Prevention of Great Obstetrical Syndromes in pregnant women with bioavailable progesterone resistance

Носенко, О. М.

doi:10.15574/hw.2020.148.15

2020

DOI: 10.15574/hw.2020.148.15

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Prevention of Great Obstetrical Syndromes in pregnant women with bioavailable progesterone resistance

О. М. Носенко¹

Abstract: The article presents modern literature data on the role of defective deep placentation in the development of great obstetrical syndromes, bioavailable progesterone and its receptors in the formation of the placenta and the development of pregnancy, mechanisms of development of resistance to bioavailable progesterone, and a scheme of the pathogenesis of progesterone deficiency during pregnancy as one of the main causes of great obstetrical syndromes. Modern data on the development of resistance to bioavailable… Show more

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2022

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Peculiarities of clinical characteristics of pregnant with symptoms of Great obstetrical syndromes

Lemish

2022

RHW

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The objective: to establish the risk factors for development of great obstetrical syndromes (GOS) on the basis of a prospective analysis of somatic, reproductive, obstetric anamnesis in pregnant women with clinical manifestations of GOSMaterials and methods. We conducted the analyses of somatic, reproductive and obstetrical history of 572 pregnant with clinical symptoms of GOS, who had the following complications: 21 – preeclampsia, 38 – preterm deliveries, 13 – placental abruption, 457 – gestational anemia, 27 – intrauterine growth retardation, 16 – fetal distress, that were diagnosed based on clinical, functional, laboratory, ultrasound, cardiotocographic and morphological investigations. All these complications are included in the group of GOS.Statistical analyze was conducted by using standard programs of Microsoft Excel 5.0 and Statistica 6.0.Results. The average age of the pregnant women was 26.5±2.3 years, most of them were in young reproductive age. The prevailing diseases in the structure of somatic pathology were thyroid gland pathology – 427 (74.6 %) persons, anemia 182 (31.8 %), arterial hypertension – 114 (19.9 %), kidney diseases – 241 (42.1 %) and diseases of gastro-intestinal tract –187 (32.7 %). Disorders of menstrual cycle were determined in 137 (23.9 %) women, chronic pelvic inflammatory diseases – 98 (17.1 %), background diseases of cervix (erosion, cervical dysplasia) had 142 (24.8 %) patients in anamnesis, colpitis – 296 (51.7 %), polycystic ovaries – 74 (12.9 %). The following pregnancy complications were diagnosed as preeclampsia – in 21 (3.7 %) persons, threatened preterm interruption of pregnancy in different gestational terms – in every third pregnant women (192 individuals – 33.7 %), anemia – 457 (79.9 %), preterm delivery – 38 (6.6 %) women, placental abruption – 13 (2.3 %), fetal growth retardation – in 27 cases (4.7 %), fetal distress – 16 (2.8 %). The rate of cesarean section in this group was 28.8 %.Conclusions. The identified peculiarities of somatic, reproductive history and obstetrical and perinatal pathology in pregnant with complications from GOS group allowed to define the following risk factors of their development: young reproductive age, significant frequency of socio-hygienic, medical and demographic and socio-psychological problems, complicated somatic, gynecological and reproductive history.

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Peculiarities of clinical characteristics of pregnant with symptoms of Great obstetrical syndromes

Lemish

2022

RHW

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Basic principles and structure of risk assessment of Great obstetrical syndromes

Lemish

2022

RHW

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The objective: to develop a method for predicting the individual risk for great obstetric syndromes (GOS).Materials and methods. An analysis of the somatic, reproductive, and obstetric anamnesis was conducted in 572 pregnant women with clinical manifestations of GOS, in 81 of them (prediction group) signs of placental dysfunction were detected based on clinical, functional, laboratory, and ultrasound data. Control group (CG) – 50 practically healthy pregnant women with a favorable reproductive history and an uncomplicated course of this pregnancy.Functional, biophysical, hormonal, immunological and hemocoagulation indicators were calculated to determine the informative (prognostic) significance. Quantitative signs were divided into diagnostic intervals, and qualitative signs were assigned a code. The following indicators were included in the standard protocol: age, data on somatic and gynecological history, data on the pregnancy course, results of functional and laboratory examinations. Statistical processing of research results was carried out using standard Microsoft Excel 5.0 and Statistica 6.0 programs. Results. In the I trimester of pregnancy the concentration of placental lactogen (PL) in the prediction group was 29.4 % lower than the CG indicator, estradiol (E2) amount – by 27.4 %, estriol (E3) – by 28.6 %, progesterone (PG) – by 34.4%, human chorionic gonadotropin (hCG) – by 28.3 % lower, and cortisol (CR) – by 36.1 % higher. At the beginning of the II trimester of pregnancy in the prediction group the level of PL was already reduced by 33.8 %, E2 – by 26.2 %, E3 – by 32.3 %, PG – by 37.4 %, hCG – by 30.6 %, and CR – increased by 43.6 % compared to CG.The indicators of placenta hormonal activity in the early stages of pregnancy and at the beginning of the II trimester can be prognostic signs of further disruption of the adaptive compensatory and adaptive reactions of the fetal placental complex (FPC) in the II and III trimesters of pregnancy. Among a wide range of hemostasiological indicators in the I trimester of pregnancy in the prediction group the most informative were: activated partial thromboplastin time (-23 %) and activated recalcification time (+16.2 %), the changes of which remained at the beginning of the II trimester (-40% and - 11.7% respectively). During the evaluation of thromboelastogram data, the value of “r+k” was fixed by 33.3 % lower in the I trimester and by 36 % – at the beginning of the II trimester of pregnancy. As a result of the analysis the indicators with a high information value (more than 3.0 c.u.) were selected for quantitative assessment of the degree of individual risk for the development of maladaptive disorders in the FPC. The clinical trial of the scoring method of prediction proved its high sensitivity (91.8 %) and specificity (85.6 %). Conclusions. A multi-faceted analysis of anamnestic data, features of the pregnancy course, basic clinical, laboratory and functional indicators in women with clinical manifestations of GOS made possible to develop an effective methodology for predicting the risk for GOS development with high levels of sensitivity and specificity.

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Prevention of Great Obstetrical Syndromes in pregnant women with bioavailable progesterone resistance

Cited by 2 publications

References 0 publications

Peculiarities of clinical characteristics of pregnant with symptoms of Great obstetrical syndromes

Peculiarities of clinical characteristics of pregnant with symptoms of Great obstetrical syndromes

Basic principles and structure of risk assessment of Great obstetrical syndromes

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