo, A., Valsecchi, L.; ATIII-Early Preeclampsia Study Group. “High dose antithrombin supplementation in early preeclampsia: A randomized, double blind, placebo-controlled study.” Thromb Res 140 (2016): 7–13.

Elliot, M.G. “Oxidative stress and the evolutionary origins of preeclampsia.” J Reprod Immunol 114 (2016): 75–80.

Erez, O., Mastrolia, S.A., Thachil, J. “Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management.” Am J Obstet Gynecol 213.4 (2015): 452–63.

Friedman, A.M., Cleary, K.L. “Prediction and prevention of ischemic placental disease.” Semin Perinatol 38.3 (2014): 177–82.

Hladunewich, M., Karumanchi, S.A., Lafayette, R. “Pathophysiology of the clinical manifestations of preeclampsia.” Clin J Am Soc Nephrol 2 (2007): 543–9.

Maged, A.M., Helal, O.M., Elsherbini, M.M., et al. “A randomized placebo-controlled trial of preoperative tranexamic acid among women undergoing elective cesarean delivery.” Int J Gynaecol Obstet 131.3 (2015): 265–8.

Peitsidis, P., Kadir, R.A. “Antifibrinolytic therapy with tranexamic acid in pregnancy and postpartum.” Expert Opin Pharmacother 12.4 (2011): 503–16.

Sentilhes, L., Daniel, V., Darsonval, A., et al. “Study protocol. TRAAP – TRAnexamic Acid for Preventing postpartum hemorrhage after vaginal delivery: a multicenter randomized, double-blind, placebo-controlled trial.” BMC Pregnancy Childbirth 15 (2015): 135.

Sergeeva, O.N., Chesnokova, N.P., Ponukalina, E.V., et al. “Pathogenetic relationship between endothelial dysfunction and disorders of blood coagulation potential in pregnancy complicated by pre-eclampsia.” Herald of RAMN 5 (2015): 599–603.

Simonazzi, G., Bisulli, M., Saccone, G., et al. “Tranexamic acid for preventing postpartum blood loss after cesarean delivery: a systematic review and meta-analysis of randomized controlled trials.” Acta Obstet Gynecol Scand 95.1 (2016): 28–37.

Uzan, J., Carbonnel, M., Piconne, O., et al. “Pre-eclampsia: pathophysiology, diagnosis, and management.” Vasc Health Risk Manag 7 (2011): 467–74.


GOST Style Citations


1. Daneva, A.M., Hadži-Lega, M., Stefanovic, M. “Correlation of the system of cytokines in moderate and severe preeclampsia.” Clin Exp Obstet Gynecol 43.2 (2016): 220–4.

2. D’Angelo, A., Valsecchi, L.; ATIII-Early Preeclampsia Study Group. “High dose antithrombin supplementation in early preeclampsia: A randomized, double blind, placebo-controlled study.” Thromb Res 140 (2016): 7–13.

3. Elliot, M.G. “Oxidative stress and the evolutionary origins of preeclampsia.” J Reprod Immunol 114 (2016): 75–80.

4. Erez, O., Mastrolia, S.A., Thachil, J. “Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management.” Am J Obstet Gynecol 213.4 (2015): 452–63.

5. Friedman, A.M., Cleary, K.L. “Prediction and prevention of ischemic placental disease.” Semin Perinatol 38.3 (2014): 177–82.

6. Hladunewich, M., Karumanchi, S.A., Lafayette, R. “Pathophysiology of the clinical manifestations of preeclampsia.” Clin J Am Soc Nephrol 2 (2007): 543–9.

7. Maged, A.M., Helal, O.M., Elsherbini, M.M., et al. “A randomized placebo-controlled trial of preoperative tranexamic acid among women undergoing elective cesarean delivery.” Int J Gynaecol Obstet 131.3 (2015): 265–8.

8. Peitsidis, P., Kadir, R.A. “Antifibrinolytic therapy with tranexamic acid in pregnancy and postpartum.” Expert Opin Pharmacother 12.4 (2011): 503–16.

9. Sentilhes, L., Daniel, V., Darsonval, A., et al. “Study protocol. TRAAP – TRAnexamic Acid for Preventing postpartum hemorrhage after vaginal delivery: a multicenter randomized, double-blind, placebo-controlled trial.” BMC Pregnancy Childbirth 15 (2015): 135.

10. Sergeeva, O.N., Chesnokova, N.P., Ponukalina, E.V., et al. “Pathogenetic relationship between endothelial dysfunction and disorders of blood coagulation potential in pregnancy complicated by pre-eclampsia.” Herald of RAMN 5 (2015): 599–603.

11. Simonazzi, G., Bisulli, M., Saccone, G., et al. “Tranexamic acid for preventing postpartum blood loss after cesarean delivery: a systematic review and meta-analysis of randomized controlled trials.” Acta Obstet Gynecol Scand 95.1 (2016): 28–37.

12. Uzan, J., Carbonnel, M., Piconne, O., et al. “Pre-eclampsia: pathophysiology, diagnosis, and management.” Vasc Health Risk Manag 7 (2011): 467–74.





DOI: http://dx.doi.org/10.18370/2309-4117.2016.31.80-84

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ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)