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Introduction. One of the actual problems of modern obstetrics is hypertensive disorders during pregnancy. Pregnant women living in highlands are exposed to adverse factors, the most important of which is decreased oxygen in the air. Hypertension of pregnant women in high altitude conditions is conjoin with exogenous hypobaric hypoxia, and as a total organ pathology leads to functional and morphological changes in all organs and systems.Aim: to study the features of hemostasis system in pregnant women with hypertensive disorders in highlands.Materials and Мethods. A prospective comparative study included 114 pregnant women with hypertensive disorders, which were divided into 2 groups: group 1 – 63 pregnant women living in highlands, and group 2 – 51 pregnant women living in lowlands. In group 1, 42 pregnant women (67 %) and in group 2, 24 (47 %) pregnant women were diagnosed with severe preeclampsia. Hemostasis parameters were studied: blood clotting time, prothrombin index, content of fibrinogen and soluble fibrin-monomer complexes (SFMC), international normalized ratio (INR), activated partial thromboplastin time (APTT) index, thrombin time, platelet count.Results. In pregnant mountaineers, compared with pregnant women in lowlands, a higher content of such hemostasis parameters as APTT index (1.654 ± 0.426 vs. 0.892 ± 0.1145; p < 0.001) and SFMC level (4.921 ± 0.753 mg% vs. 3.590 ± 0.5676 mg%; p < 0.001), thrombin time values (103.206 ± 3.734 seconds vs. 93.920 ± 7.8268 seconds; p < 0.001) were revealed, as well as lower fibrinogen concentration (3.762 ± 0.809 g/l vs. 4.160 ± 1,3015 g/l; p = 0.048).Conclusion. In pregnant women living in highlands compared with pregnant women in lowlands with the addition of severe forms of preeclampsia (67 % vs. 47 %) hypercoagulation characteristic of normal pregnancy disappears, but, on the contrary, iso- and hypocoagulation appears.

Among the diverse picture of preeclampsia, the hematological component, thrombocytopenia, attracts attention. Platelets are able to form microvesicles by budding the plasma membrane from the cell surface during apoptosis, stimulation, and also in a small amount in normal conditions. The membrane of these particles has a negative charge and contains phospholipids and an integral glycoprotein on the outer monolayer, due to which platelet microvesicles are involved in the process of blood coagulation and angiogenesis. Microvesicles are of platelet origin, they were first discovered in the middle of the last century in England when describing the phenomenon of plasma and serum coagulation in the absence of platelets in them. The number of platelet microvesicles dynamically changes during the formation of preeclampsia in pregnant women and in women with risk factors for the development of preeclampsia, which include obesity, arterial hypertension, diabetes mellitus, antiphospholipid syndrome. Exposure to these risk factors for preeclampsia before pregnancy leads to a change in the concentration of cells that produce microvesicles, which in turn can create conditions favorable for the development of preeclampsia during pregnancy. A special risk group are women with a history of preeclampsia. Taking into account the direct role of microvesicles in the processes of angiogenesis and blood coagulation, the study of these particles will allow a more detailed study of the pathophysiological aspects of the preeclampsia development, which will expand the possibilities for early prediction of this pathology and improvement of perinatal outcomes.

AIM: We aimed at assessing the significance of first-trimester biochemical screening of pregnancy-associated plasma protein A (РАРР-А) and human chorionic gonadotropin (hCG) in predicting the recurrence of preeclampsia (PE) in pregnant women with early and late history of gestational PE. MATERIALS AND METHODS: A retrospectively included 94 labor histories and prenatal medicals records of pregnant women (20202021). Moreover, their first-trimester biochemical screening parameters (РАРР-А and hCG) with a gestational PE history were performed to predict the recurrence of PE. They were divided into three groups (two study groups and a control group). Groups 1 and 2 included 31 labor histories each with late- and early-onset PE, respectively. Group 3 (controls) consisted of 32 labor histories with uncomplicated pregnancies. RESULTS: In the groups with a gestational PE history and recurrence, a significant decrease in РАРР-А levels was found at 1114 weeks of gestation. We equally observed high levels of first-trimester hCG in late-onset PE, most probably due moderate degrees of PE recurrence and not gestational age. However, severe degrees of recurrence prevailed in early-onset PE. CONCLUSIONS: A decrease in РАРР-А levels measured at 1114 weeks of gestation is a significant predictor of recurrence of PE in the group of pregnant women with a gestational PE history.