CC BY
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6. Maynard S.E., Min J.Y., Merchan J., Lim K.H., Li J., Mondai S., Libermann T.A., Morgan J.P., Sellke F. W., Stillman I.E., Epstein F.H., Sukhatme V.P., Karumanchi S.A. Excess placental soluble fms-like tyrosine kinase 1 (sFltl) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J ClinInvest, 2003. V. 111. P. 649-658.
7. Tuffneil D.J., Shennan A.H., Waugh J.J., Walker J.J. The management of severe pre-eclampsia / eclampsia. London (UK): Royal College of Obstetricians and Gynaecologists, 2006. Mar. 11 p.
8. Zhou C.C., Ahmad S., Mi T., Abbasi S., Xia L., Day M.C., Ramin S.M., Ahmed A., Kellems R.E., Xia Y. Autoantibody from women with preeclampsia induces soluble Fms-like tyrosine kinase-1 production via angiotensin type 1 receptor and calcineurin / nuclear factor of activated T-cells signaling. Hypertension, 2008. V. 51. P. 1010-1019.
CLINIC-EPIDEMIOLOGICAL FEATURES AND WAYS OF PREVENTION OF IRON DEFICIENCY CONDITIONS IN PREGNANT WOMEN Mamadaliyeva M.M.1, Asrankulova D.B.2 Email: Mamadaliyeva17161@scientifictext.ru
'Mamadaliyeva Mehriyor Mansurbekovna — Assistant; 2Asrankulova Diloram Bahtiyarovna - Doctor of Medical Sciences, Professor, DEPARTMENT № ' OF OBSTETRICS AND GYNECOLOGY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: the article presents a review of recent literature on an urgent global problem in obstetric and perinatal practice - iron deficiency anemia in pregnant women. This pathology, despite the introduction of modern methods of diagnosis, prevention and treatment, remains significant at the present time. It was found that among blood diseases in pregnant women, various forms of anemia account for 90%, of which 75-90% is iron deficiency anemia (IDA). Other forms of anemia are no more common than in the population of non-pregnant women.
Keywords: iron deficiency state, prevention, pregnant woman, clinical and epidemiological peculiarity.
КЛИНИКО-ЭПИДЕМИОЛОГИЧЕСКИЕ ОСОБЕННОСТИ И ПУТИ ПРОФИЛАКТИКИ ЖЕЛЕЗОДЕФИЦИТНЫХ СОСТОЯНИЙ У
БЕРЕМЕННЫХ Мамадалиева М.М.1, Асранкулова Д.Б.2
'Мамадалиева Мехриёр Мансурбековна — ассистент; 2Асранкулова Дилорам Бахтияровна — доктор медицинских наук, профессор, кафедра № ' акушерства и гинекологии, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: в статье представлен обзор литературы последних лет по актуальной мировой проблеме в акушерской и перинатальной практике — железодефицитной анемии у беременных. Данная патология, несмотря на внедрение современных методов диагностики, профилактики и лечения, остается значимой в настоящее время. Установлено, что среди болезней крови у беременных на долю различных форм анемии приходится 90 %, из которых 75—90 % составляет железодефицитная анемия (ЖДА). Другие формы малокровия встречаются не чаще, чем в популяции небеременных женщин.
Ключевые слова: железодефицитная состояния, профилактика, беременная женщина, клинико-эпидемиологическая особенность.
UDC 6'6.'55.'94.8:6'8.3-06
Relevance. According to the World Health Organization, the number of pregnant women who have been diagnosed with iron deficiency anemia reaches 20 million annually. Despite the organization of preventive programs in many developed countries, the level of IDA does not decrease, but, on the contrary, tends to increase by 12 times [2, 5].
If we consider world statistics, then the frequency of IDA in pregnant women is almost 3 times lower in developed countries compared to developing countries. This is explained by the programs carried out at the state level, which provide for mandatory examination of all pregnant women for the purpose of further management [1, 7].
Currently, in Russia, according to various sources, the level of anemia in pregnant women remains at a constant level and ranges from 35% to 42% [4, 6].
The great importance of IDA is due not only to the high incidence of this pathology in the structure of extragenital diseases among pregnant women, but also to the negative impact on the functioning of all systems and organs, as well as on pregnancy, childbirth, postpartum periods and on the fetus.
Anemia (from the Greek "lack of blood") is a clinical and hematological symptom complex, in which there is a decrease in hemoglobin and (or) erythrocytes in the blood.
Iron deficiency anemia is characterized by a lack of iron in the blood, red bone marrow (CMC), as well as in the depot (liver, spleen, muscles), which leads to a disruption in the formation of heme, the main structural component of hemoglobin [3].
Many authors distinguish the so-called physiological IDA of pregnant women, which is manifested by moderate and sometimes latent (latent) iron deficiency. The reason for this is to increase the volume of circulating blood required for the blood circulation of the fetus. Due to physiological IDA, the blood changes its rheological properties, its viscosity decreases, as the hematocrit decreases. At the same time, there is an improvement in microcirculation, which is a natural adaptation mechanism during pregnancy - the normal functioning of the placenta and nutrition of the fetus [8].
To date, according to L.F. Mozheiko, there are lower hemoglobin normal limits for pregnancy trimesters: in the first trimester - 110 g / l, in the second - 105 g / l, in the third - 100 g / l. Anything below these indicators already refers to pathological IDA.
Purpose of the study. Optimization of diagnostics, prevention and treatment of iron deficiency conditions in pregnant women and postpartum women based on the established pathogenetic variants.
Materials and research methods. The prospective study included 102 women, divided depending on the objectives of the study into 4 independent groups.
Research results. The frequency of manifest iron deficiency (MID) in pregnant women and women in childbirth over the past 5 years does not tend to decrease and is 25.9% in pregnant women and 11.2% in women in childbirth.
In pregnancy, complicated by mild MJ, compared with pregnancy not complicated by iron deficiency, placental insufficiency and premature birth are 4 times more likely to develop; 1.5 times more often - the threat of termination of pregnancy; in 1/3 of patients, the postpartum period is complicated by MJ; postpartum hemorrhage and infectious complications occur significantly more often; the incidence of premature babies and complications in newborns in the early neonatal period is significantly higher. In pregnant women with mild MJ, there was no significant effect of iron deficiency on the body weight of term infants and the value of their assessment on the Apgar scale at birth.
In pregnant women and postpartum women, with the development of iron deficiency states, there is a decrease in the level of the coefficient of adequacy of erythropoietin production in proportion to the stage of iron deficiency. The frequency of inadequate production of erythropoietin is on average detected in 47.2% of pregnant women with mild MJ, and in puerperas - in proportion to the severity of MJ (in 12% of puerperas with mild severity, in 50% - with moderate and 80% - with severe severity of MJ).
The effectiveness of treatment with iron preparations for pregnant women with IDS depends on the dose of elemental iron and on the level of endogenous erythropoietin. In pregnant women with an adequate level of erythropoietin, the effectiveness of treatment is 2.5 times higher than that in pregnant women with an inadequate level.
An algorithm for the diagnosis, prevention and treatment of IDS has been developed, which allows, based on the results of screening pregnant women and postpartum women (determination of indicators of various iron metabolism funds), to establish the pathogenetic variant of IDD and individualize treatment.
The introduction of the developed algorithm into widespread obstetric practice allows detecting early stages of IDD, effectively preventing the development of MAD (94%) and associated complications in the mother, fetus and newborn, and providing effective pathogenetic treatment.
Output. Thus, from all of the above, we can conclude that IDA of pregnant women is a serious pathology that entails many complications from both the mother and the fetus. Therefore, this problem requires mandatory and immediate correction.
References / Список литературы
1. Amonov I.I. Experience of using intramuscular iron preparation in the treatment of postpartum anemia Text. / I.I. Amonov // Hematology and Transfusiology, 2004. T.49. № 2. P. 42-43.
2. Bshchadze V.O. Application of the preparation of 3-valent iron "Ferlatum" and low molecular weight heparin in pregnant women with anemia and thrombophilia Text. / V.O. Bitsadze, E.S. Egorova, A.D. Makatsaria // Mother and Child: Materials of the VII Russian Forum. M., 2005. S. 31-32.
3. Danilova O.V. Indicators of the content of some trace elements in the blood serum in case of anemia of pregnant women Text. / O.V. Danilova, L.M. Tukhvatullina // Mother and Child: Materials of the IV Russian Forum. Part 1. M., 2002. S. 265-267.
4. Kholova D.P. Ultrasound indices of uterine involution in primiparous women with anemia Text. / D.P. Kholova, A.T. Boev, JI.M. Jalilova // Mother and Child: Materials VII Ros. forum. M., 2005. S. 282-283.
5. Akinsooto P.J. Soluble transferrin receptors in anemia of pregnancy Text. / P.J. Akinsooto, T. Ojwang, J. Govender, et al. // J. Obstet. Gynaecol., 2001. Vol. 21. № 3. P. 250-252.
6. Haram K. Iron supplementation in pregnancy evidence and controversies Text. / K. Haram, S. Nilsen, R. Ulvik // Acta. Obstet. Gynecol. Scand., 2001. Vol. 80. P. 683-688
7. Nishiyama S. Zinc and IGF-I concentrations in pregnant women with anemia before and after supplementation with iron and / or zinc Text. / S. Nishiyama, K. Kiwaki, Y. Miyazaki, et al. // Am. Coll. Nutr., 1999. Vol. 18. № 3. P. 261-267.
8. Ziaei S. Iron status markers in nonanemic pregnant women with and without iron supplementation Text. / S. Ziaei, M. Mehrnia, S. Faghihzadeh // Int J Gynaecol Obstet, 2008. Vol. 100. № 2. P.130-132.
