Pregnancy complications in G20210A mutation carriers associated with high prothrombin activity.

OBJECTIVE: To study the association between high activity of Factor II (prothrombin) in blood plasma with G20210A mutation and the development of great obstetrical syndromes. MATERIAL AND METHODS: A prospective clinical cohort study was conducted on 290 pregnant women (average age 31.7 ± 4.7 years old). The main group was made up of 140 G20210A patients, while the control group comprised 150 women with the wild G20210G type. The aim was to evaluate the activity of Factor II in the venous blood plasma during the stages of pregnancy with regard to trophoblast invasion waves. As per results, association analysis of Factor II activity value and gestational complications was carried out. RESULTS: In the control group, the median (Me) of Factor II activity ranged from 108% (preconception period) to 144% (pregnancy) [95% CI 130-150]. In patients with the GA type, the value was significantly higher in related periods, ranging from 149 to 181% [95% CI 142-195], p < 0.0001. With Factor II activity ranging from 148.5 to 180.6%, pregnancies in the main group had no complications. Higher levels of Factor II activity were associated with the development of early and/or severe preeclampsia (PE) and fetal growth retardation (FGR). CONCLUSION: The data obtained regarding Factor II activity in blood plasma, juxtaposed with the development of great obstetrical syndromes, allow to assume that manifestation of G20210A in early and/or severe PE and FGR is associated with this coagulation factor's level of activity. Threshold value of the Factor II activity with G20210A mutation, allowing to predict the development of PE, comprised 171.0% at the preconception stage (AUC - 0.86; p < 0.0001) and within 7-8 weeks of gestation it was 181.3% (AUC - 0.84; p < 0.0001).

Detection of microparticles of leukocytic origin in the peripheral blood in normal pregnancy and preeclampsia.

Microparticles are microvesicles forming during cell activation and as a result of apoptotic cell death. Normal pregnancy is associated with apoptosis induction in active immune system cells, present in the decidual tissue. Preeclampsia is associated with activation of the peripheral blood leukocytes and more intense apoptosis of the trophoblast cells. As a result, the number of microparticles in the peripheral blood is changing in normal gestation and in preeclampsia. The content of the leukocytic microparticles in the peripheral blood is evaluated in normal pregnancy and preeclampsia. The content of neutrophilic and monocytic microparticles is higher than normally in preeclampsia, this indicating activation of these cells. The number of microparticles formed by NK cells is low in preeclampsia, which can reflect the incompetence of immunological tolerance mechanisms under these conditions.

[Prophylaxis of coagulopathic bleeding in pregnant patient of high-risk during delivery].

A clinic, laboratory and Doppler ultrasound study including women with a high risk of coagulopathic bleeding in delivery was carried out. When indicated, a coagulopathic bleeding prophylaxis was performed with administration of the tranexamic acid or with autotransfusion of the pre-stored fresh frozen plasma. Also, a reinfusion of washed red blood cells was performed using a Cell Saver. It was found out that the infusion of tranexamic acid during surgical delivery in severe gestosis patients has significantly reduced the intraoperative blood loss and prevented the coagulopathic bleeding. Autotransfusion of plasma has favoured the recovery of blood clotting potential during and after the delivery. The obtained data have shown the safety of preparing the auto-plasma for both pregnant and foetus. The results of study prove the possibility of reducing the use of donor blood components with the aid of modern blood-saving technologies.

Clinical and laboratory manifestations of the prothrombin gene mutation in women of reproductive age.

RESEARCH OBJECTIVE: To research the association of prothrombin (factor II) activity given the prothrombin G20210A mutation carriage with its clinical manifestations as thrombotic complications. MATERIALS AND METHODS: A prospective clinical cohort study of 290 women of reproductive age was conducted. Two cohort groups were identified: the study group of 140 patients with prothrombin mutation G20210A genotype and the control group of 150 women with G20210G genotype. RESULTS: The prothrombin G20210A mutation carriage is associated with the risk of thrombotic complications compared to the wild G20210G type (RR =17.1; p<0.0001) and is characterized by thrombosis localized both in the venous (66.7%) and arterial (33.3%) vascular pools. The threshold value of prothrombin activity (174.8%) for G20210A genotype was calculated, making it possible to conclusively predict the risk of thrombotic events with the accuracy of 90.4%. CONCLUSION: The phenotypic manifestation of the prothrombin G20210A mutation in the form of venous and arterial thromboses in women of reproductive age is associated with a super-threshold increase in prothrombin (factor II) activity, which makes it possible to stratify the patients into the group of high risk of thromboses.