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ÑÒÎÏ èññëåäîâàíèÿì ãåìîñòàçà (Ä-äèìåðà) ïðè íîðìàëüíî ïðîòåêàþùåé áåðåìåííîñòè!
Ïîâûøåíèå Ä-äèìåðà âî âðåìÿ áåðåìåííîñòè - íîðìàëüíûé ôèçèîëîãè÷åñêèé ïðîöåññ, îòðàæàþùèé àêòèâàöèþ ñèñòåìû ãåìîñòàçà ïðè áåðåìåííîñòè, íàïðàâëåííûé íà áûñòðîå ïðåêðàùåíèå ïîñëåðîäîâîãî êðîâîòå÷åíèÿ, è ó çäîðîâûõ áåðåìåííûõ óðîâåíü Ä-äèìåðà ìîæåò äîñòèãàòü 1400-1700 íã/ìë íà ñðîêå äî 28 íåäåëü è äî 3000 íã/ìë ìåæäó 29-42 íåäåëÿìè áåðåìåííîñòè. Ïîýòîìó, åñëè áåðåìåííîñòü ïðîòåêàåò íîðìàëüíî, Ä-äèìåð áåññìûñëåííî ìåðÿòü âî âðåìÿ áåðåìåííîñòè (à ðàâíî ÐÊÌÔ è äð. ïîêàçàòåëè êîàãóëîãðàììû) è òåì áîëåå ïûòàòüñÿ êîððåêòèðîâàòü åãî óêîëàìè ôðàêñèïàðèíà èëè äð. ÍÌÃ, ñóëîäåêñèäîì, àñïèðèíîì, êóðàíòèëîì, âîáåíçèìîì è äð. òàáëåòêàìè.
îòðûâêè èç íèæåïðèâåäåííîé ñòàòüè ïîêàçûâàþò, ÷òî íàçíà÷åíèå íèçêîìîëåêóëÿðíîãî ãåïàðèíà ó áåðåìåííûõ æåíùèí ñ òðîìáîôèëèåé íå ïðåïÿòñòâóåò ðîñòó Ä-äèìåðà è äð. ïîêàçàòåëåé àêòèâàöèè ñâåðòûâàíèÿ ïî ñðàâíåíèþ ñ êîíòðîëåì: ...patients at high risk of pregnancy complications with confirmed thrombophilia are randomized to receive either dalteparin (5,000 units/day until 20 weeks then 5,000 units q12h until 37 weeks or onset of labor) or no treatment... dalteparin had no significant effects on the levels of thrombin-antithrombin complexes (TAT), prothrombin fragments 1 + 2 and D-dimer throughout pregnancy in thrombophilic women. The effect of dalteparin on coagulation activation during pregnancy in women with thrombophilia. A randomized trial. Abou-Nassar K, Kovacs MJ, Kahn SR, Wells P, Doucette S, Ramsay T, Clement AM, Khurana R, Mackinnon K, Blostein M, Solymoss S, Kingdom J, Sermer M, Rey E, Rodger M; TIPPS investigators. Thromb Haemost. 2007 Jul;98(1):163-71.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#2
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Íîðìû êîàãóëÿöèîííûõ ïàðàìåòðîâ ó áåðåìåííûõ
"×àñòî âîçíèêàåò âîïðîñ – ïî÷åìó íåëüçÿ ïîëüçîâàòüñÿ ó áåðåìåííûõ ïàðàìåòðàìè êîàãóëîãðàììû äëÿ íåáåðåìåííûõ æåíùèí?
Áåðåìåííîñòü ñîïðîâîæäàåòñÿ âûðàæåííûìè èçìåíåíèÿìè â ïîêàçàòåëÿõ ãåìîñòàçà. Ïðè íîðìàëüíîé áåðåìåííîñòè ñîäåðæàíèå ôèáðèíîãåíà ïîâûøàåòñÿ âäâîå, êîíöåíòðàöèÿ ðÿäà ôàêòîðîâ ñâåðòûâàíèÿ, òàêèõ êàê VII, VIII, IX, X, è XII ïîâûøàåòñÿ íà 200-1000% îò èñõîäíûõ çíà÷åíèé. Òàêæå îòìå÷àåòñÿ çíà÷èòåëüíîå ïîâûøåíèÿ óðîâíÿ ðàñòâîðèìûõ êîìïëåêñîâ ôèáðèíà è Ä-äèìåðà, ïðè÷åì ó 25% çäîðîâûõ áåðåìåííûõ òàêîå ïîâûøåíèå ìîæåò èìåòü ìåñòî óæå â ïåðâîì òðèìåñòðå.  òîæå âðåìÿ, åñòåñòâåííàÿ àíòèêîàãóëÿíòíàÿ àêòèâíîñòü ñíèæàåòñÿ, òàê óðîâåíü ïðîòåèíà S ìîæåò ñíèæàòüñÿ â òðè ðàçà îò èñõîäíûõ ïîêàçàòåëåé." http://www.forums.rusmedserv.com/sho...21&postcount=3
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#3
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Ðåòðîñïåêòèâíûé àíàëèç èç Õåëüñèíêè ïîêàçûâàåò, ÷òî íàçíà÷åíèå íèçêîìîëåêóëÿðíûõ ãåïàðèíîâ (ôðàêñèïàðèíà è òï.) âî âðåìÿ áåðåìåííîñòè íå óìåíüøàåò íè ðèñê ïðåæäåâðåìåííûõ ðîäîâ, íè ìåðòâîðîæäåíèÿ, íè çàäåðæêè âíóòðèóòðîáíîãî ðàçâèòèÿ, íè ïðåýêëàìïñèè, â ïîëòîðà ðàçà ïîâûøàåò ÷àñòîòó àíòåíàòàëüíîãî êðîâîòå÷åíèÿ - ïîýòîìó äàííûå ïðåïàðàòû äîëæíû íàçíà÷àòüñÿ òîëüêî ïî ïîêàçàíèÿì (ëå÷åíèå-ïðîôèëàêòèêà òðîìáîçà, ïðèâû÷íîå íåâûíàøèâàíèå ïðè ÀÔÑ), à íå äëÿ óëó÷øåíèÿ êðîâîòîêà â ïëàöåíòå, ðàçæèæåíèÿ ãóñòîé êðîâè ïðè áåðåìåííîñòè, ñíèæåíèÿ Ä-äèìåðà, ÐÊÌÔ è òï.
648 pregnancies exposed to LMWH were compared with 626 unexposed pregnancies. The incidence rates of various pregnancy complications did not differ between the groups (LMWH group vs control group): 1.56% vs 1.1% for thrombocytopenia, 8.7% vs 6.5% for preterm delivery, 0.7% vs 0.3% for stillbirth, 1.4% vs 1.0% for severe pre-eclampsia, 2.7% vs 2.2% for foetal growth restriction, and 10.7% vs 7.8% for antenatal bleeding. --- Galambosi PJ, Kaaja RJ, Stefanovic V, Ulander VM. Safety of low-molecular-weight heparin during pregnancy: a retrospective controlled cohort study. Eur J Obstet Gynecol Reprod Biol. 2012 Aug;163(2):154-9.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#4
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Ïîâûøåíèå Ä-äèìåðà âî âðåìÿ íîðìàëüíîé áåðåìåííîñòè áîëåå âûðàæåíî ïðè ìíîãîïëîäíîé áåðåìåííîñòè:
The d-dimer levels (μg/ml, mean±SD [number of specimens]) determined at the 1st trimester did not differ significantly (0.81±0.82 [102] for singleton vs. 1.20±0.77 [7] for multifetal), but those at the 2nd (1.61±1.45 [216] vs. 2.62±2.26 [59]) and 3rd (2.37±2.22 [659] vs. 4.02±2.14 [46]) trimesters were significantly higher in women with multifetal than singleton pregnancies. --- Thromb Res. 2013 Jun;131(6):493-6. Difference in the D-dimer rise between women with singleton and multifetal pregnancies.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#5
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 Ìàêåäîíèè òîæå ëåä òðîíóëñÿ:
260 pregnant women were admitted in Outpatient department in the first 3 months in 2012 year. The values of D-D show those results: In the first trimester in 34 women values of D-D was until 1316 ng/mL. In second trimester 107 women had D-D values until 2369 ng/mL. In last trimester in 167 women values was until 3122 ng/mL. All those women have born healthy child. Summary/Conclusions: Range of D-D not correlates with pregnancy problems. D-Dimers and pregnancy. J Thromb Haemost. 2013; 11 (Suppl 2):1102.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#6
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Íîðìàëüíûé óðîâåíü Ä-äèìåðà íàáëþäàåòñÿ ó æåíùèí äî ÝÊÎ âíå çàâèñèìîñòè îò èñõîäà è ïîâûøàåòñÿ ó âñåõ îäèíàêîâî ïîñëå ñòèìóëÿöèè - íåò ñìûñëà åãî ìåðÿòü è åãî "ëå÷èòü" âî âðåìÿ äàííîé ïðîöåäóðû:
J Ovarian Res. 2014 May 22;7:58. Plasma concentrations of D-dimer and outcome of in vitro fertilization. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |