Prevention and prediction of the development of placenta-associated complications in a patient with aggravated thrombotic and obstetric anamnesis (clinical case)




pregnancy, genetic polymorphisms, thrombophilia, preeclampsia, prognostication, angiogenic growth factors, antiangiogenic growth factors


Purpose - to analyze the effectiveness of the timely appointment of pathogenetically justified secondary prevention in a patient with a burdened thrombotic and obstetric anamnesis based on the assessment of the course of pregnancy and the postpartum period in this woman.

Clinical case. A woman with fetal loss syndrome and recurrent venous thrombosis applied for a consultation to plan pregnancy. The examination revealed a homozygous polymorphism of the F2-prothrombin gene (-20210 G>A), a decrease in protein S activity to the level of 35%, which indicated an extremely high risk of thromboembolic complications. Pregnancy occurred on the background of anticoagulant therapy in combination with pregravid cofactor vitamin therapy. During pregnancy, the patient received low molecular weight heparins in therapeutic doses in combination with acetylsalicylic acid at a dose of 150 mg per day, diosmin 600 mg and cofactor vitamin therapy. According to the results of combined screening in the I trimester, with the calculation of the risks of preeclampsia, the woman was classified as a high risk group for its development. At 23-24 and 32-33 weeks of gestation, an analysis was performed to calculate the risk of perinatal complications in the II-III trimesters by determining the ratio of water-soluble tyrosine kinase-1 / placental growth factor (Sflt-1/PlGF). The data obtained indicated that the preventive therapy prescribed to the patient was adequate and effective. The pregnancy was completed at the full 37 weeks of gestation by spontaneous delivery in cephalic presentation without complications. A boy was born weighing 2950 g, Apgar score - 7/8.

Conclusions. The clinical case is a vivid example of how well-timed, adequate prophylactic therapy can work efficiently and effectively, even in women with a rather burdensome thrombotic and obstetric history. This case confirms the necessity and expediency of using the entire modern diagnostic arsenal that exists in Ukraine to predict the occurrence of «Great» obstetric syndromes, which to this day occupy one of the leading places in the structure of maternal and perinatal losses.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.


Arya R. (2011). How I manage venous thromboembolism in pregnancy. British journal of haematology. 153 (6): 698-708.; PMid:21501137

Duka IuM. (2018). Henetychni polimorfizmy ta systema hemostaza u zhinok iz zahrozoiu nevynoshuvannia vahitnosti zalezhno vid masy tila. Z turbotoiu pro Zhinku. 87 (3): 11-12.

Duka YuM. (2016). Patohenetychne obhruntuvannia diahnostyky, likuvalnoi taktyky ta profilaktyky vynyknennia systemnykh porushen u vahitnykh zhinok z nadmirnoiu masoiu tila. Thesis. Repozytarii DDMU. URL:Дука.pdf.

Duka YuM. (2017). Henetychni polimorfizmy ta systema hemostaza u zhinok iz zahrozoiu nevynoshuvannia vahitnosti zalezhno vid masy tila. Z turbotoiu pro Zhinku. 82 (7): 7-8.

Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ. (2005). Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Annals of internal medicine. 143 (10): 697-706.; PMid:16287790

James AH. (2009). Pregnancy-associated thrombosis. Hematology. American Society of Hematology. Education Program. 1: 277-285.; PMid:20008211

Loskutova TO, Demchenko TV, Kryachkova NV. (2020). Gene polymorphism of blood coagulation factors and endothelial dysfunction in early and late preeclampsia. Medicni perspektivi (Medical perspectives). 25 (2): 66-71.

Robertson L, Wu O, Langhorne P, Twaddle S, Clark P, Lowe GD et al. (2006). Thrombophilia in pregnancy: a systematic review. British journal of haematology. 132 (2): 171-196.; PMid:16398652

Royal College of Obstetricians and Gynaecologists. (2015, April). Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium. Green-top Guideline: 37a: 40.

Van Oppenraaij RH, Jauniaux E, Christiansen OB, Horcajadas JA, Farquharson RG et al. (2009). Predicting adverse obstetric outcome after early pregnancy events and complications: a review. Human reproduction update. 15 (4): 409-421.; PMid:19270317

Vasylieva IA. (2019). Ryzyky ta profilaktyka venoznykh tromboziv ta koahuliatsiinykh rozladiv pid chas vahitnosti, polohiv ta pisliapolohovoho periodu u zhinok iz nabutoiu abo vrodzhenoiu trombofiliieiu. Z turbotoiu pro Zhinku. 95: 2.

Villalaín C, Herraiz I, Valle L, Mendoza M, Delgado JL, Vázquez-Fernández M et al. (2020). Maternal and Perinatal Outcomes Associated With Extremely High Values for the sFlt-1 (Soluble fms-Like Tyrosine Kinase 1) / PLGF (Placental Growth Factor) Ratio. Journal of the American Heart Association. 9 (7): e015548.; PMid:32248765 PMCid:PMC7428600