The role of herpetic infections in genesis of endothelial damage in pregnant women with fetal loss syndrome

Abstract number: P0457

Dolgushina^* N., Makatsaria† A. D.

^*Moscow Medical Academy, Chair of Obstetrics and Gy, Russia; †Moscow Medical Academy, Russia

It is well-known that the negative role of herpetic viral infections (HSV, CMV, VVZ) during pregnancy is connected with direct cytotoxic action of viruses on tissues of fetoplacental complex. But last investigations of molecular mechanisms of endothelial function showed the great role of viruses in endothelial damage. Moreover the role of herpes in APS development is also proved. So, herpetic infection causes the thrombophilia development in two ways: by direct endothelial damage and by indirect hemostasis influence through APA production. Thrombophilic state cause different complications of pregnancy such as gestoses, placental insufficiency and fetal loss syndrome.

Methods  

We observed 147 pregnant women with severe herpetic infection (HSV and CMV infection). APA circulation was revealed in 47.4% of cases and thrombophilia markers (TAT, d-dimer) in 94% of cases. All women had fetal losses or placental insufficiency with fetal growth retardation in anamnesis. The recurrences of HSV-infection or increase of HSV- and CMV-IgG titers correlated with clinical and laboratory deteriorations (placental blood circulation decrease and thrombophilia markers increase). We started anticoagulant therapy (Fraxiparin 0.3 mL (150 ICU kg^-1) once per day and low doses of aspirin) in 97 women in the I trimester and in 50 women in the II trimester. The efficacy of treatment was evaluated by clinical and laboratory criteria (TAT, d-dimer).

Results  

Ninety-two percent of women were delivered at term, 8% had preterm labor, 20% had cesarean delivery. 26% of newborns had low weigh and fetal losses composed 2% in women with late onset of anti-thrombotic therapy.

Conclusion  

Herpetic infection causes endothelial damage, thrombophilia development, and as a consequence placental blood circulation violations during pregnancy. Early anti-thrombotic therapy (LMWH) in these patients is the prophylactic measure of fetal losses and other obstetric pathology.