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The influence of active inflammation on parameters of central hemodynamics in pregnant women...
7. Dye Bruce A., Shenkin Johnathan D., Ogden Cynthia L., Marshall Teresa A., Levy Steve M., Kannellis Michael J. The relationship between healthful eating practices and dental caries in children aged 2-5 years in the United States, 1988-1994//J. of the Am. Dental Ass.
8. Davenport E. S., Litenas C., Barbayiannis P., Williams C. E. S. The effects of diet, breast-feeding and weaning on caries risk for pre-term and low birth weight children//Int. J. Paediatr. Dent. - 2004. - Vol. 14(4). - P. 251-259.
Zakirova Feruza Akildjanovna, Candidate of Medical Sciences, Doctoral Student of the Republican Specialized Center of Cardiology E-mail: [email protected] Bekbulatova Indira Rinatovna, Candidate of Medical Sciences, Scientific Secretary of the Republican Specialized Center of Cardiology E-mail: [email protected] Eliseeva Marietta Rafaelevna, Doctor of Medical Sciences, Professor, Chief Editor of the magazine «International Journal of Biomedicine»
E-mail: [email protected]
The influence of active inflammation on parameters of central hemodynamics in pregnant women with rheumatic heart defects
Abstract: The functional state of the cardiovascular system in women with rheumatic heart defect in conjunction with the activity of rheumatic process has been studied thoroughly. The results have revealed a higher frequency of heart contractions, the prevalence of ectopic activity in pregnant women with active rheumatic process. The activity and effectiveness of rheumatic process has also caused the slowing of the pulse conducts in myocardium of atria and ventricles, increasing of both linear and volumetric parameters of heart.
Keywords: pregnancy, rheumatic heart defects, rheumatic process activity, functional state of the cardiovascular system.
The cardiovascular system defects (CSD) in pregnant women continue to occupy the leading position within the structure of extra genital pathology and appear to be an important issuedue totheir prevalence, as well as the influence on maternal and perinatal mortality. During manydecades the rheumatic defects were frequent extra genital pathology in pregnant women [7]. But in recent decades, the incidence of the above mentioned defectin pregnant womenhas been declined due to the successful prevention of rheumatic fever [4]. It was established that 0.1-0.3 % of people, predominantly youth age, and women more often than men, are suffering from rheumatism. Moreover, 90 % of acquired heart defects have rheumatic etiology. Theheart disordersare referred to the group ofhigh risk cardiovascular complications and make up 5-10 % of all cardiovascular defects (CVD) [3]. There has been recently observed an increase in the number of pregnant women and mothers suffering from heart defects, which is explained bya number ofreasons: the early diagnosis of such defects; the possibility ofpregnancy maintenance in cases which were previously impossible; an increase in the number of women who have had a heart surgery, and the number of seriously ill women who are either by doctors'permission, or independently themselves decide to continue the pregnancy, being confident in the success of medical science and practice. The exacerbation of rheumatoid process affects the fetal developmentadversely, increases the risk of developing of complications from mother's side during pregnancy, as well as childbirth and postpartum period. This is explained by the fact that pregnancy increases the load on cardiovascular system, even in healthy women, while at risk of hemodynamic changes due to existing defects, the load increase many times многократно [5]. Fetal hypoxia, fetal death, malnutrition, prematurity, neonatal asphyxia, malformationsare common cases [6].
Objective: The identification of the influence of an active inflammatory process on parameters of central hemodynamics in pregnant women with rheumatic heart defect.
Research methods and materials
The study involved 70 pregnant women with rheumatic heart defectat the age of 19-35 years, in 2 and 3 trimester of gestation. Along with collecting the complaints and anamnesis data, the physical examination was also conducted during pregnancy. The evaluation of the functional state of the cardiovascular system was carried out comprehensively, taking into account the electrocardiographic and hemodynamic parameters. The electrocardiographic (ECG) indicators included: ECG in 12 standard leads. The assessment of hemodynamic parameters includedthe analysis of heart rate (HR); the level of blood pressure (BP), measured due to the standard method of Korotkov. For studying the intracardiac hemodynamics, the echocardiography method was appliedby device "SONOLINE VERZA PRO" («Siemens», Germany), in accordance with the recommendations of the American Association ofEchocardiography in M and B modes (Sahn D. J. et al. 198.) The image was obtained using the M-method, which allows to record the movement of reflective surfaces and provides an opportunity to measure the distance changing over the time. The measurements in M-mode were carried out via the parasternal access along the axis of the left ventricle in accordance with the recommendations of the Penn Convention Method.
The laboratory blood tests included complete blood count (CBC), the revmo sample definition (RS) and prothrombin index. According to the results of the CBC and the RS, the surveyed patients were divided into 2 groups: 1stgroup — 50 pregnant women (71.4 %) with the presence of active rheumatic process; 2ndgroup — 20 pregnant women (28.6 %) without activity of rheumatic process.
Section 5. Medical science
The research results were subjected to statistical processing based on BIOSTAT program for Windows (version 4.03). The sample mean (X) and the sample standard deviation (SD) was determined. The reliability of intergroup differences was assessed by Student's T-test. For all types of analysis, the p-value < 0.05 was considered as statistically significant.
Theresearch results
The mean age in 1st and 2nd groups amounted to 27.36 ± 4.68 years, and in 2nd group — 27.3 ± 5.68 years. The data did not vary between the groups due to gestational date, which amounted to 26.54 ± 7.62 weeks in 1st group, and 2 25.2 ± 7.9 weeks in 2nd one (r > 0.05). In 1st group the number of births reached 2.16 ± 0.96, and in 2nd group — 2.1 ± 0.97; the number of pregnancies in the 1st group was 2.65 ± 1.63, while in
2nd group it was — 2.55 ± 1.5. The analysis of physical examination showed that the presence of active rheumatoid HR process in pregnant women is higher compared to pregnant women without its activity, 98.6 ± 12.4 beats/min, against 91.5 ± 9,87 beats/min (p = 0.025) respectively. Thus the level of sistolic arterial pressure (SAP) and diastolic arterial pressure (DAP) in subgroups did not differ: SAP in 1st group was 101.35 ± 11.19 mm. Hg., in 2nd group — 94.3 ± 24.05 mm. Hg. (R > 0.05); DAP in 1st group was 64.2 ± 8.04 mm. Hg., and in the 2nd group — 66.2 ± 11.4 mm. Hg. (R > 0.05).
The analysis of hemogram, revmo sample and coagulation indicated a high importance of prevalence of the changes in blood parameters in the group with active inflammation, which contributed to an increase in its coagulation activity (Table 1).
Table 1. - Comparative evaluation of blood parameters in pregnant women having heart defects with and without the rheumatic process activity
Parameters Active inflammation n = 50 P Inactive inflammation n = 50
Leukocytes (109/l) 9.3 ± 3.1 0.042 7.78 ± 1.66
Hemoglobin (g/l) 106.64 ± 11.12 > 0.05 105.4 ± 7.6
ESR (mm/h) 26.8 ± 9.08 0.01 20.9 ± 6.43
RF (IU/ml) 11 ± 2.07 0.013 10 ± 0.7
CRP (mg/l) 12.83 ± 14.4 0.029 5.59 ± 1.58
ACAO (IU/ml) 354.4 ± 118.02 0.000 170.3 ± 69.53
PI( %) 96.57 ± 9.2 0.038 91.67 ± 7.39
PR 1.01 ± 0.06 0.000 1.07 ± 0.05
INR 1.02 ± 0.07 0.000 1.08 ± 0.06
PT 13.87 ± 0.76 0.002 14.53 ± 0.76
According to the ECG data, low atrial rhythm was observed in 2 pregnant women (4 %) of 1st group, and the blockade of the right bundle branch block was observed in 8 pregnant women (16 %) of 1st group and 5 pregnant women (25 %) of 2nd group. In 22 pregnant women (44 %) of 1stgroup was revealed cardiac arrhythmias in the form of ventricular premature beats (VPB), whereas in 2nd group the VPB (x2 = 5.898, p = 0.015) was observed only in 2 pregnant women (10 %). The supraventricular arrhythmias (SA) was detected in 10 surveyed patients of 1st group and only in 1 pregnant woman of 2nd group (x2 = 1.426, p = 0.232). The violations of repolarization processeswas observed in 28 pregnant women (56 %) of 1st group, and in 2 pregnant women (10 %) of 2nd group (x2 = 10.537, p = 0.001). The comparative analysis of
the electrocardiogram showed that the presence of inflammatory process activity causes the deceleration of the impulses through the cardiac conduction system, extending the PQ, QRS, QT intervals. Thus, the PQinterval in 1st group amounted to 15 ± 0.1 sec., in 2nd group — 4 ± 0.1 sec. (p = 0.000); the QRS interval in 1st group reached to 9 ± 0.01 seconds, in 2nd group — 8 ± 0.01 sec. (p = 0.000); the duration of the QT interval in 13 group was 35 ± 0.2 sec, in 2nd group was — 33 ± 0.2 sec. (p = 0.000).
The investigation of central hemodynamic parameters indicated an increase of heart size (mostly leftist sections), the frequency of pericardial effusion occurrence, as well as significant tendencyto reduction of the left ventricular myocardium contractility in pregnant women with active rheumatoid process (Table 2).
Table 2. - Comparative evaluation of central hemodynamics parameters in pregnant women having heart defects with and without rheumatic process activity
Parameters Active inflammation n = 50 P Inactive inflammation n = 20
Ao (mm) 28.9 ± 3.07 0.025 27.15 ± 2.32
LA (mm) 33.74 ± 4.65 > 0.05 31.6 ± 6.55
LVEDD (mm) 53.44 ± 3.9 0.000 48.1 ± 2.9
LVESD (mm) 33.24 ± 3.53 0.000 29.6 ± 2.96
IVS (mm) 8.24 ± 0.66 0.029 7.82 ± 0.83
PW (mm) 7.46 ± 0.67 > 0.05 7.19 ± 0.66
RV (mm) 21.5 ± 3.86 > 0.05 21.7 ± 2.95
LV mass (g) 145.3 ± 25.3 0.000 118.4 ± 23.87
EDV (ml) 136.34 ± 27.37 0.000 110.71 ± 15.78
ESV (ml) 48.24 ± 15.92 0.001 35.58 ± 7.2
EF ( %) 63.7 ± 4.5 0.002 67.4 ± 3.54
E/A 1.42 ± 0.27 > 0.05 1.62 ± 0.52
The fluid in the pericardial cavity (amount) 18 x 2 = 5.463 p = 0.019 1
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: [email protected]
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
