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Conducting pregnancy with sensitization to the chorionic gonadotropin
Last reviewed: 23.04.2024
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Glucocorticoid therapy continues with the onset of pregnancy, and the dose is adjusted depending on the specific clinical picture. As a rule, in terms of increasing antibody levels in 20-24, 33-34 weeks of pregnancy, it is advisable to increase the dose of prednisolone by 2.5-5 mg. This provides a reduction in the levels of thrombophilic complications.
Antithrombotic therapy was already directed in the first trimester to stop hypercoagulation in the plasma link of hemostasis and chronic DVS-syndrome. In this case, prolonged subcutaneous administration of heparin or LMWH (fractiparin or fragmine) is more effective than intravenous fractional administration of heparin. In this case, control of hemostasis is often necessary, weekly, due to the large variability of hemostatic parameters. The remaining issues of the tactics of conducting: prevention of the activation of a viral infection, placental insufficiency is carried out in a similar way as it is recommended for patients with antiphospholipid syndrome.
Extremely interesting is the question of how the level of chorionic gonadotropin changes in autosensitization to the chorionic gonadotropin.
A high activity of lymphocyte cells at d level was established . basalis. On the other hand, the normal level of chorionic gonadotropin can be explained by the sharp increase in the number of free symplasts that represent the scrotal areas of the syncytiotrophoblast that enter the intervillum space, and then into the blood-tight system of the mother's lungs, where at the level of small venules their destruction occurs. With electron microscopic examination, the symplasts in large numbers "split off" from the surface of the syncytiotrophoblast. In addition, they contained 10-15 cores, which is 2 times more than during physiological pregnancy, and were surrounded by a network of microvilli.
The shape of the symplasts was unusually elongated, sometimes bulbous, in the structure of the symplasts there were found reticular structures, which is extremely rare in normal pregnancy. These data indicate the intensive export of proteins and hormones of pregnancy into the bloodstream of the mother, which allows us to view these results as a compensatory reaction of syncytiotrophoblast to the binding of the chorionic gonadotropin with antibodies.
In the postpartum period, thrombophilic complications with sensitization to the chorionic gonadotropin are practically not observed, therefore, hemostasis control is not required. Gradually reduce the level of glucocorticoids in 3-4 days, if the dose was above 10 mg and 2-3 days at a lower dosage.
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