子痫前期妇女胎盘功能障碍矫正的选择

Amrullo Karimov, D. M. Davlietova
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Patients underwent standard clinical, laboratory and instrumental examination with color Doppler mapping of vessels of the uterine-placental-fetal system and ultrasound evaluation of the fetoplacental system. \nResults and discussion. Premature aging of the placenta was found in 77.3 % of cases, turbid amniotic fluid – in 59.09 %, oligohydramnion – in 27.3 %. Disorders of uteroplacental blood flow were detected in 28.3 % of cases, placentofetal blood flow – in 26.7 %. Impaired blood flow at both levels without critical values occurred in 10 % of pregnant women. In case of insufficiency of a blood circulation of 2nd grade the syndrome of fetal growth restriction was observed in 16,7 % of cases. Compensated forms of PD were subject to the comprehensive treatment with the addition of infusions of L-arginine (Tivortin, “Yuria-Pharm”) in the inpatient phase and oral administration of Tivortin aspartate in the outpatient phase. The length of the fetal thigh in the group of L-arginine at the beginning of treatment was 47.33 mm, which was by 9.04 % less than this parameter in physiological pregnancy. After treatment with Tivortin, in the full-term period, no significant difference was found. In pregnant women who received L-arginine at 25-29 weeks of pregnancy, after 2 weeks, the resistance indices (RI) of the umbilical artery and uterine artery decreased from 0.68±0.09 to 0.58±0.05 and from 0,58±0.16 to 0.43±0.08, respectively. The RI of the middle cerebral artery increased from 1.05±0.23 to 1.27±0.19. Parameters of RI dynamics indicate that the early treatment with Tivortin is more effective than late. \nConclusions. 1. Regardless of the presence of fetal growth restriction syndrome in women with disorders of uterine-placental-fetal circulation, it is advisable to include L-arginine in the treatment to prevent this condition. 2. 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摘要

背景。胎盘功能障碍(PD)是妊娠期最常见的并发症之一,不仅具有医学意义,而且具有社会意义。PD发病的环节包括内皮功能障碍、胎盘血管血流动力学紊乱、胎盘内动、静脉血流量紊乱。目标。探讨女性子痫前期PD矫正的诊断方法及可能性。材料和方法。该研究涉及68名妊娠二、三期PE患者,2017-2019年期间在塔什干医学院多学科诊所接受治疗。患者接受标准的临床、实验室和仪器检查,包括子宫-胎盘-胎儿系统血管的彩色多普勒测绘和胎儿-胎盘系统的超声评估。结果和讨论。胎盘早衰占77.3%,羊水混浊占59.09%,羊水过少占27.3%。子宫胎盘血流异常占28.3%,胎盘胎儿血流异常占26.7%。10%的孕妇出现两种水平的血流受损,但没有达到临界值。在2年级血液循环不足的情况下,胎儿生长受限综合征在16.7%的病例中被观察到。代偿型PD在住院期接受l -精氨酸(Tivortin,“Yuria-Pharm”)输注的综合治疗,在门诊期口服天冬氨酸Tivortin。治疗初期l -精氨酸组胎儿大腿长度为47.33 mm,比生理妊娠时缩短9.04%。经替沃汀治疗后,足月无明显差异。妊娠25 ~ 29周服用l -精氨酸的孕妇,2周后脐动脉和子宫动脉阻力指数(RI)分别由0.68±0.09降至0.58±0.05,由0.58±0.16降至0.43±0.08。大脑中动脉的RI由1.05±0.23增加到1.27±0.19。RI动力学参数表明,早期使用Tivortin治疗比晚期治疗更有效。结论:1。无论子宫-胎盘-胎儿循环紊乱的妇女是否存在胎儿生长受限综合征,建议在治疗中加入l-精氨酸以预防这种情况。2. 超声检查是评价PD治疗效果的可靠方法。
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Options of the placental dysfunction correction in women with preeclampsia
Background. Placental dysfunction (PD) is one of the most common complications of pregnancy, which has not only medical but also social significance. The links of the PD pathogenesis include endothelial dysfunction, hemodynamic disorders of the placental vessels, disorders of arterial and venous blood flow in the placenta. Objective. To study diagnostic methods and possibilities of PD correction in women with preeclampsia (PE). Materials and methods. The study involved 68 women with PE in the II and III trimesters of pregnancy, treated at the multidisciplinary clinic of the Tashkent Medical Academy during 2017-2019. Patients underwent standard clinical, laboratory and instrumental examination with color Doppler mapping of vessels of the uterine-placental-fetal system and ultrasound evaluation of the fetoplacental system. Results and discussion. Premature aging of the placenta was found in 77.3 % of cases, turbid amniotic fluid – in 59.09 %, oligohydramnion – in 27.3 %. Disorders of uteroplacental blood flow were detected in 28.3 % of cases, placentofetal blood flow – in 26.7 %. Impaired blood flow at both levels without critical values occurred in 10 % of pregnant women. In case of insufficiency of a blood circulation of 2nd grade the syndrome of fetal growth restriction was observed in 16,7 % of cases. Compensated forms of PD were subject to the comprehensive treatment with the addition of infusions of L-arginine (Tivortin, “Yuria-Pharm”) in the inpatient phase and oral administration of Tivortin aspartate in the outpatient phase. The length of the fetal thigh in the group of L-arginine at the beginning of treatment was 47.33 mm, which was by 9.04 % less than this parameter in physiological pregnancy. After treatment with Tivortin, in the full-term period, no significant difference was found. In pregnant women who received L-arginine at 25-29 weeks of pregnancy, after 2 weeks, the resistance indices (RI) of the umbilical artery and uterine artery decreased from 0.68±0.09 to 0.58±0.05 and from 0,58±0.16 to 0.43±0.08, respectively. The RI of the middle cerebral artery increased from 1.05±0.23 to 1.27±0.19. Parameters of RI dynamics indicate that the early treatment with Tivortin is more effective than late. Conclusions. 1. Regardless of the presence of fetal growth restriction syndrome in women with disorders of uterine-placental-fetal circulation, it is advisable to include L-arginine in the treatment to prevent this condition. 2. Ultrasound examination is a reliable method for evaluating the effectiveness of PD treatment.
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