Pathogenetic background of occurrence of venous thromboembolic complications in women with antenatal fetal death

Abstract

Improving the quality of medical services provided to pregnant women remains an urgent issue in modern obstetrics. Women with perinatal losses, especially in the second half of pregnancy, deserve special attention, mainly in connection with an increased incidence of thromboembolic complications.

Aim: The aim is to search for coagulation predictors of antenatal fetal death, to determine the main indicators of hemostasis and correlation between the case of antenatal fetal death and the risk of thromboembolic complications.

Materials and methods: According to the goal, we examined 54 pregnant women with antenatal fetal death. Control group included 30 healthy primigravida women Comparative characteristics of the state of the hemostatic system during pregnancy and childbirth in the case of antenatal fetal death and during physiological pregnancy were conducted. Evaluation of the hemostatic system was performed before delivery and in the postpartum period with a dead fetus. The condition of the vessels of the pelvic organs was determined by dopplerometry of the internal iliac, uterine and ovarian veins.

Results: The assessment of the hemostatic system parameters in the second group of pregnant women in 65% revealed a tendency to hypercoagulation, which manifested itself much earlier than in physiological pregnancy.

Conclusions: Antenatal fetal death is a trigger for activation of coagulation and formation of blood clots, and, accordingly, is a factor of the occurrence of thrombotic exacerbations in the perinatal period. In pregnant women with antenatal fetal death, it is necessary to determine the soluble fibrinogen monomer complex and D-dimer parameters, which most informatively indicate the degree of intravascular coagulation. In pregnant women at high risk of antenatal fetal death at the stage of antenatal clinic should be performed duplex scanning of the pelvic veins with the determination of average blood flow velocity, cross-section diameter, cross-section area indicators and the calculation of volumetric blood flow velocity, and if there are changes venous thromboembolism prevention should be provided.

Keywords: D-dimer; dead fetus; pelvic veins; thromboprophylaxis.