Zagorodnya O. The new aspects of pathogenesis and prognostication of placental abruption

Placental abruption is a severe complication of pregnancy, one of most frequent causes of maternal hemorrhage, perinatal mortality and morbidity. Plentity of investigations devoted to problem are not enough to explain either reason of it's development, or ways of prevention. The possibility of urgent delivery allows to increase the neonatal surviving and to reduce the level of maternal invalidisation. The role of trombopfilias, first of all it's most frequent form - antyphospholipid syndrome, in pathogenesis of pretem placental abruption and other gestational complications is considered. It is confirmed by a strong correlation between placental abruption, severe preeclampsia, syndrome of fetal growth restriction and subclinical manifestation of trombopfilia, such as pathology of cardiac valves without haemodynamic disorders, subcutaneous veins' dilatation, thyreoid hyperplasia with normal function, migraine etc. The syndrome of fetal loss, that also can be caused by local haemostasis disorders, ispointed on in history of more half women with these complications. Pregnancy interruption in early terms had place in all groups of trombophilia associated complications. The stillbirth after 22 weeks of pregnancy is a specific sign of women with placental abruption. This can be used for estimating of pregnancy risk in cases of usual fetal loss. Increased frequency of vaginal bleeding during present pregnancy among women with placental abruption is a sign of chronic kind of placental changes predicting pathology. The peculiarity of histological structure of placentas, gotten from women with preterm placental abruption, other trombophilia associated gestational complications and women with uncomplicated outcome of pregnancy and different ways of delivery are considered. Preterm abrupted placentas have been studied in three zones - zone of abruption, unchanged zone and limiting them zone. Placental microcirculation disorders, compensation and dystrophic disorders, their expansion in different regions of maternal and fetal parts are discovered. Hemorrhages in intervillous space, diffusive thrombosis, excessive cyprinoids masses are peculiar to trombophilia and found in all groups of complicated pregnancy. Except them, in preterm abrupted placentas hemorrhages in decidua and thrombosis of spiral arteries is exposed. Described disorders are disseminated and present all studies of microcirculation disturbance from new hemorrhage to atypical located fybrinoid accumulation. These changes of ultrastructure indicate the main role of endothelial dysfunction in pathogenesis of preterm placental abruption and chronic origin of pathological process. The trustworthy raising of level of antiphospholipid immunoglobulines of various classes and subtypes by observed pregnancy complications is discovered. Quantity of found antibodies subtypes correlates with the dissemination of typical for placental abruption histological changes. The increased concentration of Ig M to phosphatidilethanolamin occurs among patients with placental abruption 7-times more often, then among healthy women and women with other gestation pathology. This serological sign has a strong correlative tie with the diffusion of decidual hemorrhage and spiral arteries thrombosis. Circulation of Ig M to phosphatitdilethanolamin in pregnant with clinical manifestation of antiphospholipid syndrome can be used as a placental abruption prognosticative criterion. Key words: placental abruption, antiphospholipid antibodies, prognostication, thrombophilias.