CHANGES IN HEMODYNAMIC INDICATORS IN WOMEN WITH THREATENED ABORTION AGAINST ENDOTHELIAL DYSFUNCTION

Abstract

Miscarriage accounts for 20–25% of all pregnancies, and there is no tendency to decrease the level of this problem. The pathogenesis of early pregnancy loss includes the activation of the hemostasis system and is usually realized due to the pathology of the vascular endothelium, the development of placental infarctions, which is manifested by symptoms of detachment of the trophoblast or chorion. According to researchers, 80% of patients with early pregnancy loss have hemostasiological changes that contribute to hypercoagulation. Detection of such changes of women with a history of spontaneous abortion can serve as predictors of a possible threat of spontaneous abortion and help in the implementation of preventive measures aimed at preserving the desired pregnancy. The aim of the work was to assess changes in hemodynamic indicators in women with threatened abortion against the background of endothelial dysfunction. Materials and methods. We examined 2 groups of women. The first (main) group consisted of 60 women with miscarriage who were undergoing inpatient treatment in the gynecological department of the Chernivtsi Regional Perinatal Center in the period from 2021–2022. The control group included 30 patients with uncomplicated pregnancies in the period of 6–12 weeks of gestation. Previously we established a reliable increase in the concentration of endothelin-1 by 3–5 times and a decrease in the level of nitric oxide by 1.7–2 times and E-selectin by 1.3–1.6 in women of the main group. These indicators served as one of the criteria for inclusion in the study and indicated the ED in patients of the main group. Results. We found that women with a threat of miscarriage have a tendency to decrease the number of platelets. Analysis of the platelet aggregation activity of patients with a threat of early termination of pregnancy revealed a small but significant increase in platelet aggregation compared to the indicator during a physiological pregnancy. In the representatives of group I, platelet diameter, perimeter and, accordingly, all derived indicators – perimeter, area and volume – were characterized by similar changes. of the studied cells significantly exceeded the corresponding values in the control group. Identified disorders in the hemostasis system indicated an increase in blood coagulation potential (hypercoagulation). Conclusions. The development of endothelial dysfunction, changes in the morphometric parameters of circulating platelets and coagulogram indicators cause a pathological decrease in peripheral vascular resistance in the uterine, spiral and radial arteries, which together significantly worsens the prognosis for early pregnancy.