ALGORITHM FOR THE MANAGEMENT OF PATIENTS WITH GENETIC THROMBOPHILIAS BEFORE AND DURING PREGNANCY. CLINICAL ASSESSMENT OF ITS EFFICIENCY
Objective: to establish and apply an algorithm for the management of patients with genetic thrombophilia, including medical examination, aftercare and comprehensive prevention and also to evaluate its clinical efficiency. Materials and methods. 273 pregnant women with genetic thrombophilia were examined in Donetsk Republic Center of Motherhood and Childhood Protection for the period from 2018 to 2020. The patients were divided into groups where observation and treatment were carried out in accordance with the developed algorithm (main group, n=123) and according to the existing protocol (comparison group, n=150). All patients underwent a detailed collection of personal and family anamnesis, clinical examination, a comprehensive assessment of the course of pregnancy, childbirth, the postpartum period, and the condition of newborns. In addition to general clinical, clinical-anamnestic and statistical methods, modern highly informative instrumental and laboratory methods were used. The algorithm of step-by-step management of patients with genetic thrombophilia has been developed and implemented: stage I - pre-pregnancy preparation, stage II - prevention and treatment of gestational complications of the entire gestation period and delivery, stage III - prevention of complications of the postpartum (postoperative) periods. Results. The developed and implemented algorithm for the management of pregnant women with genetic thrombophilia made it possible to achieve a statistically significant reduction in the frequency of the threat of termination of pregnancy in the first trimester from 24.7 to 12.5% (p < 0.05), in the second trimester from 35.3 to 8.9% (p < 0.05); structural changes in the placenta from 28.0 to 10.7% (p < 0.05); fetal growth restriction from 42.7 to 3.6% (p < 0.05); fetal distress from 49.3 to 10.7% (p < 0.05); preeclampsia from 66.0 to 21.4% (p < 0.05); antenatal fetal death from 5.3 to 0%; operative delivery from 41.8 to 21.8% (p < 0.05); thromboembolic complications from 7.3 to 0% (p < 0.05). Conclusions. The application of the developed algorithm based on an individual differentiated approach to the use of antithrombotic drugs, taking into account the type and variant of genetic thrombophilia, with the presence of additional factors potentiating the clinical effects of thrombophilia, and the obtained data from laboratory and functional studies made it possible to achieve a statistically significant reduction in gestational losses.