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Efficiency expectant management in women with premature rupture of membranes
The received data testify that active inflammatory process in women with rheumatic heart defects is associated with a moderate sympathetic-adrenal activation, which is evidenced by statistically meaningful increase in heart rate without a significant effect on SAP and DAP [1]. However, in this situation, the inflammation activity, along with an increase of the myocardial hypoxia degree, clinically manifested in authentic fourfold prevalence of cardiac arrhythmias (especially ventricular arrhythmia), the repolarization process disturbances and significant trend to decelerate conduction of impulses in the myocardium of the atria and ventricles, in a minute, as well as volumetric parameters of heart,
especially its leftistsections, the misbalance of diastolic myocardial function and statistically significant trend to increase [2]. In addition, the blood coagulation activity in the group of women with active inflammation was slightly, but statistically significantly increased.
Thus, the presence of an active inflammatory process in women with rheumatic heart defects requires a careful analysis of clinical, functional and laboratory parameters. It is not excluded, that the monitoring of the above mentioned indicators of pregnant women in the dynamics, allows enough time to prevent the development of serious complications.
References:
1. Brytkova Y., Stryuk R., Bukhonkina Y. Elevated Sympathetic Tone as a Reason of Complex Arrhythmia during Pregnancy. First International Congress on Cardiac Problems in Pregnancy. - Hilton Valencia, Spain, 25-28 February, 2010. - P. 92.
2. Bukhonkina Y., Stryuk R. Ultrasound changes in pregnant women with congenital and acquired heart defects in the third trimester of gestation. First International Congress on Cardiac Problems in Pregnancy. - Hilton, Valencia, Spain. 25-28 February, 2010. - P. 101.
3. Collins L. J., Douglas P. S. Pregnancy in Heart Defect Patients. In Crawford M. H., DiMarco J. P. (eds): Cardiology 1st ed. - London: Mosby International Ltd, 2001. - P. 8.11.1-8.11.9.
4. Khairy P., Ionescu-Ittu R., Maskie A. S. et all. Changing mortality on congenital heart defect//J. Am. Coll. Cardiol. - 2010. - 56: 1149-1157.
5. Robson S. C., Dunlop W., Moore M. et all. Combined Doppler end echocardiographic measurement of cardiac output: theory and application in pregnancy//Br. J Obstet Gynaecol. - 1987. - 94: 1014-1027.
6. Siu S. C., Sermer M., Colman J. M. et all. Prospective multicenter study of pregnancy outcomes in women with heart defect/Circulation. - 2001. - 104: 515-521.
7. Stangl V., Schad J., Gossing G. et all. Maternal heart defect and pregnancy outcome: a single-centre experience//Eur J Heart Fail. -2008. - 10: 855-860.
Ismailova Savrinisa Sultanovna, Independent competitor, Andijon State Medical Institute, Uzbekistan E-mail: evovision@bk.ru
Efficiency expectant management in women with premature rupture of membranes
Abstract: The aim of this study is to evaluate the effectiveness of the monitoring of pregnant women with preterm rupture of membranes, including the determination of the level of white blood cells, ESR in the blood, assessment of vaginal flora and the presence of elements of amniotic fluid in vaginal discharge (every 12 hours), thermometry (every 3 hours). Also assessed the condition of the fetus: Doppler and cardiotocography utero-placental and fetal blood flow.
Keywords: premature labor, premature rupture of membranes, pregnancy, expectant management.
Premature rupture of membranes (PROM) — a complication of pregnancy, often enough entailing a number of perinatal and obstetric problems, especially in preterm pregnancy. waters of the waste at one time in large numbers, and diagnosis of PROM is not difficult, but in 47 % of cases, when there are microcracks or lateral rupture of membranes without the massive outpouring, doctors doubt the correct diagnosis, which threatens to overdiagnosis and unnecessary hospitalizations or vice versa infectious complications of late detection. If uterine activity PROM is correct, choose watchful waiting [1].
The aim of our study was to evaluate the effectiveness of expectant management in women with PROM, depending on ges-tational age.
Material and methods. We examined 203 pregnant women with premature rupture of membranes are divided into 3 groups according to the duration of anhydrous period:
- group 1 of 75 (35.9 %) of women with premature rupture of membranes who underwent pregnancy prolongation in a dry period, the duration of which amounted to 24 hours;
- group 2 — 69 (33.0 %) of women with premature rupture of membranes who underwent pregnancy prolongation in a dry period, the duration of which amounted to 72 hours.
- group 3 — 59 (28.2 %) of women with premature rupture of membranes who underwent pregnancy prolongation in a dry period, the duration of which accounted for more than 72 hours.
Results and its discussion
Analysis of examination of pregnant women by age showed that the vast majority of women in all three groups (68.3 %, 53.0 % and 65.0 % respectively in groups) experienced premature rupture of membranes in the period from 20 to 25 years primigravidae 1 group was slightly more than half (51.2 %); in group 2 — 41.9 %; in group 3 — 65.0 %. Primigravidae in group 1 were slightly more than half (51.2 %); in group 2 — 41.9 %; in group 3 — 65.0 %.
In somatic history of childhood infections occurred in 16 (39.6 %) of pregnant women group 1, 19 — (44.2 %) and 5 (12.5 %) — 3 groups. Frequent SARS to present pregnancy
Section 5. Medical science
occurred in 33 (80.5 %) ofpregnant women 1 group, 24 (55.8 %) — 2 group and in 10 (25.0 %) — 3 groups.
The index of an illness in group 1 was 1.9, in group 2 — 1.6 in group 3 — 1.2, indicating that the connection between the frequency and timing of an illness prolongation. Apparently, this dependence is the result of reduction of immunity in women with a history burdened. Diseases of the liver and biliary tract, thyroid, respiratory and urinary system is not common, and in rare cases. PROM during previous pregnancy, not to full-term period of time (the risk of "relapse" is 16-32 %, which is 8.4 times higher than in women without a history of PROM — 4 %); uterine bleeding during the current pregnancy — 18 (24.0 %), 6 (8.7 %) and 0, respectively, groups; systemic connective tissue disorders (Ehlers-Danlos syndrome, systemic lupus erythematosus) — 2 (2.7 %), 2 (2.9 %), 1 (2.5 %), respectively, groups; blunt abdominal trauma — 1 (1.3 %), 1 (1.4 %), and 0; premature birth — 6 (8.0 %), 3 (4.3 %), 2 (5.0 %); bad habits: smoking; drug addiction (cocaine) — 3 (4.0 %), 1 (1.4 %) and 0; anemia — 38 (50.7 %), 40 (58.0 %) and 39 (97.5 %); underweight before pregnancy (BMI < 19.8 kg/m 2) 2 (2.7 %), 0 and 0; moreover inadequate intake of copper and ascorbic acid, and low socioeconomic status.
When PROM pregnant complained of liquid discharge from the genital tract. In marked leakage of amniotic fluid decreases the volume and height of the belly of a pregnant uterus is reduced. Joining chorioamnionitis is characterized by symptoms of intoxication: chills, fever.
The course of this pregnancy was complicated by the threat of an interruption in the early and late stages. All pregnant women with PROM used expectant management of labor management, which consisted in the rejection of induction oflabor in the absence of the evidence. All pregnant women carried out a monitoring control: determination ofwhite blood cell count, erythrocyte sedimentation rate in blood, assessment of vaginal flora and the presence of amniotic fluid cells in vaginal discharge (every 12 hours), thermometry (every 3 hours). Also assessed the condition of the fetus: Doppler and cardiotocography utero-placental and fetal blood flowWhen PROM pregnant complained of liquid discharge from the genital tract. In marked leakage of amniotic fluid decreases the volume and height of the belly of a pregnant uterus is reduced. Joining chorioamnionitis is characterized by symptoms of intoxication: chills, fever.
The course of this pregnancy was complicated by the threat of an interruption in the early and late stages. All pregnant women with PROM used expectant management of labor management, which consisted in the rejection of induction oflabor in the absence of the evidence. All pregnant women carried out a monitoring control: determination ofwhite blood cell count, erythrocyte sedimentation rate in blood, assessment of vaginal flora and the presence of amniotic fluid cells in vaginal discharge (every 12 hours), thermometry (every 3 hours). Also assessed the condition of the fetus: Doppler and cardiotocography utero-placental and fetal blood flow. Expectant management is used to enable the development of spontaneous labor, and, in order to complete the prevention of fetal distress. Prevention of fetal distress syndrome was conducted in the 1st group of women by the conventional scheme: intramuscular injections with an interval of 8 hours trisubstituted dexamethasone 8 mg. Induction of labor with oxytocin was carried out in 8 (33.3 %) women in group 2 when dry period from 24 to 48 hours. This tactic was due to the results of monitoring: growth leukocytosis and acute phase indicators, the emergence of hyperthermia, the emergence of the state of violations of the fetus according to CTG and DOPPLE-ROGRA.PHY. In the 2nd group ofwomen anhydrous period of time
from 24 to 48 hours was 20.8 % of women. Of these, 3 pregnant women noted the growth of white blood cells and hyperthermia, in 2 women — violation of utero-placental circulation II stage, which was the justification for induction of labor and delivery is urgent. In 5 pregnant women who had signs of horeoamnionita, antibiotic therapy was started [2].
In our studies of pregnant women born 203, 147 (72.4 %) living children immediately after birth, 57 (27.6 %) died in the antenatal and intrapartum periods. Anthropometric data of newborns, including deaths in antenatal and intrapartum periods, groups are statistically indistinguishable, no significant changes. In our study, antenatal fetal death occurred only in 2 (5.0 %) cases, and the fruits were killed in prolonging pregnancy over 72 hours to 12 hours — 5 (12.2 %), and 25 to 72 hours — 3 (7.0 %). With the extension of the prolonged period of more than 72 hours, we found no increase in the frequency of antenatal fetal death, when PROM in terms of22-27 weeks.
Childbirth in intrapartum period in group 1 and in group 2 died on the 2 (4.9 % and 4.7 %, respectively) infants.
The frequency of intrapartum fetal death in pregnant women undergoing pregnancy prolongation was 2.5 times lower than those who gave birth immediately. In the group where it was possible to prolong pregnancy for more than 72 hours, there is the significant reduction in intrapartum mortality — 2.5 times. In assessing the state of infants in both groups surveyed were identified that were born in a state of asphyxia 33.3 % (8) infants in the 1st group and 8.3 % (2) newborn — in the 2nd group. The highest percentage of early neonatal mortality 6 (14.6 %) were in the group, where the duration of the prolonged period was less than 12 hours. Less all died in the early neonatal period, only those infants who were in a prolonged period of more than 72 hours.
In prolongation of pregnancy complicated missile defense more than 72 hours, there is a fairly significant reduction in child mortality — 5 times. But the prolongation of pregnancy less than 72 hours, the infant mortality rate is comparable to 1 group.
If you move to a common denominator of all mortality rates fetuses and newborns with premature rupture of membranes, in terms of gestation 22-27 weeks, it should be possible to prolong pregnancy, at least 8 days, since the only way to reduce the overall mortality rate from 83.3 to 19.2 %.
The highest percentage of early neonatal mortality 6 (14.6 %) were in the group, where the duration of the prolonged period was less than 12 hours. Less all died in the early neonatal period, only those infants who were in a prolonged period of more than 72 hour-sIn prolongation of pregnancy complicated missile defense more than 72 hours, there is a fairly significant reduction in child mortality — 5 times. But the prolongation of pregnancy less than 72 hours, the infant mortality rate is comparable to 1 group.
If you move to a common denominator of all mortality rates fetuses and newborns with premature rupture of membranes, in terms of gestation 22-27 weeks, it should be possible to prolong pregnancy, at least 8 days, since the only way to reduce the overall mortality rate from 83.3 to 19.2 %.
The highest percentage of early neonatal mortality 6 (14.6 %) were in the group, where the duration of the prolonged period was less than 12 hours. Less all died in the early neonatal period, only those infants who were in a prolonged period of more than 72 hours.
In prolongation of pregnancy complicated missile defense more than 72 hours, there is a fairly significant reduction in child mortality — 5 times. But the prolongation of pregnancy less than 72 hours, the infant mortality rate is comparable to 1 group.
Morphological changes of newborns coronary vessels in preeclampsia in mothers
Conclusion terms of gestation 22-27 weeks, it should be possible to prolong
If you move to a common denominator of all mortality rates pregnancy, at least 8 days, since the only way to reduce the overall fetuses and newborns with premature rupture of membranes, in mortality rate from 83.3 to 19.2 %.
References:
1. Premature V. M. Birth/V. M. Sidelnikova//Materials of the V Russian forum "Mother and child". - M., 2003. - P. 320.
2. Caughey A. B. Contemprorary Diagnosis and Management of Preterm Premature Rupture of Membranes/A. B. Caughey, J. N. Robinson, E. R. Norwiz//Rev. Obstet. Gynecol. - 2008. - Vol. 1, № 1. - P. 11-12.
Israilov Radjab Israilovich, MD Professor, Tashkent Medical Academy E-mail: rpam89@mail.ru Tursunov Khasan Ziyaevich, MD Professor, Tashkent Medical Academy E-mail: tursunov.hasan@bk.ru Eshbaev Erkin Abdukhalimovich, Chair assistant, Tashkent Medical Academy
Morphological changes of newborns coronary vessels in preeclampsia in mothers
Abstract: In this work we made heart measuring, tissue measuring of coronary vessels and their walls in newborns born from mothers with preeclampsia. Heart weight is decreased when the edematous form of preeclampsia is present. Heart weight is increased with vessels number multiplication when the hypertensive form of preeclampsia is present. Walls of small arteries (SA) and arterioles (Ar) tunica media area is increased in 1.7 times, a major artery (MaA) in 1.2 times and a middle artery (MiA) in 1.3 times in comparison with the control values. The wall thickness and sectional area of the tunica media, the size of the lumen of the coronary arteries of all sizes have changed ambiguously. Thus in MaA and MiA the wall thickness and sectional area of the tunica media is increased, and in SA and Ar is decreased.
Keywords: preeclampsia, heart, newborn, coronary vessels, tissue measuring.
Relevance of the topic
Changes in a woman's body in pre-eclampsia, studied much better than the body of children born to mothers with a history of preeclampsia during pregnancy. The mother base body pathologies of the cardiovascular system of a spasm ofblood vessels, reduction in circulating blood volume, a change in blood clotting and flow, disturbance of microcirculation. The defeat of the inner lining of vessels — the endothelium leads to increase vascular permeability and exudation of fluid into the tissues, the yield change, viscosity and clotting, susceptibility to blood clots in the bloodstream. Furthermore, in preeclampsia there is a weakening of the heart and a reduction in the circulating blood. All this leads to a significant reduction ofblood supply to tissues with the development of degenerative changes in them up to tissue destruction. The organs most sensitive to the lack ofblood supply, are the heart, kidneys, liver and brain [1; 2; 5]. When preeclampsia pregnant structural and functional abnormalities in the internal organs: violation ofmicrocirculation, blood clots, degenerative changes in parenchymal cells, the development of punctate or small focal hemorrhage, increased intracranial pressure.
The placenta, mostly made up ofvessels that underwent characteristic for preeclampsia change, can not cope with its core function of ensuring the exchange of oxygen and nutrients between mother and fetus, causing the defeat of the cardiovascular system of the fetus and the intrauterine and the formation of a heart, and cardiovascular system of the fetus.
Objective. In order to identify pathological changes in coronary vessels by us laws hearts studied 27 infants died in the neonatal period born to mothers with preeclampsia.
Material and methods
They were measured and separately weighing the modified method [3; 4; 9]. Heart filmed as a whole, and after the division into departments. Pieces of myocardium was excised for histological examination in accordance with the existing guidelines Avtandilov G. G. The material was fixed in 10 % neutral formalin and embedded in paraffin. Histological sections stained with he-matoxylin and eosin, by van Gieson. To determine the density of myocardial blood vessels counted in their number to 1.72 mm 2 cut area not less than 20 sites. Coronary artery divided major artery (MaA) (more than 115 microns), middle artery (MiA) (35-115 microns), small arteries (SA) (25-35 microns) and arterioles (Ar). Measurements were carried out screw ocular micrometer MOV-1-15*. In each vessel was determined diameter, width and thickness of the wall of the lumen [6; 7; 8]. Media cross-sectional area was calculated by the formula: 0.785 (ab-a1b1), where a, b and a1 and b1 — large and small, respectively, the outer and inner diameters of the shell. Also, in the media wall of the coronary vessels to count the number of smooth muscle cells. All digital material was subjected to statistical analysis. To determine the reliability of the data used t-test.
Results of the study
The results showed that the presence of maternal edematous forms preeclampsia neonatal noted a slight decrease in heart weight, on average to 23.4 ± 1.3 g. (rate of 26.6 ± 1.5 g.) of ventricular wall thickening due to edema endocardium, pericardial and myocardial interstitium. Hypertensive form of preeclampsia was accompanied by a narrowing of the lumen of the coronary vessels,
