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P72 Catastrophic antiphospholipid syndrome, genetic and acquired thrombophilia
S160 which in 70% required preterm delivery and were responsible for lower birth weight and Apgar score (p < 0.05). Conclusions: Thrombophilia might be the main pathogenic mechanism of stroke and obstetrics complications. Preconception treatment with LMWH allows preventing pregnancy complications and recurrent thrombosis. P71 Evaluation of the preconception treatment in prevention of recurrent preeclampsia V.O. Bitsadze, Z.K. Gadaeva, S.M. Baimuradova, C. Atabaeva, M. Selkhadzhieva. Department of Obstetrics and Gynecology, Moscow Medical Sechenov academy, Russia Aims: To evaluate the preconception treatment efficiency in women with recurrent preeclampsia. Material and methods: Group I: 56 patients with recurrent preeclampsia and group II: 55 primigravida with preeclampsia were tested to have genetic thrombophilia, antiphospholipid antibodies and elevated homocysteine level. Group I received treatment in preconception period and during pregnancy. The preconception treatment included LMWH, omega-3-acides, vitamins of B group, folic acid. The basic therapy during pregnancy was enoxaparin (from 40 mg in the first trimester to 80 100 mg in the third trimester) guided by D-dimer. In the group II treatment was started after the preeclampsia symptoms development. Results: Thrombophilia was detected in 100% women with 2 and more recurrent preeclamsia, in 93.7% with one previous preeclampsia and in 60% women from the group II. In the group I nobody had moderate or severe form of preeclampsia, mild preeclampsia was observed in 16%. In the group II therapy with LMWH was not effective: 27 patients developed severe and 28 moderate preeclampsia. All patients from the group I were delivered after 37 weeks (50% via c.s.), all babies were alive. In the group II 32.7% patients were delivered prematurely via s.c., and in 34.5% c.s. was performed after 37 weeks of gestation. Babies did not survive in 27.2%. Conclusions: Thrombophilia might be the essential pathogenic mechanism of recurrent preeclampsia. Preconception treatment with LMWH, antioxidants and vitamins allows preventing severe and moderate preeclampsia in 100% cases. Patients with preeclampsia require the early pathogenic therapy in future pregnancies.
Abstracts selected for Poster Presentation Conclusion: CAPS bring together systemic syndromes like APS, DIC and systemic inflammatory response syndrome. Thrombophilia might be an important trigger factor for CAPS by predisposing to procoagulant and proinflammatory state. Coexisting of APS and multigenic thrombophilia represents the most unfavorable condition, which determines a high risk of obstetric complications and CAPS. CAPS might be more frequent than it was previously thought. The development of obstetric complications in patients with APS makes it necessary to suppose presence of the catastrophic variant of this syndrome. LMWH is essential for prophylaxis and treatment of CAPS due to its anticoagulant and anti-inflammatory activities. P73 The genetically determined hyperhomocysteinemia and antenatal fetal death I.N. Talalaeva, V.O. Bitsadze, Z.K. Gadaeva. Department of Obstetrics and Gynecology, I.M. Sechenov Moscow Medical academy, Russia Background: Over recent years it has been increasingly recognized that metionin and homocysteine play potential role in maternal metabolism and associated with fetal abnormalities. Aim: We assessed the roles of folates and homocysteine in the developmental abnormalities and intrauterine fetal death. Materials and Methods: We measured plasma homocysteine levels and genetic forms of thrombophilia (MTHFR C677T, MTRR, 2756 MTS, 1958 G/A MTDD, 1298 A/C MTAC) in 100 married couples with a history of antenatal fetal loss in term 28 39 weeks after 2 12 months after episode of fetal death and in 50 healthy controls received preventive therapy (folates and vitamins group B) before pregnancy. Results: Homocysteine level was high in 86% of mothers with antenatal fetal death in anamnesis, in 84% cases fathers had increased homocysteine and in 96% homocysteine was high in married couple. In 70% of mild hyperhomocysteinemia there were diagnosed fetal abnormalities such as malformation, Down syndrome, neural tube defects andcardiovascular system defects. Conclusions: Genetic hyperhomocysteinemia is associated with the involvement of folate metabolism and homocysteine in developmental abnormalities and in pregnancy complications.
P72 Catastrophic antiphospholipid syndrome, genetic and acquired thrombophilia A.D. Makatsaria, V.O. Bitsadze, S.M. Baimuradova, D.H. Khizroeva, S.V. Akinshina. Department of Obstetrics and Gynecology, I.M. Sechenov Moscow Medical academy, Russia
P74 The role of occult haemorrhagic and thrombophilic disorders of haemostasis in the genesis of massive obstetrical bleeding V.V. Smurygina, A.D. Makatsaria. Department of Obstetrics and Gynecology, Moscow Medical Sechenov Academy, Moscow, Russia
Introduction: The term Catastrophic Antiphospholipid Syndrome (CAPS) is used to define an accelerated form of APS resulting in thrombosis, primarily affecting the microvasculature and frequently leading to multiorgan failure. CAPS is a lifethreatening condition that requires high clinical awareness. Materials and Methods: We examined 17 patients with CAPS. Results: The triggering event for the development of CAPS was severe preeclampsia in 3 patients, HELLP-syndrome in 2 patients and infection (pneumonia, septicaemia) in 4 patients. In 2 of these women multiorgan failure precipitated by severe preeclampsia complicated with placental abruption was fatal despite intensive treatment (anticoagulants LMWH, corticosteroids, plasma exchange). In other 15 cases conducted therapy was successful. Multigenic thrombophilia was identified in 88% cases. Thrombophilia included protrombin gene G20210A mutation (11.7%), MTHFR C677T (29.4%), 4G/5G PAI-1 polimorphism (47%), 455G/A fibrinogen (41.2%), t-PA I/D (23.5%). In all patients we found acute or subacute wavelike disseminated intravascular coagulation syndrome (DIC).
Aim: To study the role and structure of occult blood coagulation disorders in the genesis of massive blood loss in women with history of obstetrical haemorrhage. Materials and Methods: 51 women with a history of massive obstetrical haemorrhage accounting for 1.5% to 5% of the body 72.5%, weight underwent evaluation. Primiparous patients secundiparous 27.5%, and 17.6% out of them had a recurrent in-labour haemorrhage. Fifteen women were observed prospectively, during a repeated pregnancy. Results: 60.7% of the women had a thrombophilia: genetic (55%), acquired (7.8%) or multi-origin one (4%). The diagnosis “genetic thrombophilia” means that women had three and more the homozygous or five and more the heterozygous forms of haemostasis genes polimorphisms, or FV Leiden and prothrombin G20210A mutations. All women with thrombophilic disorders had a different complication during pregnancy, such as preeclampsia, abruptio placentae, fetal growth retardation and others.
Abstracts selected for Poster Presentation Conclusion: CAPS bring together systemic syndromes like APS, DIC and systemic inflammatory response syndrome. Thrombophilia might be an important trigger factor for CAPS by predisposing to procoagulant and proinflammatory state. Coexisting of APS and multigenic thrombophilia represents the most unfavorable condition, which determines a high risk of obstetric complications and CAPS. CAPS might be more frequent than it was previously thought. The development of obstetric complications in patients with APS makes it necessary to suppose presence of the catastrophic variant of this syndrome. LMWH is essential for prophylaxis and treatment of CAPS due to its anticoagulant and anti-inflammatory activities. P73 The genetically determined hyperhomocysteinemia and antenatal fetal death I.N. Talalaeva, V.O. Bitsadze, Z.K. Gadaeva. Department of Obstetrics and Gynecology, I.M. Sechenov Moscow Medical academy, Russia Background: Over recent years it has been increasingly recognized that metionin and homocysteine play potential role in maternal metabolism and associated with fetal abnormalities. Aim: We assessed the roles of folates and homocysteine in the developmental abnormalities and intrauterine fetal death. Materials and Methods: We measured plasma homocysteine levels and genetic forms of thrombophilia (MTHFR C677T, MTRR, 2756 MTS, 1958 G/A MTDD, 1298 A/C MTAC) in 100 married couples with a history of antenatal fetal loss in term 28 39 weeks after 2 12 months after episode of fetal death and in 50 healthy controls received preventive therapy (folates and vitamins group B) before pregnancy. Results: Homocysteine level was high in 86% of mothers with antenatal fetal death in anamnesis, in 84% cases fathers had increased homocysteine and in 96% homocysteine was high in married couple. In 70% of mild hyperhomocysteinemia there were diagnosed fetal abnormalities such as malformation, Down syndrome, neural tube defects andcardiovascular system defects. Conclusions: Genetic hyperhomocysteinemia is associated with the involvement of folate metabolism and homocysteine in developmental abnormalities and in pregnancy complications.
P72 Catastrophic antiphospholipid syndrome, genetic and acquired thrombophilia A.D. Makatsaria, V.O. Bitsadze, S.M. Baimuradova, D.H. Khizroeva, S.V. Akinshina. Department of Obstetrics and Gynecology, I.M. Sechenov Moscow Medical academy, Russia
P74 The role of occult haemorrhagic and thrombophilic disorders of haemostasis in the genesis of massive obstetrical bleeding V.V. Smurygina, A.D. Makatsaria. Department of Obstetrics and Gynecology, Moscow Medical Sechenov Academy, Moscow, Russia
Introduction: The term Catastrophic Antiphospholipid Syndrome (CAPS) is used to define an accelerated form of APS resulting in thrombosis, primarily affecting the microvasculature and frequently leading to multiorgan failure. CAPS is a lifethreatening condition that requires high clinical awareness. Materials and Methods: We examined 17 patients with CAPS. Results: The triggering event for the development of CAPS was severe preeclampsia in 3 patients, HELLP-syndrome in 2 patients and infection (pneumonia, septicaemia) in 4 patients. In 2 of these women multiorgan failure precipitated by severe preeclampsia complicated with placental abruption was fatal despite intensive treatment (anticoagulants LMWH, corticosteroids, plasma exchange). In other 15 cases conducted therapy was successful. Multigenic thrombophilia was identified in 88% cases. Thrombophilia included protrombin gene G20210A mutation (11.7%), MTHFR C677T (29.4%), 4G/5G PAI-1 polimorphism (47%), 455G/A fibrinogen (41.2%), t-PA I/D (23.5%). In all patients we found acute or subacute wavelike disseminated intravascular coagulation syndrome (DIC).
Aim: To study the role and structure of occult blood coagulation disorders in the genesis of massive blood loss in women with history of obstetrical haemorrhage. Materials and Methods: 51 women with a history of massive obstetrical haemorrhage accounting for 1.5% to 5% of the body 72.5%, weight underwent evaluation. Primiparous patients secundiparous 27.5%, and 17.6% out of them had a recurrent in-labour haemorrhage. Fifteen women were observed prospectively, during a repeated pregnancy. Results: 60.7% of the women had a thrombophilia: genetic (55%), acquired (7.8%) or multi-origin one (4%). The diagnosis “genetic thrombophilia” means that women had three and more the homozygous or five and more the heterozygous forms of haemostasis genes polimorphisms, or FV Leiden and prothrombin G20210A mutations. All women with thrombophilic disorders had a different complication during pregnancy, such as preeclampsia, abruptio placentae, fetal growth retardation and others.