PROCENA UČESTALOSTI TROMBOFILIJE KOD ISPITANICA SA GUBITKOM PLODA
Sažetak
Uvod: Pored antifosfolipidnog sindroma (AFLS), nasledna trombofilija predstavlja jedan od najvažnijih hematoloških poremećaja koji mogu da dovedu do komplikacija trudnoće u vidu gubitaka ploda, zaostajanja u rastu i razvoju ploda (IUGR), preeklampsije i fetalne smrti. Učestalost spontanih pobačaja je do 20 % svih klinički prepoznatih trudnoća.
Cilj: Cilj rada je bio da se utvrdi učestalost urođene trombofilije kod ispitanica sa gubitkom ploda, analizira period trudnoće i godine života u kojima je došlo do gubitka ploda, kao i učestalost uspešnih trudnoća nakon profilaktičke primene heparina male molekulske težine (NMH).
Materijal i metode: Istraživanje je dizajnirano kao retrospektivna opservacijska studija u trajanju od 30 meseci na Klinici za ginekologiju i akušerstvo Univerzitetskog kliničkog centra Republike Srpske, kojom je obuhvaćeno 69 ispitanica sa jednim ili više gubitaka ploda u drugom i trećem trimestru trudnoće, ili dva i više ponavljanih gubitaka ploda u prvom trimestru trudnoće. Kod svih ispitanica su urađeni testovi za dokazivanja prisustva trombofilije.
Rezultati: Prosečna starost ispitanica je bila 30,7 godina, sa 167 prethodno neuspešnih trudnoća. Trombofilija je dokazana kod ukupno 40 ispitanica (58%). Rezultati su pokazali da su se kombinovane trombofilije, uključujući i polimorfizme, javljale s najvećom učestalosti od 47,5% (n=19). U grupi ispitanica sa trombofilijom primenjen je NMH kod 22 ispitanice uz uspešan ishod trudnoće kod 19 ispitanica.
Zaključak: Na osnovu sprovedenog istraživanja zaključuje se da kombinovane trombofilije, uključujući i kombinovane polimorfizme MTHFR i PAI-1, nose značajno veći rizik za gubitak trudnoće kod ispitanica svih starosnih grupa. Starost preko 35 godina nosi rizik za veće učestalosti spontanih pobačaja nezavisno od tipa nasledne trombofilije. Primena NMH značajno poboljšava ishode trudnoća kod ispitanica sa urođenom trombofilijom i prethodnim gubicima trudnoće.
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