Summary.
Schurevskaya O.D. “Improvement of the treatment and prophylactic methods of fetoplacental complex disturbances at EPH-gestosis”.
The dissertation (manuscript) on competition of the candidate of medical science on speciality 14.01.01-obstetrics and gynaecology. National Medical University of O.O.Bogomolets. Kiev, 2003.
This dissertation work is dedicated to decision of the actual problem of the modern obstetrical science - reducing of the fetoplacental complex disorders at EPH-gestosis.
60 pregnant women with preeclampsia (divided in 2 group according to the scheme of the treatment) and 30 healthy pregnant women were inspected.
For the clear prevention and treatment of this pathology the general clinical/functional and modern diagnostical methods, such as biochemical, coagulogical, endocrinological, electron microscopy, ultrasound examination and Doppler ultrasound are observed.
First of all, we have analysed the risk factors of preeclampsia, because the nonspecific profilaction of the pregnancy complications starts from their detection. The results of the researches have showed, that there are such the most significant medical risk factors of EPH-gestosis and fetoplacental insufficiency as the background somatic and the genital pathology, the high level of spontaneous pregnancy loss and the defective pregnancy.
According to the results of instrumental examinations methods, the essential pathophysiological way of this disorders are the haemorrheological and the microcirculation disturbances. It was established the haemostasis activation by external and internal ways and hypercoagulabilyty in the group with EPH-gestosis. Electronic microscopy of thrombocytes confirm received results. It was found that the level of thrombocytes changes depends of EPH-gestosis gravity.
The ultrastructure of placenta at gestosis is characterised by heterogeneity of the texture and the presence of the Kaschenco-Hoffbauer cells, that replies to the primary placental insufficiency. The high frequency of the imminent abortions in women with preeclampsia at early pregnancy terms can be explained and corroborated by this results.
Diagnosis of placental dysfunction at gestosis indicates by decreasing of placental hormones levels, high systole to diastole (S/D) ratio in umbilical artery and low biophysical profile of the fetus. The strain function of placenta was showed by hormonal method.
We suggested a possible favourable influence of the hydroxyethylstarch (HES) in the correction of fetoplacental insufficiency at EPH-gestosis. The complex therapy of preeclampsia was completed by HES medicine – Refortan (HES 200/0,5) 6%, that was used in dose 10 mg/kg per day intravenously.
Volume therapy with HES has different positive haemorreological effects with favourable influence on the platelet aggregation, platelet-association coagulation, blood viscosities etc.
This improves the circulation in placenta, decreases the level of the placental dysfunction (normalisation of the placental hormone synthesis and the Doppler ultrasound examination). The fetal circulatory changes after the therapy with hetastarch show a better oxygenation indicated by the biophysical prophyle of the fetus.
Such complex therapy of the pregnant women with a preeclampsia makes better the condition of the fetus and the newborn without any negative effects. That is why this complete therapy is scientifical feasible and expedient.
Key words: EPH-gestosis, preeclampsia, fetoplacental insufficiency, hydroxyethylstarch.
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