Features of the hemostasis procoagulation link, pregnancy outcomes and parturition in HIV-infected women

Abstract

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.