The objective: to study the changes in the procoagulant link of the hemostasis system, the course of pregnancy and parturition peculiarities in HIV-infected women, depending on the clinical stage and the onset of haart. Materials and methods. In 150 HIV-infected pregnant women and parturients, a procoagulant link of hemostasis was evaluated by meanings of total fibrinogen, prothrombin, activated fractional thromboplastin time, as well as the status of the mother-placenta-fetus system and periportal blood loss amount. Results. Study of the procoagulant link in women with II and III clinical stages of HIV-infection in the second trimester showed a tendency to a hypercoagulative conditions, with increased levels of fibrinogen, prothrombin and short activated fractional thromboplastin time. In the third trimester, these patients already had a significant difference in these parameters compared to the control group (p<0.05). Laboratory changes in the 3rd trimester correlate with impairment of the «mother–placenta–fetus» system discovered by ultrasound and doplerometry in the vast majority of pregnant women with II and III clinical stages (p<0.05). A state of hypocoagulation is observed during parturirion in women with the III clinical stage of HIV-infection and in parturients who started taking HAART during this pregnancy (p<0.05). Conclusions. The pregnancy course in women with II and III clinical stages of HIV-infection is characterized by the presence of gestational and perinatal complications caused by hypercoagulation. During parturirion in HIV-infected patients with the III clinical stage and in parturients who started taking HAART during this pregnancy, there is a tendency to periportal haemorrages, which confirmes by coagulogram changes. Key words: HIV-infected pregnant women, HIV-infected parturient, procoagulant link of hemostasis system, mother-placenta-fetus system, periportal blood loss.
The objective: was to determine the peculiarities of gestation, childbirth and the newborns state in HIV-infected women. Materials and methods. A retrospective analysis of 1050 medical cards of HIV-positive pregnant women and their newborns and 85 women without HIV during 2012-2015 years was conducted. Results. CD4+ concentration and viral load indicate effective antiretroviral therapy in most patients. The most often complication of gestation in women with HIV is placental dysfunction. Such a threatening complication as placental abruption was observed in 37 (3.5±0.56%) HIV-infected pregnant women and in 12 (1.4±0.4%) control women. Fetal distress was found in 109 (10.4±0.94%) patients of main group versus 16 (1.9±0.46%) control women (p<0.05). A higher blood loss rate during labour and caesarean section in HIV-infected women with long-term high-level antiretroviral therapy was noted. The maladaptive syndromes in early neonatal period were identified in newborns from HIV-infected women. The decompensation of placental insufficiency with critical circulation disorders plays a significant role among the causes of perinatal mortality in this newborns. Conclusions. The gestation process in pregnant women with HIV-infection is characterized by the greater frequency of perinatal complications and threatening conditions for both - the mother and the fetus. The current theory about the effects of HIV on the hemostasis system justifies the importance of studying the rheological status and the function of endothelium in HIV-infected pregnant women for timely diagnosis, treatment and prevention of obstetric and perinatal complications. Key words: HIV-infected pregnant women, pregnancy course, childbirth, mother–placenta–fetal system, perinatal consequences.
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