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PHYSICAL MULTIMORBIDITY IN PREGNANT WOMEN: ANALYSIS OF EPIDEMIOLOGICAL STATUS, ADEQUATE WAYS OF PREVENTION
AND TREATMENT Abdukaharova S.K.1, Asrankulova D.B.2 Email: Abdukaharova17161@scientifictext.ru
'Abdukaharova Sevarahon Kozimjonovna — Assistant; 2Asrankulova Diloram Bahtiyarovna — Doctor of Medical Sciences, Professor, DEPARTMENT OF OBSTETRICS AND GYNECOLOGY № ', AND1.JAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: in recent years, there is often a combination of several diseases in women during pregnancy, which requires a special approach to management in order to successfully deliver and ensure the required level of health of the mother and child.
Multimorbidity in pregnant women leads to a complex intertwining of many symptoms, reducing their usual diagnostic value for a doctor.
The article reveals the prevalence of diseases among pregnant patients. A pregnant patient has an average of 5 to '2 diseases, the leading place among which is taken by cardiovascular diseases. Keywords: multimorbidity, reproductive age, pregnant woman, epidemiological status, prevention.
ФИЗИЧЕСКАЯ МУЛЬТИМОРБИДНОСТЬ У БЕРЕМЕННЫХ: АНАЛИЗ ЭПИДЕМИОЛОГИЧЕСКОГО СТАТУСА, АДЕКВАТНЫЕ ПУТИ ПРОФИЛАКТИКИ И ЛЕЧЕНИЯ Абдукахарова С.К.1, Асранкулова Д.Б.2
'Абдукахарова Севарахон Козимжоновна — ассистент; 2Асранкулова Дилорам Бактияровна - доктор медицинских наук, профессор, кафедра акушерства и гинекологии № ', Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: в последние годы нередко встречается сочетание нескольких заболеваний у женщин во время беременности, что требует особого подхода к ведению с целью успешного родоразрешения и обеспечения необходимого уровня здоровья матери и ребенка. Мультиморбидность у беременных приводит к сложному переплетению многих симптомов, снижая их привычную для врача диагностическую ценность.
В статье выявлена распространенность заболеваний среди беременных пациенток. У беременного пациента насчитывается в среднем от 5 до '2 заболеваний, лидирующее место среди которых занимают сердечно—сосудистые заболевания.
Ключевые слова: мультиморбидность, репродуктивный возраст, беременная женщина, эпидемиологический статус, профилактика.
UDC 6'6.'3.002
Relevance. Multimorbidity is increasingly becoming the norm, especially in pregnant women, and presents huge problems for patients and their doctors [2, 6].
Quality and outcome frameworks and commitment to evidence-based practice, chronic disease care models have focused on specific diseases or conditions [5, 9].
Recommendations for individual conditions may not apply to a person with more than one of these conditions, and aggressive treatment of multiple conditions can do more harm than good.
For women with multimorbidity, attention needs to be paid to individualized care and tailored to the needs and priorities of each pregnant woman [3,7].
As the population ages, multimorbidity is becoming the norm rather than the exception. Around the world, studies show that multimorbidity increases with age and with socioeconomic deprivation [1, 4].
One primary care study in England found that one in six people had multiple chronic conditions listed in the QOF, and that these people use a third of consultations in general practice. With the definition of chronic conditions extended beyond the QOF, more than half had multimorbidity, and these accounted for more than three quarters of consultations [8].
One large Scottish study from 2012 found that about 65% of people over the age of 65 and almost 82% of people age 85 and over had multimorbidity.
The likelihood of a mental health disorder increases with the number of physical health conditions. Purpose of the study. To identify the prevalence of diseases among pregnant patients. Materials and research methods. We examined 65 patients who were on examination and inpatient treatment in the therapeutic departments of the AGMI clinic in pregnant women with multimorbid diseases.
Research results. The presence of multiple somatic pathology seriously complicates the course of pregnancy. Polymorbidity increases the risk of pathological conditions during gestation, such as polyhydramnios / oligohydramnios, the threat of termination of pregnancy, inflammatory diseases of the pelvic organs.
At the same time, pregnancy can lead to a worsening of the course of other somatic diseases -hypertension, diabetes mellitus and its complications.
The presence of polymorbidity in a pregnant woman requires obstetricians-gynecologists to be especially wary of such a patient.
To reduce the risk of pregnancy pathology, it is necessary to carefully monitor the course of pregnancy and childbirth and timely correction of concomitant pathology by a group of specialists - an obstetrician, endocrinologist, therapist, nephrologist.
In recent years, there has been an increase in the number of pregnant women with type II diabetes in the population due to the fact that the disease has become "younger", and the average age of pregnancy is "older."
The prevalence of all forms of diabetes mellitus (DM) among pregnant women reaches 3.5%, type 1 and 2 diabetes mellitus - 0.5%, gestational diabetes, or pregnancy diabetes - 1-3%. Diabetes mellitus complicates the course of both pregnancy and childbirth, and the postpartum period. Compared to healthy women, pregnant women with type II diabetes are more likely to have preeclampsia (60-70%), polyhydramnios, placental insufficiency, urinary tract infections, and pelvic inflammatory disease.
In the course of our clinical and experimental studies, it has been shown that in the first weeks of pregnancy, hyperglycemia and associated metabolic disorders affect the development of such perinatal complications as spontaneous abortion (35-70%), early delivery (25-60%), diabetic fetopathy ( 4483%), intrauterine hypoxia (37-76%), neonatal hypoglycemia (29%), respiratory distress syndrome.
Most researchers have recognized the presence of hyperglycemia in early gestation as the main teratogenic factor. The most common malformations in children from mothers with type II diabetes are congenital heart defects. In addition, women with diabetes by the time of pregnancy, as a rule, have various comorbidities: morbid obesity, arterial hypertension, metabolic disorders, micro- and macrovascular complications of diabetes (diabetic retinopathy, diabetic nephropathy, vascular lesions of the heart, brain, peripheral vessels of the lower extremities, etc.), which has an additional negative impact on the outcome of pregnancy.
Output. The possibility of successful management of a pregnant woman with multimorbidity has been demonstrated. This became possible due to the interdisciplinary interaction of several specialists: cardiologist, obstetrician-gynecologist, endocrinologist, rheumatologist.
References / Список литературы
1. Barnett K., Mercer S.V., Norbury M. et al. The epidemiology of multimorbidity and its implications for health care, research and medical education: a cross-sectional study. Lancet, 2012. Jul. 7380 (9836): 37-43.
2. Guthrie B., Payne K., Alderson P. et al. Adaptation of clinical guidelines to account for multimorbidity. BMJ, 2012. Oct. 4345: e6341.
3. Durden Martin and others. Optimizing Polypharmacy and Drugs: Ensuring Safety and Reliability, TheKingsFund. 28 November, 2013.
4. Moffat K., Mercer S. W. Problems of managing people with multimorbidity in modern health care systems. BMC FamPract., 2015. Oct. 1416: 129.doi: 10.1186 / s12875-015-0344-4.
5. Payne R.A., Avery A.J., Duerden M. et al. Prevalence of polypharmacy in the Scottish primary population. Eur J ClinPharmacol., 2014. May. 70 (5): 575-81. doi: 10.1007 / s00228-013-1639-9. Epub. 2014 Feb 1.
6. Smith S.M., Wallace E., O'Dowd T. et al. Interventions to improve outcomes in patients with multimorbidity in primary care and community settings. Cochrane SystRev Database, 2016. March. 143: CD006560. doi: 10.1002 / 14651858.CD006560.pub3.
7. Salisbury S., Johnson L., Purdy S. et al. Epidemiology and the impact of multimorbidity in primary care: a retrospective cohort study. Br J GenPract. Jan., 2011. 61 (582): e12-21. doi: 10.3399 / bjgp11X548929.
8. O'Mahony D, O'Sullivan D, Byrne S. et al. STOPP / START Criteria for Potentially Inappropriate Prescribing of Medicines to the Elderly: Version 2. Age Aging., 2015. Mar. 44 (2): 213-8. doi: 10.1093 / aging / afu145. Epub 2014. Oct 16.
9. Violan C., Foguet-Boreu Q., Flores-Mateo G. et al. Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies. APPROVES, 2014 Jul 219 (7): e102149. doi: 10.1371 / journal.pone.0102149. eCollection 2014.
HYPERTENSIVE AND VEGETATIVE CRISES DURING PREGNANCY: EPIDEMIOLOGY, RISK FACTORS AND STRATEGIC DIRECTIONS FOR PREVENTION IN THE CONDITIONS OF THE FERGANA VALLEY Kuziyeva G.A.1, Asrankulova D.B.2 Em ail: Kuziyeva17161 @scientifictext.ru
'Kuziyeva Gulruh Alijonovna - Assistant; 2Asrankulova Diloram Bahtiyarovna - Doctor of Medical Sciences, Professor, DEPARTMENT OF OBSTETRICS AND GYNECOLOGY № ', AND1.JAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: arterial hypertension (AH) in pregnant women occupies a special place among the pressing issues of modern medicine. It is an integral part of at least two extremely acute medical and social problems today: hypertension in general and the reproductive health of the nation. The main problem of hypertension in pregnant women: the lack of a unified terminology, the use of different classification and criteria for hypertension, tactics of patient management. We tried, on the basis of evidence-based medicine, to present the classification of hypertension in pregnant women and the principles of drug therapy, including emergency care in hypertensive crisis. Keywords: pregnancy, arterial hypertension, pharmacotherapy.
ГИПЕРТЕНЗИВНЫЕ И ВЕГЕТАТИВНЫЕ КРИЗЫ ПРИ БЕРЕМЕННОСТИ: ЭПИДЕМИОЛОГИЯ, ФАКТОРЫ РИСКА И СТРАТЕГИЧЕСКИЕ НАПРАВЛЕНИЯ ПРОФИЛАКТИКИ В УСЛОВИЯХ ФЕРГАНСКОЙ ДОЛИНЫ Кузиева Г.А.1, Асранкулова Д.Б.2
'Кузиева Гулрух Алижоновна - ассистент; 2Асранкулова Дилорам Бактияровна - доктор медицинских наук, профессор, кафедра акушерства и гинекологии № ', Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: артериальная гипертония (АГ) беременных занимает особое место среди актуальных вопросов современной медицины. Она является составной частью как минимум двух чрезвычайно остро стоящих сегодня медико-социальных проблем: АГ в целом и репродуктивного здоровья нации. Основная проблема АГ у беременных: отсутствие единой терминологии, использования различных классификаций и критериев АГ, тактики ведения пациенток. Мы попытались на основе доказательной медицины представить классификацию АГ у беременных и принципы лекарственной терапии, включая неотложную помощь при гипертоническом кризе.
Ключевые слова: беременность, артериальная гипертензия, фармако-терапия.
UDC 6'6 - 009. '2 - 055. 26: 616.839
Relevance. Hypertensive disorders in pregnant women are the main among the most common and most important diseases and syndromes of the cardiovascular system. The significance of this problem
