Predictors of the Development of Obstetrics Complications and the Management Algorithm of Pregnant Women With Connective Tissue Dysplasia of the Heart

Abstract

Pregnancy, even under the condition of its physiological course, is accompanied by tension of all functional systems of the body, which occurs already from the first trimester of pregnancy and increases during the period of their functional restructuring. In the presence of undifferentiated connective tissue dysplasia (UCTD), gestational processes may be disrupted and lead to obstetric losses. The purpose of the work is devoted to the optimization of pregnancy management tactics, treatment and prevention of obstetric complications in women with connective tissue dysplasia and mitral valve prolapse, complicated by extrasystolic arrhythmia, through the differentiated use of complex drug treatment, which makes it possible to normalize the main pathogenetic factors of the development of pregnancy complications with this comorbid pathology. Material and methods. To solve the goal, 164 pregnant women with signs of UCTD and mitral valve prolaps (MVP) and 26 healthy pregnant women were examined. In addition to a general clinical and obstetric examination, all pregnant women underwent a laboratory-instrumental study of the state of the fetus and fetoplacental complex, the state of the cardiovascular system, vascular endothelium, the activity of lipid peroxidation and antioxidant defense systems, and the determination of blood electrolyte balance. Research results and their discussion. It was established that the course of pregnancy in women with undifferentiated connective tissue dysplasia and mitral valve prolapse, complicated by extrasystolic arrhythmia (EA), is accompanied by a significantly higher frequency of obstetric and perinatal pregnancy complications during the entire gestation period (r=0.756-0.869, p<0.05). In pregnant women with UCTD and MVP syndrome, complicated by EA, the disease is clinically manifested by the development of both arrhythmic symptoms and signs of impaired vegetative status, which significantly shortens the time of blood supply and worsens metabolic processes in the myocardium and placenta, which are the direct causes of placental dysfunction, fetal growth retardation, the development of labor abnormalities and complications in the early postpartum period. The specified disorders in pregnant women with PMC on the background of UCTD are associated with hypo- and dyselectrolytemia of Mg2+, K+ and hypercalcemia, imbalances in the redox system, and the severity of endothelial dysfunction. In pregnant women with UCTD and MVP under the influence of the recommended treatment with arginine-carnitine and vitamin-mineral complex, the level of electrolytes, electrophysiological and functional indicators of the systolic-diastolic function of the myocardium were normalized to the level of healthy pregnant women due to the restoration of metabolic processes and improvement of peripheral hemodynamics, which was accompanied by satisfactory uterine placental-fetal blood flow (according to dopplerometry), a decrease in the frequency of miscarriage, preeclampsia, FGR and complications during childbirth and the postpartum period. Addition of the selective beta-adrenergic blocker nebivolol to the proposed medical support of pregnant women contributed to the elimination of extrasystole, was manifested by a reliable improvement of electrophysiological parameters and systolic-diastolic function of the heart. The obtained hemodynamic, antiarrhythmic and metabolic effects of the proposed complex therapy in pregnant women with UCTD and MVP complicated by extrasystolic arrhythmia were accompanied by a significant decrease in the frequency of pregnancy and childbirth complications. Conclusions. Recommended treatment algorithm have been proposed for the optimal management of pregnant women with UCTD and MVP syndrome, complicated by EA