Gynecology, Obstetrics and Perinatology

Prevention and therapy of placental insufficiency and gestosis in pregnant women with hypertensive disease

For the purpose of working out optimal schemes of medication for impaired blood flow in the fetoplacental link and fetal blood flow in fetoplacental insufficiency on the background of maternal arterial hypertension the authors conducted a complex  dynamic  examination  of  175  pregnant  women  with  hypertensive  disease  stages  I  and  IIА  (basic  group)  at  terms  of 12–41 wks. The control group comprised 60 women with a non-complicated course of pregnancy and favorable outcomes of labor aged from 18 to 35 years and terms of gestation 12–41 wks, who underwent a complex dynamic examination that included  echocardiography  of  a  pregnant  woman,  Doppler  studies  of  blood  flow  in  the  umbilical  artery  and  its  terminal branches, and also in the aorta and middle cerebral artery of the fetus, its venous ducts, and the vena cava inferior. The use of highly technological methods of examination (echography, dopplerometry, cardiac flow imaging) and modern laboratory tests (detection of levels of growth factors) permits, based on new understanding of the pathogenesis of placental insufficiency  and  gestosis,  to  optimize  the  obstetric  tactics  in  these  complications  of  pregnancy  in  women  with  arterial hypertension  and  to  decrease  maternal  and  perinatal  morbidity  and  mortality.  Early  detection  of  impairments  of  fetoplacental blood flow and their early medication contributed to a decrease of the frequency of adverse perinatal outcomes in pregnant  women  with  arterial  hypertension.  For  instance,  FGRT  was  diagnosed  at  terms  35–38  wks  by  6.8  times  more rarely, the neonate received 7 and less Apgar scores by 7 times more rarely. The average term of delivery in this group of pregnant women was 38.9 ± 0.6, and the neonate considerably more rarely (no case in this study) required transition to the 2nd stage of the nursing care plan.