The thesis contains a new approach to solving the current task of modern obstetrics - improving the quality of life and reducing the rates of obstetric and perinatal complications in women with thrombocytopenia.
According to clinical statistical analysis, the general trend is the decrease the number of platelets during pregnancy, with a minimum number during the delivery period and a further increase in the postpartum period. Not the only clinical manifestation of thrombocytopenia can be the presence of a hemorrhagic syndrome.
According to the data obtained, it was concluded that a high and very high level of aggressiveness was observed in all pregnant women who had a severe course of ITP.
The study of the level of anxiety showed that in the majority of pregnant women with HT, a moderate level of anxiety has a protective function, taking into account the satisfactory condition of women. A high level of anxiety in women with a severe course of ITP indicates an unstable psycho-emotional state of pregnant women of this group.
The presence of a chronic somatic disease in a pregnant woman causes significant challenges during pregnancy. These include: optimizing health-promoting behaviors, medication adherence, maintaining a healthy diet, regular physical activity, and improving weight control. The abovementioned can improve outcomes associated with chronic diseases.
According to our study, in pregnant women with ITP of mild and moderate severity, suppression of spontaneous aggregation of platelets induced by ADP and adrenaline and absence of aggregation with acetylsalicylic acid was observed. Absence of spontaneous aggregation of platelets was observed in the studied pregnant women with severe ITP. Regarding indicators of induced aggregation, it is important that AK-induced and adrenaline-induced aggregation is practically absent. Collagen-induced aggregation is also significantly suppressed.
According to the study results, light transmission during spontaneous and induced platelet aggregation in pregnant women with HT showed an adequate response to inducers of platelet aggregation, which correlates with the absence of hemorrhagic complications and the need for special treatment (r = 0.7). In contrast to the indicators with HT, in pregnant women with immune thrombocytopenia, significantly suppressed or almost absent light transmission during induced aggregation is noted. Hemorrhagic syndrome was observed in all women of this group with severe ITP.
According to the examination data for antiplatelet antibodies, their detection was observed only in 85,6% women with verified ITP. The above proves that the analysis for antiplatelet antibodies is not routine for diagnosis due to insufficient sensitivity and specificity.
The results of the study of uteroplacental blood circulation in pregnant women with gestational thrombocytopenia prove the absence of reliably significant deterioration of the state of uteroplacental blood circulation, In pregnant women with severe ITP, there is a significant increase in the resistance index of the umbilical and uterine arteries, which indicates the presence of placental insufficiency, which, in turn, contributes to the deterioration of the condition of the fetus and newborn.
The results of the microscopic and morphological examination of the placenta indicate significant changes in the structure in the group of women with ITP.
Based on the above mentioned results, it was developed algorithm for the diagnostics and treatment of thrombocytopenia in pregnant women. According to the results of the evaluation of the effectiveness of the system developed by us, it has been reliably proven that an ordered sequence of treatment stages depending on the gestation period and clinical manifestations, with step-by-step control of the effectiveness, allows to avoid the progression of the autoimmune process and the need for premature delivery according to indications from the mother, the fetus or combined, avoid perinatal losses, and also reduce the rate of premature births by 33.8% and the probability of the birth of fetuses in a state of hypoxia by 24.1%.
