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Section 6. Medical science
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Zufarova Shakhnoza Alimjanovna, Professor, Department of Obstetrics and Gynecology, Tashkent Pediatric Medical Institute Muftaydinova Shakhnoza Kiemitdinovna, Assistant of the Department of Obstetrics and Gynecology of Andijan State Medical Institute E-mail: evovision@bk.ru
The effectiveness of individual pregravid preparation at early and late stages of pregnancy in women with hyperandrogenism
Abstract: Individualized complex therapeutic measures conducted for the purpose of correction and prevention of GA TF
with in pregravid preparation, reduces the level of active androgens and hemostasis parameters to values close to normal, and
reduce the incidence of pregnancy loss.
Keywords: Hyperandrogenism, pregnancy, pregravid preparation.
The main task of modern obstetrics is to reduce the number of reproductive losses, and the relevance of miscarriage is not in doubt, since it is the most frequent complication.
The main task of modern obstetrics is to reduce the number of reproductive losses, and the relevance of miscarriage is not in doubt, since it is the most frequent complication. Despite the progress in recent years, advances in the prevention and treatment of this disease, the frequency of NB is stable and high enough. Thus, according to different authors, it is from 2 % to 55 %, reaching 80 % of the first trimester [2; 3]. No degradation of NB frequency points to the difficulties encountered in the management of this group of patients. On the one hand, they are due to multifactorial etiology and pathogenetic mechanisms of disease. On the other — the imperfection of diagnostic methods used and the lack of adequate monitoring of complications arising during pregnancy.
Fetal loss syndrome — a new term that emerged in recent years and includes [4]:
- one or more spontaneous abortions or developing pregnancy on term of10 weeks or more;
- Stillbirth;
- Neonatal death;
- Three or more spontaneous abortions before 8 weeks of embryonic development.
The aetiology of the syndrome of fetal loss is extremely varied and depends on many factors. Some of them lead directly to abnormal embryo tab, others create unfavorable conditions for its normal development.
The main causes of pregnancy loss: genetic, endocrine disorders, infectious and inflammatory diseases, immunological mechanisms and thrombophilia. By genetic factors often involve embryonic chromosomal abnormalities, which appear as a result of the merger of the two parent cells with point mutations in the chromosome set, arising from a violation of the process of meiosis.
Purpose of the study
To study the efficacy of individualized comprehensive pregravid preparation of patients with hyperandrogenism of various origins in order to reduce the frequency of complications during pregnancy, childbirth and CPR warning.
Materials and methods
The work is based on the results of clinical and hormonal inspection 19 pregnant women aged 21 to 41 years (mean age: 29 ± 0.9 years), including 14 pregnant women from the prospective
The effectiveness of individual pregravid preparation at early and late stages of pregnancy in women with hyperandrogenism
study group and 5 patients with non-developing pregnancy from the group of retrospective surveillance.
Inclusion criteria were before pregnancy: clinical signs GA — an-drogen-dependent dermopathy (hirsutism, acne, seborrhea, alopecia); laboratory signs of HA with the assessment of androgen metabolites with increased steroid activity (Tobsch > 3.0 nmol/L, TSV> 2.5 pg/ml, androstenedione [An] > 10.0 nmol/L, DHT > 350 pg/ml).
In 9 (51 %) with the GA core group research revealed violations of hemostasis system, including signs of congenital and acquired thrombophilia (TF). Finally, in the study included 19 patients diagnosed with GA: in 16 GA patients was identified before pregnancy, it has been assigned and carried out comprehensive predravid preparation; in 3 pregnant women with hyperandrogenism NRB was identified for admission to hospital in the early stages of pregnancy and pregravid preparation have not been evaluated.
Efficiency pregravid preparation was assessed by clinical characteristics of pregnancy (especially in the early stages to 10 weeks), as well as the values and dynamics of hormonal parameters in comparison with the group of patients without GA.
Preparing for pregnancy was conducted in women with HA as the first stage of the prevention of complications of pregnancy and the development of NGN.
GA correction performed depending on the origin of the state: the detection of adrenal genesis GA women administered dexa-methasone in individually adjusted doses (initial dose — 0.125 mg. or 1/4 tablets); when ovarian genesis of HA administered combined oral contraceptives and the appropriate therapy is insulin resistance (metformin 500 mg/day).
Inclusion criteria were before pregnancy: clinical signs GA — an-drogen-dependent dermopathy (hirsutism, acne, seborrhea, alopecia); laboratory signs of HA with the assessment of androgen metabolites with increased steroid activity (Tobsch > 3.0 nmol/L, TSV> 2.5 pg/ml, androstenedione [An] > 10.0 nmol/L, DHT > 350 pg/ml).
Preparing for pregnancy patients with a combination of HA and HF was performed in fertile cycle, taking into account the identified defects ofhemostasis and history features. The complex preparation
for pregnancy patients with HA and HF administered vitamin that is activated folic acid (at least 1 mg/day), vitamin E 400 IU, polyunsaturated fatty acids (omega-3). In the presence of hyperhomocys-teinemia and MTNRI mutations. C677T carried pathogenetically substantiated therapy include folic acid 5 mg/day (5 mg. folacin), B vitamins Due to the low molecular weight heparins, in most cases used fraxiparine dose of 2850-5700 IU 1 time/day, sc), in doses that depend levels of thrombophilia markers and platelet aggregation activity. Specific methods of investigation include ultrasound and Doppler study, cardiotocography (CTG) in dynamics, ECG, echocardiography.
Hormonal dynamics studies were conducted after detection of pregnancy, or from 5 to week 10 and further 12-13, 15-16, 20-21, 25-26, 30-31, 35-37 weeks of pregnancy. Defines the following hormonal parameters — serum concentrations of progesterone (P), estradiol (E2), estriol (E3), Tobsch, TSV 17-OH, DHT.
Revealed a history of GA patients with higher burdened menstrual, reproductive and gynecological and somatic medical history indicates a high risk of fetal loss (especially in the early stages) in the current pregnancy. These data confirm the results of other researchers, from which it follows that a greater or lesser degree to 70 % of menstrual disorders, and 75 % of endocrine infertility, and 30 % — of pregnancy loss due to hyperandrogenism.
Note that in our study PCOS was diagnosed in 32.9 % of the women in group I and 41.7 % — in the II group; adrenal and Mixed HA diagnosed in 67.1 and 58.3 % of women, respectively. These data are consistent with results of studies M. Hunter et al. (2000) reported that among patients with PCOS GA frequency of 30-40 %.
Conclusions
Patients with hyperandrogenism (HA), have a high risk of reproductive disorders and early fetal loss (up to 1012 a week) are characterized by significantly higher rate in the history of ovarian dysfunction (57.6 % versus 35.3 % in the group of patients without GA), infertility (41.2 % vs. 5.8 %), and the reproductive losses (56.5 % in the HA against 17.7 % in the group without GA).
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