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INNOVATIVE APPROACHES TO SCREENING, PREVENTION, THERAPY OF PREECLAMPSY AND "END POINTS" FROM IT IN THE CONDITIONS OF THE FERGHANA VALLEY Mamadiyeva M.S.1, Asrankulova D.B.2 Em ail: Mam adiyeva17161@scientifictext.ru
'Mamadiyeva Maxliyo Sobirxodjayevna—Assistant; 2Asrankulova Diloram Bahtiyarovna - Doctor of Medical Sciences, Professor, DEPARTMENT № ' OF OBSTETRICS AND GYNECOLOGY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: the incidence of obstetric and perinatal complications in the mother and newborn is proportional to the severity of preeclampsia. The use of water aerobic scan help prevent preeclampsia.
Preeclampsia is an important medical and social problem throughout the world, remaining one of the main causes ofperinatal and maternal morbidity and mortality. According to the Ministry of Health of Russia, over the past decade, hypertensive disorders during pregnancy rank 3-4 among the causes of maternal mortality/
Keywords: preeclampsia, therapy, prevention, screening.
ИННОВАЦИОННЫЕ ПОДХОДЫ К СКРИНИНГУ, ПРОФИЛАКТИКЕ, ТЕРАПИИ ПРЕЭКЛАМПСИИ И «КОНЕЧНЫХ ТОЧЕК» ОТ НЕЁ В УСЛОВИЯХ ФЕРГАНСКОЙ ДОЛИНЫ Мамадиева М.М.1, Асранкулова Д.Б.2
'Мамадиева Мехлиё Собирходжаевна — ассистент; 2Асранкулова Дилорам Бахтияровна — доктор медицинских наук, профессор, кафедра № ' акушерства и гинекологии, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: частота акушерских и перинатальных осложнений у матери и новорожденного пропорциональна тяжести преэклампсии. Использование аквааэробики может способствовать профилактике преэклампсии.
Преэклампсия - важная медицинская и социальная проблема во всем мире, она остается одной из основных причин перинатальной и материнской заболеваемости и смертности. По данным Минздрава России, за последнее десятилетие гипертонические расстройства во время беременности занимают 3-4 место среди причин материнской смертности. Ключевые слова: преэклампсия, терапия, профилактика, скрининг.
UDC 618.3-06-084
Relevance. Preeclampsia is an important medical and social problem throughout the world, remaining one of the main causes of perinatal and maternal morbidity and mortality. According to the Ministry of Health of Russia, over the past decade, hypertensive disorders during pregnancy rank 3-4 among the causes of maternal mortality [2, 6].
In developing countries, preeclampsia remains the cause of 40-80% of maternal mortality [4, 5]. Complications of preeclampsia are HELLP-syndrome, cerebrovascular accident, placental abruption, placental insufficiency with fetal growth retardation syndrome, obstetric bleeding [1, 3].
The consequences of severe preeclampsia and eclampsia reduce the quality of a woman's later life, which is associated with a high incidence of atherosclerosis, diabetes mellitus, and cardiovascular diseases.
In premature babies from mothers with preeclampsia, physical and mental developmental disorders are recorded, as well as a high percentage of somatic diseases [3, 8].
Purpose of the study. Reduction of complications of pregnancy and childbirth as a result of screening, prevention and therapy of PE in the Fergana Valley.
Materials and methods of research. Prenatal training with aqua-erobics was carried out in 67 pregnant women at risk of perinatal complications. 73 pregnant groups at risk of perinatal
complications received only drug therapy. 70 pregnant women with uncomplicated pregnancies, when registered, made up the control group. The course of pregnancy, childbirth and early neonatal period in children was studied using biochemical and instrumental methods.
Research results. Significant anamnestic determinants of early and severe preeclampsia are hypertension in the father of the pregnant woman, chronic arterial hypertension in the patient, the woman's history of infertility and cases of preeclampsia. The risks of early and severe preeclampsia are statistically significantly increased by true multiple pregnancies and pregnancies induced in an in vitro fertilization program.
The developed anamnestic model for the prognosis of preeclampsia in the first trimester of pregnancy with sufficient specificity (up to 83.7%) and sensitivity (up to 89.4%) makes it possible to identify a group of high risk of developing preeclampsia.
Significant clinical, laboratory and instrumental predictors of severe preeclampsia in the first trimester are platelet counts more than 243.00 x 109 / L, low-density lipoproteins more than 3.33 mmol / L, erythropoietin less than 9.61 mIU / ml, the coefficient of adequacy of erythropoietin production is less 0.758, the systolic-diastolic ratio in the uterine arteries for a period of 11-14 weeks is more than 3.25; for early preeclampsia - indicators of low density lipoproteins more than 3.22 mmol / l, erythropoietin less than 10.75 mIU / ml, the coefficient of adequacy of erythropoietin production less than 0.770.
The developed clinical-laboratory-instrumental model for the prognosis of preeclampsia in the first trimester of pregnancy with a specificity of up to 88.1% and a sensitivity of up to 88.6% (for severe preeclampsia up to 98.7%) allows us to establish a high-risk group of developing preeclampsia.
In pregnancy complicated by severe or early preeclampsia, anemia develops associated with preeclampsia (anemia of chronic diseases), characterized by redistributive iron deficiency, inhibition of erythropoiesis and inadequate production of erythropoietin.
In the dynamics of pregnancy, the number of platelets decreases, pro-inflammatory changes in the leukoformula are observed with a decrease in integral indicators of peripheral blood against the background of an increase in markers of endogenous intoxication and systemic inflammation, significant procoagulation shifts, an increase in liver function tests and nitrogen metabolism, and a change in electrolyte status are recorded.
In severe as well as early preeclampsia, a significant increase in placental expression of erythropoietin is recorded, which in the vascular endothelium and macrophages of the villous stroma is accompanied by an increase in the expression of markers of antiapoptosis and cell proliferation. In the syncytiotrophoblast, where the highest expression of erythropoietin is detected, there is a significant decrease in the expression of antiapoptosis markers in comparison with the indicators of cell proliferation and proapoptosis.
Inadequate production of erythropoietin during pregnancy in preeclampsia is associated with increased placental expression of erythropoietin, markers of cell proliferation ki-67 and antiapoptosis bcl-2 in the capillary endothelium and macrophages of the villous stroma, as well as an indicator of p53 proapoptosis in synchorithiotic vorins. In severe preeclampsia, there is a decrease in the expression of erythropoietin in fetal erythrocytes, which is associated with inadequate production of erythropoietin in the mother's body.
In severe as well as early preeclampsia, inadequately low erythropoietin production from the first trimester of gestation is accompanied by increased erythropoietin expression in the ischemic placenta. In conditions of inadequate production of erythropoietin, its pleiotropic effects on target organs (endothelium, liver, kidneys, central nervous system) decrease, which contributes to the development of multiple organ failure. The formation of hyporegenerative erythropoietic deficiency anemia additionally leads to an increase in hemic hypoxia and aggravation of systemic disorders.
In pregnant women who received complex prevention of preeclampsia using medical ozone, the adequacy of erythropoietin production is restored, hyporegenerative anemia of chronic diseases does not develop, there is no relative thrombocytopenia, an increase in markers of systemic inflammation, procoagulation shifts in hemostasis parameters, changes in liver function tests, parameters of protein, nitrogen, electrolyte metabolism , the normal parameters of the placental protein of trophoblastic P-globulin are preserved.
The developed algorithm for the prediction and prevention of preeclampsia made it possible to reduce the frequency of preeclampsia by 2.4 times, the severity of it by 4.6 times, which reduces the risks of sub- and decompensated placental insufficiency, increases the duration of pregnancy and improves maternal and perinatal pregnancy outcomes.
Output. Preeclampsia occurs in 10% of women. In the etiology of maternal mortality, this pathology is in third place. The incidence of obstetric and perinatal complications in the mother and newborn is proportional to the severity of the disease.
The transferred preeclampsia leaves unfavorable consequences in the subsequent years of life in the mother and child, the frequency of which is proportional to the severity of the disease and the duration of its course.
To date, the etiology and pathogenesis of preeclampsia have not been sufficiently studied. Therefore, the treatment of this pathology is distinguished by a significant variety and, often, with little expressed effectiveness.
In recent years, exercise in water, the so-called aqua aerobics, has been used in the complex treatment of preeclampsia. In the pathogenesis of preeclampsia, the leading role is played by disturbances in microcirculation processes, the development of oxidative stress, disturbances in central hemodynamics, gas exchange, which ultimately leads to.
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