Telmisartan 80 mg was consistently more effective than ramipril 10 mg in reducing both DBP and SBP during the last 6 h of the dosing interval, a measure of the early morning period when patients are at greatest risk of life-threatening cardiovascular and cerebrovascular events. Telmisartan 80 mg was also more effective than ramipril 10 mg in reducing BP throughout the entire 24-h dosing interval. Both drugs were well tolerated.

The objective: determining of the characteristics of hemodynamic disorders in pregnant women with varicose veins. Patients and methods. The study involved 80 pregnant women with varicose veins of the lower limbs: 42 pregnant women with varicose veins of the lower extremities (study group) suggested usage of complex therapy; 38 pregnant women (group) – traditional therapy. Performed duplex mapping dopplerometry pool pelvic vein, external iliac and ovarian veins; pool venous legs, hip and great saphenous veins. The authors suggested regimen that includes use of drug Dioflan®. Results. Analysis of the data allowed to define features and its hemodynamic disturbances in venous pools pelvis and lower extremities in pregnant women with varicose veins. The study conducted by the authors proposed estimation methods of their correction using the drug Dioflan®. Conclusion. The proposed method is statistically more effective correction of hemodynamic disorders in pregnant women with varicose veins. Key words: pregnancy, varicose veins, dopplerometry, Dioflan®.

The objective: evaluation of the impact of the complex therapy on indexes of dysfunction of endothelium homocysteine and fibronectin in pregnant women with varicose veins of lower extremities. Patients and methods. 80 pregnant women with varicose veins of the lower extremities before and after treatment underwent the determination of the indexes of homocysteine and fibronectin. The main group – 42 pregnant women with varicose veins of the lower extremities received complex therapy within 30-36 weeks (medication with angioprotective effect, direct anticoagulant; graduated elastic compression; flavonoid with immunotropic effect); comparison group – 38 women with varicose veins of the lower extremities, received local heparin-contenting medication. The control group included 50 pregnant women without VVLE. Results. In analysis of the concentration of the homocysteine in blood plasma in pregnant women with varicose veins of the lower extremities the increase of the level was detected in 38% and 28.9% of the patients of the main group and comparison group accordingly; in control group – only in 2%. In main group the content of fibronectin was elevated in 69%; in comparison group in 71% of the patients, in control group – only in 6%. After treatment, the assessment of the markers of the endothelium dysfunction in examined groups was performed. The content of homocysteine decreased in 1.7 times in main group and only in 0.8% times in comparison group. The average level of fibronectin in main group decreased on 31.2% in comparison with benchmark; in comparison group its level decreased only on 12.2%. Conclusions. Thereby, we detected in third trimester in pregnant women with varicose veins of the lower extremities statistically credibly high indexes of homocysteine and fibronectin compared to the control group. Decrease of the level of homocysteine in 1.7 times and content of fibronectin in blood plasma in 1.5 times can be a sign of positive stabilizing effect on endothelium of blood vessels in suggested therapy. Key words: varicose veins of lower extremities, homocysteine, fibronectin, complex therapy.

The number of pregnant women with kidney transplant is growing and will continue to increase in Ukraine and all over the world, taking into account the development of transplantology. Such patients belong to the high-risk group, however, a clear understanding and adequate evaluation of the prognostic factors which are described in the literature will allow to transfer from prohibition and intimidation to the stage of supporting motherhood and providing highly qualified medical care to women with kidney transplants.This article presents two clinical cases of pregnancy and childbirth in women with kidney transplants, which occurred in the Department of Internal Pathology of Pregnant Women of the State Institution “Institute of Pediatrics, Obstetrics and Gynecology named after Acad. O. M. Lukyanova National Academy of Sciences of Ukraine”. Both patients with kidney transplants that functioned for 4 and 5 years, respectively, visited the doctor in early pregnancy.The anamnesis of the first pregnant woman was without peculiarities, while the second patient already had an episode of acute transplant rejection in the anamnesis and organ retransplantation from her mother. In addition, she had viral hepatitis B and C, as well as an insufficient level of immunosuppression. The function of the transplants in both women was satisfactory, each of the persons suffered from secondary nephrogenic anemia. Correction of immunosuppression in both patients was difficult, especially at 28 weeks, which is associated with hemodilution of pregnant women. Both women experienced an episode of urinary tract infection, which is experienced by about 40 % of pregnant kidney recipients.The first pregnant woman was practically healthy at full term pregnancy and had no indications for abdominal operation delivery, however, due to a clinically narrow pelvis she had cesarean section, which is a technically difficult surgery in such cases. In the second patient, the last weeks of pregnancy were complicated by hypertension of non-placental origin and transplant function disorders, which became an indication for cesarean section at 38 weeks. In the postpartum period kidney function began to recover. The condition of both newborns was satisfactory.Therefore, despite the reliable pregnancy outcomes in kidney transplant patients, an increased risk of obstetric complications and adverse perinatal outcomes remains. Interdisciplinary monitoring with timely correction of kidney transplant function disorders, monitoring of immunosuppressive therapy, prevention of premature births, careful control of blood pressure and adequate fetal monitoring allows to hope for favorable obstetric and perinatal outcomes in this group of patients.

Immune thrombocytopenia (ITP) is an autoimmune disease which is characterized by antibody-mediated destruction of platelets by the reticuloendothelial system. The rate of ITP is 3.3 per 100,000 adults per year with a prevalence of 9.5 per 100,000 adults. Pregnancy does not increase the frequency or severity of ITP, but ITP can significantly affect pregnancy and cause bleeding in women.Pregnancy requires regular control of the number of platelets: monthly in the I and II trimesters, every 2 weeks – in the III trimester, and weekly control near the delivery date. Indications for treatment are determined by the pregnant woman condition, not the fetus, since it has not been proven that the treatment reduces the risks of thrombocytopenia in newborns with the development of cerebral hemorrhage.The drug of the first line of treatment of such pathology is prednisolone at a dose of 1 mg/kg orally once a day. An increase in the number of platelets is usually observed within 3-7 days, the maximum response is determined after 2-3 weeks. If necessary, the dose can be increased. When the required level of platelets is reached, the dose can be gradually reduced by 10-20 % to the minimum dose necessary to maintain the number of platelets at an acceptable level.Thrombocytopathy can be the cause of primary hemostasis disorders, even if the number of platelets in the blood is normal. For diagnosis, tests are carried out to detect the aggregation ability of platelets. In addition, flow cytometry can be used, which makes it possible to detect the defects of surface membrane receptors, as well as defects of the end point of secretion.ITP is a common cause of thrombocytopenia after viral infections. The onset of this pathology is more often detected in the second and third weeks after the onset of COVID-19. The treatment aim is to prevent the significant bleeding in patients with COVID-19.The article presents a clinical case of a pregnant woman with ITP and thrombocytopathy, whose pregnancy was complicated by COVID-19. The patient complained on bleeding gums, the appearance of hematomas on the skin. Medical treatment of the main disease included prednisolone, eltrombopag, intravenous human immunoglobulin, transfusion of platelet concentrate. At 34–35 weeks of pregnancy alive boy was born with a body weight of 2800 g, length of 49 cm, 7–8 points on the Apgar scale.