medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-015medsovet-7461Research ArticleПРЕГРАВИДАРНАЯ ПОДГОТОВКА И БЕРЕМЕННОСТЬPREGRAVID PREPARATION AND PREGNANCYВарианты поражения систем и органов у пациенток при различных подтипах тромботической микроангиопатии в акушерской практикеVariants of system and organ damage in patients with various thrombotic microangiopathy subtypes in obstetric practicehttps://orcid.org/0000-0003-0362-580XБалакиреваА. И.BalakirevaA. I.

Балакирева Алина Игоревна, заведующая отделением специализированной медицинской помощи, 

119991, Москва, ул. Ломоносовский проспект, д. 27, корп. 10

Alina I. Balakireva, Head of Department of Specialized Medical Care,

27, Bldg. 10, Lomonosovsky Ave, Moscow, 119991

koluvanova@gmail.comhttps://orcid.org/0000-0002-6125-590XКирсановаТ. В.KirsanovaT. V.

Кирсанова Татьяна Валерьевна, к.м.н., ведущий научный сотрудник Института анестезиологии-реаниматологии и трансфузиологии,

117997, Москва, ул. Академика Опарина, д. 4

Tatiana V. Kirsanova, Cand. Sci. (Med.), Leading Researcher of the Institute of Anesthesiology-Resuscitation and Transfusiology, 

4, Academician Oparin St., Moscow, 117997

a_tatya@mail.ruhttps://orcid.org/0000-0002-7647-3942КрасноваТ. Н.KrasnovaT. N.

Краснова Татьяна Николаевна, к.м.н., ведущий научный сотрудник отдела внутренних болезней,

119991, Москва, ул. Ломоносовский проспект, д. 27, корп. 10

Tatiana N. Krasnova, Cand. Sci. (Med.), Leading Researcher of the Department of Internal Diseases,

27, Bldg. 10, Lomonosovsky Ave, Moscow, 119991

krasnovamgu@yandex.ruhttps://orcid.org/0000-0001-6883-4456ФедороваТ. А.FedorovaT. A.

Федорова Татьяна Анатольевна, д.м.н., профессор, заведующая отделением трансфузиологии и экстракорпоральной гемокоррекции,

117997, Москва, ул. Академика Опарина, д. 4

Tatiana A. Fedorova, Dr. Sci. (Med.), Professor, Head of the Department of Transfusiology and Extracorporeal Hemocorrection, 

4, Academician Oparin St., Moscow, 117997

tfedorova1@mail.ruhttps://orcid.org/0000-0001-8382-9671ПыреговА. В.PyregovA. V.

Пырегов Алексей Викторович, д.м.н., директор Института анестезиологии-реаниматологии и  трансфузиологии, заведующий кафедрой анестезиологии и реаниматологии,

117997, Москва, ул. Академика Опарина, д. 4

Alexey V. Pyregov, Dr. Sci. (Med.), Director of the Institute of Anesthesiology-Resuscitation and Transfusiology, Head of the Department of Anesthesiology and Resuscitation, Gynecology and Perinatology;

4, Academician Oparin St., Moscow, 117997

pyregov@mail.ruМедицинский научно-образовательный центр Московского государственного университета имени М.В. ЛомоносоваРоссияMedical Scientific and Educational Center of Lomonosov Moscow State UniversityRussian FederationНациональный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. КулаковаРоссияKulakov National Medical Research Center of Obstetrics, Gynecology and PerinatologyRussian Federation20232104202305119129Copyright © Балакирева А.И., Кирсанова Т.В., Краснова Т.Н., Федорова Т.А., Пырегов А.В., 20232023Балакирева А.И., Кирсанова Т.В., Краснова Т.Н., Федорова Т.А., Пырегов А.В.Balakireva A.I., Kirsanova T.V., Krasnova T.N., Fedorova T.A., Pyregov A.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7461Введение

Введение. Все варианты тромботической микроангиопатии (ТМА) в акушерской практике имеют разнообразную клиническую картину и могут проявляться поражением различных систем и органов, что зачастую затрудняет или спутывает диагностику, тем самым замедляя старт необходимой терапии.

Цель исследования

Цель исследования. Изучить клинические проявления различных вариантов ТМА в акушерской практике.

Материалы и методы

Материалы и методы. В исследование было включено 313 пациенток, из которых у 71 женщины был установлен диагноз «аГУС», у 124 – «HELLP-синдром», у 70 – «ПЭ» различной степени выраженности, также была выделена группа пациенток с более редкими причинами ТМА: ТТП и сепсисом – 13 пациенток, 35 пациенток без признаков ТМА были включены в контрольную группу. Были оценены и сопоставлены основные клинические, лабораторные и инструментальные данные.

Результаты

Результаты. Было выявлено поражение различных систем и органов при различных вариантах ТМА в акушерской практике. Поражение почек, печени, нервной системы, органа зрения было отмечено у  пациенток с  аГУС, HELLP-синдромом, ТТП, септическими ТМА и ПЭ, тогда как поражение кожи, сердечно-сосудистой системы и легких было выявлено у пациенток из  всех групп, кроме ПЭ. Также у  пациенток из  первых трех групп были выявлены тромботические осложнения мелких и крупных сосудов. Максимальную тяжесть полиорганных проявлений продемонстрировали пациентки с аГУС.

Выводы

Выводы. Тромботическая микроангиопатия в акушерстве носит генерализованный характер, а разнообразные проявления органной дисфункции требуют мультидисциплинарного подхода к таким пациенткам. 

Introduction

Introduction. All thrombotic microangiopathy (TMA) variants in obstetric practice have a diverse clinical presentation and can manifest as various system and organ damage, which often makes it difficult or interfere with the diagnostic assessment, thus slowing down initiation of the necessary therapy.

Aim

Aim. To study the clinical presentations of various TMA variants in obstetric practice.

Materials and methods

Materials and methods. A total of 313 pregnant women were enrolled in the study, of which atypical hemolytic uremic syndrome (aHUS) was diagnosed in 71 women, “HELLP syndrome” in 124 women, and “PE” with varied severity in 70 women. A group of patients with more rare causes of TMA was also identified: TTP and sepsis in 13 patients, and 35 patients without signs of TMA were included in the control group. We assessed and compared the main clinical, laboratory and instrumental findings.

Results

Results. The study identified damage to various systems and organs in various TMA types in obstetric practice. The damage to kidneys, liver, nervous system, visual organs was observed in patients with aHUS, HELLP syndrome, TTP, septic TMA and PE, while the damage to skin, cardiovascular system and lungs was detected in patients from all groups except for PE. Small and large vessel thrombotic complications were detected in patients from the former three groups. The patients with aHUS showed the maximum multisystemic presentation severity.

Conclusions

Conclusions. The thrombotic microangiopathy in obstetrics is generalized in nature, and various symptoms of organ dysfunction require a multidisciplinary approach to such patients. 

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The authors declare that there are no conflicts of interest present.