Introduction. Severe preeclampsia in early stages can be detected by isolated thrombocytopenia, which makes it difficult to diagnose it in time and carry out the necessary therapeutic measures. As a rule, the diagnosis of severe preeclampsia can be declared with a detailed clinical and laboratory researches, and it increases the risks for the mother and the embryo. However, if there are no clinical symptoms of preeclampsia except of thrombocytopenia, there is a problem of differential diagnosis between thrombocytopenia, which has the same symptoms as preeclampsia and gestational thrombocytopenia, which is a physiological peculiarity and does not require any medical interventions and restrictions. Nowadays there are no screening methods for differential diagnosis of these conditions. Objectives. To estimate the possibilities of determing the level of neutrophil extracellular traps (NETs) during the differential diagnosis of preeclampsia and gestational thrombocytopenia. Materials and methods. The comparative analysis of the level of NETs was carried out in three groups of pregnant women. Group 1 included patients with severe preeclampsia (n = 45), group 2-patients with gestational thrombocytopenia (n = 44) and group 3 consisted of healthy pregnant women (n = 44). Results. The research revealed significant increase in the level of NETs in the group of patients with preeclampsia (15.26 %,) compared with the groups of healthy patients (7.65 %, p = 0.001) and patients with gestational thrombocytopenia (7.04 %, р = 0.002). There were no significant differences in the level of NETs between the groups of healthy patients and patients with gestational thrombocytopenia. Conclusions. A significant increase of the level of NETs among the patients with severe preeclampsia allows us to consider the method of calculating the level of NETs among patients with thrombocytopenia which can be detected after the 20th week of pregnancy, if there are no other laboratory and clinical signs of preeclampsia as a screening method for early diagnosis of this complication.

Thrombocytopenia is the second most frequent hematological complica-tion of pregnancy after anemia. Among all thrombocytopenia during pregnancy, the most common is gestational thrombocytopenia. Gestational thrombocytopenia is not accompanied by coagulation disorders, has a minimal risk of bleeding, for both a mother and her fetus. Nevertheless, according to modern concepts, thrombocytopenia is a contraindication for performing obstetric neuroaxial blockades only on the basis of quantitative count of platelets, without taking into account coagulation status. These contraindications are derived from the general surgery and traumatology practice due to the high risk of developing epidural hematoma, but do not take into account the features, including physiological hypercoagulation, of pregnant patients. Refusal of the patient to perform a neuroaxial blockade during delivery on the basis of only counting the number of platelets often leads to an unreasonable increase in the risk / benefit ratio for both the mother and the fetus. Analysis of the research results indicates a change in attitude towards this problem towards a more loyal approach, taking into account the assessment of the coagulative status of a particular patient.

Gestational thrombocytopenia (GT) is the most common type of thrombocytopenia during pregnancy. Unlike other types of thrombocytopenia, it is not accompanied by dysfunction of the cellular component of hemostasis. Currently, a quantitative decrease in platelets in GT is a contraindication to neuraxial blockades (NAB), which significantly reduces the quality of care in childbirth.The aim of the study is to determine the possibility of safe use of neuraxial blockades in gestational thrombocytopenia. A retrospective prospective study involved 70 patients who were performed delivery, depending on obstetric indications, either conservatively or surgically. The patients were divided into two groups. The main group (group No. 1) included 35 patients with gestational thrombocytopenia. The comparison group (group No. 2) consisted of 35 patients with a platelet content above 150×109/l. A comparative intergroup analysis of indicators of a general blood test, coagulogram, thromboelastography with a test for functional fibrinogen before childbirth and 2 days after delivery. The change in platelet content and its effect on the coagulation status of patients during pregnancy were retrospectively analyzed. A comparative assessment of the volume of blood loss during childbirth and the early postpartum period and the risk of complications of neuraxial blockade in patients with and without gestational thrombocytopenia was carried out.It was found that during gestational thrombocytopenia in the perinatal period, there is no decrease in coagulation potential, assessed by the results of coagulography and thromboelastography at a platelet level above 49×109/l. The investigated indicators of hemostasis did not have significant intergroup differences during pregnancy and childbirth. In the group of patients with gestational thrombocytopenia, the volume of blood loss during labor and the postpartum period did not differ from the group without thrombocytopenia, regardless of the method of delivery. The median blood loss after vaginal delivery in group 1 was 225 ml, in group 2 – 250 ml, with abdominal delivery – 572 ml and 386 ml – respectively. In this study, no complications of neuraxial blockade were observed in any of the groups.The results obtained suggest that in patients with gestational thrombocytopenia, even with a significant decrease in platelet content, it is possible to perform neuraxial blockades during labor, taking into account the clinical picture and the absence of coagulation disorders confirmed by thromboelastography.