antifosfolipidnyj a syndrome in obstetrics and gynecologies

[dr_medvedev]

Dear colleagues and patients!

Last decades became extraordinary popular and to some extent *quot; ?n?*quot; a problem antifosfolipidnogo a syndrome, especially in a -gynecologic practice. Therefore I offer all the questions concerning or touching AFS to generalize in this subject. Write.

[oksi]

The report from *quot is possible; a?N?Oa*quot;?

For me diagnosed AFS. In the anamnesis 2 not developing pregnancy on terms of 20 and 23 weeks (in both cases the arrest of development of a fetus has noted been). At present has passed or has taken place 4 months after an abortion.

I have read through a lot of the accessible information on AFS on the Internet. But all she or in the form of clauses or articles which discuss different carried out researches with different preparations, or in the form of answers to private or individual questions.



It would be desirable to discuss more particularly within the limits of this subject the saved up or saved world or global experience. To develop or produce something in the form of algorithm for decision-making *quot; than to be treated/on what parameters to turn attention/and etc. and quot; to generalize the information available for today. That to us, *quot; a?N?Oa?*quot;, it was easier to be guided and make of the decision, and that in a head *quot; a?a*quot; - and it like is good also that and what particularly to do or make on a way to achievement the *quot; treasured N??*quot;, you are all the same lost.

Something of type such: pregnancy has interrupted, diagnosis AFS is established or installed. What to do or make further?:

1. How to go through the postnatal period (after an abortion) to avoid complications AFS (it would not be desirable in fact to become the invalid at young age). What signs should guard (by way of displays of a clottage). Whether It is necessary and how the period is treated in it?

2. How to be prepared for pregnancy? What it is possible/is necessary to do or make at a stage of preparation? How to solve that it is possible to start planning (when all parameters will come to norm or rate?, and if will not come? It is necessary to be guided by what parameters?).

3. Pregnancy has come or stepped. What to do or make, after you will see striatal testik?:confused: To what expert to run and what first of all to check. Variants of therapy at pregnancy: to that in what cases?

And more a question: how experts gemostaziologi and -gynecologists concern to plazmaferezu at a stage of preparation for pregnancy and during it or her? About pluss plazmafereza I nachitalas on the Internet. But for certain there are also minuses about which do not write?

[dr_medvedev]

You have just asked me to write to you the book of pages on 500. I am ready to help or assist you and many other things, but let's agree so: you ask a concrete question, and I respond and so under the order.

[Dr. Vad]

The dear colleague,



Here some details, can will express the opinion too?



http: // forums./showthread.php? p=122164*post122164

[Dr. Vad]

Something of type such: pregnancy has interrupted, diagnosis AFS is established or installed. What to do or make further?:

1. How to go through the postnatal period (after an abortion) to avoid complications AFS (it would not be desirable in fact to become the invalid at young age). What signs should guard (by way of displays of a clottage). Whether It is necessary and how the period is treated in it?

2. How to be prepared for pregnancy? What it is possible/is necessary to do or make at a stage of preparation? How to solve that it is possible to start planning (when all parameters will come to norm or rate?, and if will not come? It is necessary to be guided by what parameters?).

3. Pregnancy has come or stepped. What to do or make, after you will see striatal testik?:confused: To what expert to run and what first of all to check. Variants of therapy at pregnancy: to that in what cases?

And more a question: how experts gemostaziologi and -gynecologists concern to plazmaferezu at a stage of preparation for pregnancy and during it or her? About pluss plazmafereza I nachitalas on the Internet. But for certain there are also minuses about which do not write?



Dear Oksi,



I shall try to respond you to some of questions in brief:



In the earliest postnatal or puerperal period it is necessary to spend prof- clottages: the prompt mobilization (as soon as possible to start to move and rise with bed), prof. Stagnation of a blood in nizhn. konechn. (stockings, bandaging, massazhirovanie and tp). sipmtomokompleks a clottage depends on system of a circulation (aOOO./veins.) and localizations. A clottage of veins nizhn. konechn. (most often) it is shown by a pain, raspiraniem, an edema, usil. Veins. A drawing and tp.;



With reference to your situation (loss beremennostej in second half) preparation has no crucial importance;



As already informed, from the moment of an establishment of pregnancy it is necessary to appoint or nominate Aspirinum of 60-80 mg day, Acidum folicum of 1-2 mg/?OO., NANOMETER a heparin (0,3-0,4 fraksiparina or kleksana; 5000 fragmina) /to. Usually last is appointed or nominated till 32-34 weeks.



Gemostaziologi do not approve plazmaferez as a way of excision of antibodies at all pregnant women in VA/ao??. This way can be applied in the extremely complex or difficult cases (accompanying collagenoses with the highest antiserum capacity, katastrofich. AFLS)

[oksi]

Dear Dr. Vad! Thanks for the answer in a topic about a coagulogram. To me it is clear. It will be necessary to track or look after in the further kidneys, for possible or probable development collagenose.

And now under the previous report it is possible some specifications?





In the earliest postnatal or puerperal period it is necessary to spend prof- clottages: the prompt mobilization (as soon as possible to start to move and rise with bed), prof. Stagnation of a blood in nizhn. konechn. (stockings, bandaging, massazhirovanie and tp). sipmtomokompleks a clottage depends on system of a circulation (aOOO./veins.) and localizations. A clottage of veins nizhn. konechn. (most often) it is shown by a pain, raspiraniem, an edema, usil. Veins. A drawing and tp.;

I.e. it is not obligatory to drink, for example, within a month Aspirinum or to prick a heparin of 10-15 days?





With reference to your situation (loss beremennostej in second half) preparation has no crucial importance;



Can be



In this occasion me the question interests: why women with AFS have discontinuings on different terms? On what it depends? Whether there Are to it or this explanations? And whether there is I in more advantageous position (if I shall spend treatment AFS during) in comparison with those at whom interrupts on early terms? (differently, success of successful pregnancy at me above?) or it about what does not speak?





There are opinions, that at AFLS, the stopping of pregnancy occurs or happens for two reasons: immediately because of disturbance of microcirculation in a placenta (hypercoagulation) and because of damaging or injuring action of antibodies, which in itself can cause inflammatory changes in a placenta, leading to a placental failure already on early terms.

Therefore absolutely without preparation I somehow am afraid.

Yes, probably, that in my case the hypercoagulation is not of great importance on early durations of gestation (I it or her wore time till 5 months). But, there is such concept as a primary placental failure which is formed already from early terms and inevitably leads to a stopping of pregnancy, and prophylaxis needs to be spent already from early terms.

And here I am am excited with such question that is possible or probable at me damaging or injuring action of antibodies on cells of a placenta is great. Then probably besides a heparin/Aspirinum it is reasonable to spend therapy on depression of antibodies. Here in a world or global practice 2 variants are offered: steroids (Methypredum) or immunoglobulins. Both those and others can effectively reduce a level of antibodies. But besides in the literature, there are many steroids given about harm, and to them categorically concern in the West. About harm of immunoglobulins I plainly did not meet anything, well unless just a fiber containing in them at some people can cause a shock.



Dear doctors, and what your opinion on application of steroids/immunoglobulins during pregnancy?



I all the same think, that is concrete to me, such therapy during to not manage. At me personally, greater trust immunoglobulins since besides all they also reduce risk of an exacerbation of chronic infections (it is considered, that women with AFS are virus carriers in a greater degree cause, than others). In me for some reason causes trust experience of the Center of the Immunology and the Reproduction (TSIR) in a to Moscow (under direction of Guzova I.I.), they specialize on pregnancy at AFS and apply immunoglobulins http: // www.cironline.ru



Besides I most have an experience of application of Dexamethazonum. After discontinuing 1-st pregnancy at me small rising man's hormones (17-) has been revealed, has been diagnosed giperandrogenii an adrenal genesis. For preparation for 2-nd I accepted Dexamethazonum some months in a dose 1/2 tabl./?OO, 17- that decreased, slightly rose above the top border of norm or rate. Then when I zaberemenila, the endocrinologist have lowered a dose up to 1/4 tab. in 2 days, having told or said that mine giperandrogenija medikamentozno controllable and we have achieved that wanted. But, thus, on a background of such therapy at me other man's hormone - DGEAS (he became below the bottom border of norm or rate) has very strongly fallen. I.e. that I wish to tell or say. I was convinced about advantage or benefit/harm of steroids. Advantage or benefit such: application of Dexamethazonum up to pregnancy, has possibly lowered level AF of antibodies, since First, I carried by the second pregnancy more longly for 3 weeks, and secondly, I was not disturbed never with threat of discontinuing (there was no tonus and so forth). Though certainly with it or this has helped or assisted and djufaston which I accepted from first days of pregnancy. Can be if a dose of Dexamethazonum have not lowered from 5-th week, I it or her and informed? Now about harm: On a background of this therapy at me has decreased DGEAS, he became below norm or rate. I read, what is it very important hormone, and its or his such depression is observed only at senile age.:eek: well and about harm of Dexamethazonum for a fetus - in the literature it is disputable opinions but if I so was affected or influenced with small doses (1/2) for certain and on the child it is reflected? Especially, for treatment AFS during doses where greater or big than 1/2 Dexamethazonums (for example, it is minimal 5 mg of Methypredum, i.e. somewhere 2 tab. of Dexamethazonum) are offered.





As already informed, from the moment of an establishment of pregnancy it is necessary to appoint or nominate Aspirinum of 60-80 mg day, Acidum folicum of 1-2 mg/?OO., NANOMETER a heparin (0,3-0,4 fraksiparina or kleksana; 5000 fragmina) /to. Usually last is appointed or nominated till 32-34 weeks..;



Dr. Vad, and whether it is impossible to replace NANOMETER heparins with a usual heparin. In the same TSIRe apply usual heparins, and they speak that also as well as the NANOMETER, do not pass or take place through a placenta. I.e., *quot; if there is no difference, what for to pay i?y?N*quot;?

For example, fraksiparin, fragmin 10 ampoules cost or stand 1300-1500 r., kleksan 1700 r. I.e. for a month terapiii will leave 4000-5000 r.:eek: And a usual heparin of 10 ampoules nearby 50 rbl.





Gemostaziologi do not approve plazmaferez as a way of excision of antibodies at all pregnant women in VA/ao??. This way can be applied in the extremely complex or difficult cases (accompanying collagenoses with the highest antiserum capacity, katastrofich. AFLS)

It is possible hardly more in detail why do not approve? Yes I read, what after depression of antibodies, there can be their even greater increase? I too am afraid or rather afraid plazmafereza, all taki this strong enough intervention in a hemostasis a little. Especially, when write, that to pregnant women for 3 procedures delete all circulating plasma (600-900 for 1 procedure). Can from softer plazmafereza, for example, 300 ml deleted plasma for 1 procedure, and will not be harm, and there will be a small advantage or benefit?

[oksi]

It is possible still a question on a coagulogram:



Analyses from 31.05.2005

Antibodies to fosfolipidam: IgG - 37.95 (at norm or rate up to 10), IgM - 4,06 (at norm or rate up to 10).

Gemostaziogramma:

Blood clotting time (mines) 8 ' 05*quot; (5-10)

Calcium clotting time (sec) more 300*quot; (60-120)

AVR, kaolinovoe time (sec) 81*quot; (50-70)

ACHTV (sec) 36*quot; (25-35)

CHTV (sec) 139*quot; (50-70)

PTI (%) 99 (85-115)

Prothrombin time (sec) 17*quot; (12-20)

Concentration of a fibrinogen (g/l) 2,88 (2-4)

Hageman a-dependent fibrinolysis *quot; - *quot; (5-15 mines)

Fibrinogen In (kach.) otsutstv. (otsutstv.)

Ethanol assay (kach.) otrits. (otrits.)

RFMK otrits. (otritsat.)

Tolerance of plasma to a heparin (mines) more than 30 ' (6-13)

System of a protein With *quot; - *quot; (0,7-1,5)



Analyses from 05.08.2005

Antibodies to fosfolipidam: IgG - 29,34 (at norm or rate up to 10), IgM - 9,27 (at norm or rate up to 10).

Gemostaziogramma:

Blood clotting time (mines) 8 ' 45*quot; (5-10)

Calcium clotting time (sec) 225*quot; (60-120)

AVR, kaolinovoe time (sec) 70*quot; (50-70)

ACHTV (sec) 30*quot; (25-35)

CHTV (sec) 107*quot; (50-70)

PTI (%) 93 (85-115)

Prothrombin time (sec) 19*quot; (12-20)

Concentration of a fibrinogen (g/l) 3,2 (2-4)

Hageman a-dependent fibrinolysis *quot; - *quot; (5-15 mines)

Fibrinogen In (kach.) otsutstv. (otsutstv.)

Ethanol assay (kach.) otrits. (otrits.)

RFMK otrits. (otritsat.)

Tolerance of plasma to a heparin (mines) 27 ' 45*quot; (6-13)

System of a protein With *quot; - *quot; (0,7-1,5)



1) That means: the System of a protein With costs or stands a crossed out section at norm or rate from 0,7-1,5

And a -dependent fibrinolysis too a crossed out section at norm or rate 5-15?

2) it is necessary to be guided By what parameters at application of a heparin i.e. how to define or determine efficiency geparinoterapii?

3) In the instruction to kleksanu I have read through, quote: *quot; the Preparation is characterized by high activity concerning factor Ha of coagulation (thrombokinase) and low activity concerning factor IIa of coagulation (Thrombinum). At application of a preparation in the doses used for prophylaxis of venous clottages, for the period of a bleeding, time of coagulation and activated partial tromboplastinovoe time (ACHTV) practically does not influence. Does not render influence on aggregation OO?i?Oo*quot;.

Time of coagulation at me in gemostaziogramme is, and here that such bleeding time with reference to mine gemostaziogramme, whether there is at me this parameter?

4) Aspirinum, I so understand, influences aggregation of thrombocytes? But at me in gemostaziogramme parameters of aggregation are not certain. Whether it is important to spend in addition to me tests for aggregation before to accept Aspirinum? There can be she at me in norm or rate? And then during it will be possible to be limited to a heparin only?

5) after 2 months of reception of Aspirinum at me time of coagulation (with 8 ' 05*quot was extended; up to 8 ' 45*quot;) and a prothrombin time (with 17 ' up to 19 '). I.e. the effect of Aspirinum consists only in it or this? But at me and so these parameters were in norm or rate, even is closer to the top border, and have now raised or increased, i.e. predilection to a bleeding has increased?

6) on ACHTV, CHTV, AVR Aspirinum does not influence? But in the second gemostaziogramme ACHTV and AVR at me have come to norm or rate, and CHTV is not present. I read, what elongation ACHTV is caused or causes by presence VA, I correctly understand? And reception of Aspirinum here not and? Then than to result or bring in norm or rate CHTV? And whether it is necessary to result or bring them in norm or rate during pregnancy? Here I have absolutely got confused.

7) that for strange such parameter *quot; time ONa?y?o?a??*quot;, which too in any way does not wish to come at me to norm or rate? How much did not try to find in this occasion of the information in and-not those or that, and could not.



Dr. Vad if it is not difficult to you to answer all these numerous questions:confused: for *quot; ?a??a*quot;, I shall be very grateful. Or can will give the link where this all is accessible and clearly described, too I shall be very grateful.:)

[Kykolka]

Yes this subject and is very interesting to me, especially about immunoglobulins and treatment by a heparin (and whether it is impossible to replace NANOMETER heparins with a usual heparin)!

[dr_medvedev]

Yes this subject and is very interesting to me, especially about immunoglobulins and treatment by a heparin (and whether it is impossible to replace NANOMETER heparins with a usual heparin)!



It is possible, but at nefraktsionirovannogo a heparin there are many disadvantages. It or him difficultly enough and dangerously to apply in out-patient conditions.

[dr_medvedev]

It is possible still a question on a coagulogram:





1) That means: the System of a protein With costs or stands a crossed out section at norm or rate from 0,7-1,5

And a -dependent fibrinolysis too a crossed out section at norm or rate 5-15?

2) it is necessary to be guided By what parameters at application of a heparin i.e. how to define or determine efficiency geparinoterapii?

3) In the instruction to kleksanu I have read through, quote: *quot; the Preparation is characterized by high activity concerning factor Ha of coagulation (thrombokinase) and low activity concerning factor IIa of coagulation (Thrombinum). At application of a preparation in the doses used for prophylaxis of venous clottages, for the period of a bleeding, time of coagulation and activated partial tromboplastinovoe time (ACHTV) practically does not influence. Does not render influence on aggregation OO?i?Oo*quot;.

Time of coagulation at me in gemostaziogramme is, and here that such bleeding time with reference to mine gemostaziogramme, whether there is at me this parameter?

4) Aspirinum, I so understand, influences aggregation of thrombocytes? But at me in gemostaziogramme parameters of aggregation are not certain. Whether it is important to spend in addition to me tests for aggregation before to accept Aspirinum? There can be she at me in norm or rate? And then during it will be possible to be limited to a heparin only?

5) after 2 months of reception of Aspirinum at me time of coagulation (with 8 ' 05*quot was extended; up to 8 ' 45*quot;) and a prothrombin time (with 17 ' up to 19 '). I.e. the effect of Aspirinum consists only in it or this? But at me and so these parameters were in norm or rate, even is closer to the top border, and have now raised or increased, i.e. predilection to a bleeding has increased?

6) on ACHTV, CHTV, AVR Aspirinum does not influence? But in the second gemostaziogramme ACHTV and AVR at me have come to norm or rate, and CHTV is not present. I read, what elongation ACHTV is caused or causes by presence VA, I correctly understand? And reception of Aspirinum here not and? Then than to result or bring in norm or rate CHTV? And whether it is necessary to result or bring them in norm or rate during pregnancy? Here I have absolutely got confused.

7) that for strange such parameter *quot; time ONa?y?o?a??*quot;, which too in any way does not wish to come at me to norm or rate? How much did not try to find in this occasion of the information in and-not those or that, and could not.



Dr. Vad if it is not difficult to you to answer all these numerous questions:confused: for *quot; ?a??a*quot;, I shall be very grateful. Or can will give the link where this all is accessible and clearly described, too I shall be very grateful.:)



1. That the system of a protein With was not investigated or researched and with-mA f- Hagemana too

2. The gold standard - ACHTV (for usual NFG)

3. Time a bleeding the rasping and out-of-date parameter. In the modern expanded coagulogram he is not necessary

4. In addition aggregatsiju tts to define or determine it is not necessary. Aspirinum in a dose of 75-85 mg/?OO is safe at pregnancy and it is recommended at least half researcher as monotherapy or addition to NMG

5. Such parameters will be hardly connected with reception of low doses of Aspirinum. A coagulogram in general such thing that can slightly vary even within day.

6. Yes VA extends ACHTV. Whether to define or determine it is connected with AFA there are correctional assays with plasma and FL. Doctors know about it or this.

7. Be guided by activated calcium clotting time AVR. It at you in norm or rate.



Do not try something korrigirovat and to result or bring in norm or rate. It is a problem or task of the doctor.

Next time ask questions in the smaller portions. It is inconvenient to respond to such questions-compositions.

[dr_medvedev]

Dear doctors, and what your opinion on application of steroids/immunoglobulins during pregnancy?



Glucocorticoids for today practically are not used at pregnancy and AFS (only in very serious cases with somatic complications). Those microdoses, that frequently appoint or nominate at pregnancy are not capable to lower antiserum capacities, but bring the certain harm of mother and to a fetus. By the way reduce immunity, helping or assisting a chronic infection.



Immunoglobulins are applied at pregnancy. But -controllable multitsentrovyh randomizir researches on this question it is not spent yet. Efficiency on preliminary data is, but cost of such therapy is rather high.

[Dr. Vad]

Many thanks, the colleague, for operative answers to patients.



With your permission, I shall a little add:



The recent update from the USA does not recommend use of an immunoglobulin at nevynashivanii as the first line of therapy:



Fertil Steril. 2004 Sep; 82 Suppl 1:S199-200.

Intravenous immunoglobulin (IVIG) and recurrent spontaneous pregnancy loss.

Practice Committee of the American Society for Reproductive Medicine.

American Society for Reproductive Medicine, Birmingham, Alabama, USA.



IMHO, the given variant of therapy in a kind vys. Costs and high risk. Actions it can be planned at unsuccess nowadays recommended at AFLS: a heparin and Aspirinum



For pregnant patients with antiphospholipid antibodies (APLAs) and a history of two or more early pregnancy losses or one or more late pregnancy losses, preeclampsia, intrauterine growth retardation, or abruption, we suggest antepartum aspirin plus minidose or moderate-dose UFH or prophylactic LMWH (Grade 2B).



Chest. 2004 Sep; 126 (3 Suppl):627S-644S.

Use of antithrombotic agents during pregnancy: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.

Bates SM, Greer IA, Hirsh J, Ginsberg JS.



By and large it is potentially possible to apply and a usual heparin, but it is less safe (more often a thrombocytopenia, more often an osteoporosis) also is interfaced or integrated to smaller convenience - napr. minim. Its or his dose 5000 ME 2 times day, considering, that otech. A heparin trad. Is issued in the form of 5 thousand ED in 1 ml 2 injections on 1 ml in a n??-FATTY TISSUE of a stomach or belly already to the middle of pregnancy will appear a hell, and to prick it is necessary more than 200 days. The corrected or adjusted dose of a heparin on ACHTV (up to 1,5 multiple augmentations - problems with slezhniem if it is already initially increased) and then its or his dose (and volume sootv sometimes is recommended.) raises or increases up to 6-8 tys twice.

[dr_medvedev]

Thanks, Vadim Valerevich.



Still I shall add a little bad about a simple heparin:

1. Its or his bioavailability rather variabelna

2. Its or his effect strongly depends on concentration and activity of an antithrombin-3, and at AFS enough it often suffers antikoaguljantnoe a part alongside with system of a protein of S.Dlja of maintenance of level -3 it is necessary to pour plasma with all accompanying problems.

3. Constant laboratory + bleedings are dictated with necessity of a finding for a hospital that promotes dissemination by hospital strains and at all in the best image affects a mental status of future mums.

4. Besides thrombocytopenias allergic reactions are frequent enough.



There are still some variants of pharmacotherapy AFS. However they are in a phase of experiment on a lab. Animals. When I shall sum up - to all I shall by all means inform.

[Kykolka]

You already responded me as staviitsja AFS. But at me he in doubt. I spread the analysis in that subject, still there is an analysis which I handed over at genetikov: antifosfolipidnye (AT to a complex b2 - -1 with a cardiolipin, fosfatidilserinom, fosfatidilovoj an acid and fosfatidiletanolaminom) - G - 1.3, M - 1.5 at norm or rate up to 10. Surrendered 3 months prior to pregnancy. Genetics have told or said, that norm or rate.

So why to me all taki appoint or nominate to prick fraksi? I can not understand, eat all taki at me AFS or not?

If in that subject to me have responded, that gemostaziogramma - norms or rates, credits not such strong on AF....?



2 not developing likely nobody will establish or install the reasons. And not pytajutsja. It is a lot of assumptions, and precisely tell or say nobody could. Were surveyed with the husband much where. But one I has noticed: from the very beginning of pregnancy embryoses lagged behind in development, i.e. term on US put for 2 weeks less, than even embryonal or fetal;embrionic term of development, the uterus was less much more and too mismatched term. Zachitie precisely occurs or happens in the middle of a cycle (about 14 day), since chustvovala pains ovulatory. And in this pregnancy it's OK from the very beginning, only there was retrohorialnaja a hematoma. Saving therapy and all has entered into norm or rate. Now 12 weeks, on US all ok! But the doctor speaks to prick fraksi. Also speaks urgently to begin. Now a problem with money, I can begin only in 2 weeks. But doubts are - is vsetaki or not AFS at me?

Please, help or assist to understand. All analyses which I showed the doctor, spread also to you: a hemostasis and antibodies to fosfalipidam.

[dr_medvedev]

And what with lupoid anticoagulant? Levels of antibodies really below norm or rate. I so understand at you except for 2 not developing beremennostej in early term (till 10 weeks) any displays *quot; Co?*quot; did not find?

Analyses once again can present in this subject.

[Kykolka]

My results gemostatsiogrammy:

ACHTV 24 (norm or rate 20-40)

dRut - 25

Tromboelastogramma - 17 (19-27)

MA 45 (48-52)

ITP - 16 (20)

Function trombotstov ADF: 55

Ristomidin 57 (30-50)

RKMF (-)

VA otr.

The conclusion: the Chronometric hypercoagulation. A structural hypocoagulation. Function of thrombocytes is raised or increased. Attributes of activation of system of a hemostasis it is not revealed.

Comment on this conclusion. I do not understand medical terms. As nibud it is brief and on more clear.

Also there are antibodies to fosfolipidam and to HGCH (the analysis on AFS: a cardiolipin of M-, G - otr; fosfatidilserin M - polozh, G - slabopol; fosfatidiletanolamin M-a floor, G - otr; the others - otr. Surrendered for half a year up to this pregnancy).

Also there are herpes 1 and 2 types. In 8 weeks - an immunoglobulin. Is TSMV and koksaka groups And, concentration 17 KS in image - 24,7 Is raised or increased at norm or rate up to 11,26. This all my problems.

That at me *quot; Co?*quot; has learned or has found out only when already pregnant was, before doctors spoke nothing. Basically prossmatrivajut analyses very quickly. Fairly, I at all do not know, how projavljajutsja clottages for example. And in general what posledtsvija AFS.

I so understand, that fraksi appoint or nominate just in case. But this or thus the expensive. 1500 rbl. for 10 nyxes, time in three weeks a hemostasis - 1000 rbl., consultation of the doctor 750 r after the analysis of a hemostasis. poluchaetsja very dear or expensive pregnancy. I easy would go on it if it was really necessary!

[dr_medvedev]

In what term have stood previous pregnancy?

You handed over DHEA-S? There Were still any hormonal disturbances? Inspection?

What antiserum capacity to HGCH otr?

Such antibodies as at you happen at an infection transferred or carried on the eve (even ORVI) - transitional AFA.

I advise in any case to begin reception of Aspirinum of 75 mg day in the evening, washing down with a lot or plenty of water (75 mg - take a tablet of 100 mg, break off chetvertinku and throw out). It is very cheap. On a coagulogram - the raised or increased function of thrombocytes. Aspirinum just that is necessary.

[Kykolka]

Previous have stood on term of 7-8 weeks.

auNa-WITH in norm or rate, that up to what during pregnancy. Testosteron-Depotum in norm or rate up to pregnancy. And all hormones which I handed over up to pregnancy - norm or rate.

Antibodies to HGCH - M slabopol 21 (norm or rate up to 30), G polozh 27 (norm or rate up to 27).

Can these antibodies in consequence or investigation of a constant exacerbation of herpes? Then I did not treat it or him, because all doctors surveyed me. Only when have addressed in good clinic, treatment have spent, but I did not hand over already AF. Here I think, mozh the reason all taki was herpes, which time in a month retsedivy gave (genital)!. And now I have passed or have taken place treatment, here all and goes while safely, not including hematomas.

About Aspirinum I shall specify: i.e. chetvertinku I throw out, the rest I drink?

I by the way talked to the doctor about Aspirinum several days ago, she speaks, that he influences plasma, instead of on that that is necessary for me. That it is necessary for me, I do not know. I do not understand medical terms as a result gemostaziogrammy: the chronometric hypercoagulation and a structural hypocoagulation) But AFS she has put in doubt.

(Now I drink utrozhestan, deksmetazon, mikrogidrin, vitamin E, Acidum folicum, jodomarin, Hendevitum)

[dr_medvedev]

Aspirinum yes without chetvertinki. Acts on thrombocytes.

And what for you accept Dexamethazonum? He is not necessary to you. Also do not drink vitamin E and mikrogidrin-it in general not clear bioadditive.

Considering terms of discontinuing beremennostej utrozhestan it is better to continue to accept time have begun.

INDICATIONS to reception NMG (fraksiparina) at you are not present

[Kykolka]

Aspirinum I shall start to drink, only wished to specify, what manufacture he should be? Import or our?

Deksmetazon have told or said to accept on a tablet till 16 weeks, and then on poltabletki. But I already slezla up to poltabletki. Today has learned or has found out, that okazyvaetsja to hand over 17, it was necessary to adhere 3 days a diet (there is nothing yellow, orange), and I did not know, can because of it or this and there were deviations or rejections in the analysis. I want all taki up to the extremity or end slezt. Too I do not understand, what for such muck to me have appointed or nominated. Very terrible instruction at it or him.

mikrogidrin and Omegu 3/60 have appointed or nominated, but Omegu did not begin to drink (greater or big capsules) why you consider or count, what mikrogidrin it is not necessary? It is the bioadditive. Whether but useful?

About vitamin E, he like saves pregnancy. Why to refuse?

Means fraksi to not prick, be limited to Aspirinum. And whether the control of analyses is necessary? And to hand over all taki once again on AF or it is not necessary?

[dr_medvedev]

What for 17- if you handed over DHEA-S? As a last resort it or him peresdat.

Aspirinum is better import than a tablet ao 100 mg (kardioaspirin).



The bioadditive - useless. Helps or assists well for growing thin (simply does not remain money for meal).



Vitamin E it is not necessary, in greater or big doses he even is harmful and precisely is not useful. Enough its or his maintenance or contents in Polyvitaminums.



The control of analyses is necessary - in a month on AFS, in a week gemostaziogramma.

[Melnichenko]

Kardiomagnil - 75 mg of Aspirinum..

[Kykolka]

How long to accept Aspirinum?

Hemostasis to retake every week?

Kardiomagnil - already there there are 75 Aspirinums, i.e. even to divide it is not necessary a tablet?

[dr_medvedev]

Aspirinum to accept all pregnancy. It is possible to limit in sorts or labors and 2 days after.

Hemostasis to hand over once in a week and to look or see dynamics or changes of changes.

Kardiomagnil 75 mg can be not divided a tablet. The professor podskazla a preparation of which I did not know (in Ukraine it or him is not present)

[Kykolka]

T.e.e as I have understood, I shall start to drink Aspirinum, in a week I hand over a hemostasis and if there is poplozhitelnaja dynamics or changes to continue to drink up to the extremity or end of pregnancy? And danger of a bleeding in sorts or labors will not be?

And if change in a hemostasis will not be?????