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Management of pregnancy with chorionic gonadotropin sensitization
Last reviewed: 08.07.2025
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Glucocorticoid therapy continues with the onset of pregnancy, and the doses are adjusted depending on the specific clinical picture. As a rule, during periods of increasing antibody levels at 20-24, 33-34 weeks of pregnancy, it is advisable to increase the dose of prednisolone by 2.5-5 mg. This ensures a decrease in the levels of thrombophilic complications.
Antithrombotic therapy is aimed already in the first trimester at stopping hypercoagulation in the plasma link of hemostasis and chronic DIC syndrome. At the same time, long-term subcutaneous administration of heparin or LMWH (fraxiparin or fragmin) is more effective than intravenous fractional administration of heparin. At the same time, hemostasis monitoring should be carried out frequently, weekly, due to the high variability of hemostasis parameters. Other issues of management tactics: prevention of activation of viral infection, placental insufficiency is carried out similarly to how it is recommended for patients with antiphospholipid syndrome.
An extremely interesting question is how the level of human chorionic gonadotropin changes during autosensitization to human chorionic gonadotropin.
High activity of lymphocyte cells at the level of d. basalis was established. On the other hand, the normal level of chorionic gonadotropin can be explained by a sharp increase in the number of free symplasts, which are detached sections of the syncytiotrophoblast that enter the intervillous space and then the blood system of the mother's lungs, where they are destroyed at the level of small venules. During electron microscopic examination, symplasts in large quantities "split off" from the surface of the syncytiotrophoblast. In addition, they contained 10-15 nuclei, which is 2 times more than in physiological pregnancy, and were surrounded by a network of microvilli.
The shape of the symplasts was unusually elongated, sometimes flask-shaped, and mesh structures were found in the structure of the symplasts, which is extremely rare in normal pregnancy. The listed data indicate intense export of pregnancy proteins and hormones into the mother's bloodstream, which allows us to consider these results as a compensatory reaction of the syncytiotrophoblast to the binding of chorionic gonadotropin to antibodies.
In the postpartum period, thrombophilic complications with sensitization to chorionic gonadotropin are practically not observed, so there is no need to monitor hemostasis. We gradually reduce the level of glucocorticoids in 3-4 days if the dose was higher than 10 mg and in 2-3 days at a lower dosage.
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