PREDICTING THE RISK OF OBSTETRIC COMPLICATIONS IN PREGNANT WOMEN WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
DOI:
https://doi.org/10.11603/24116-4944.2024.1.14698Keywords:
pregnancy, chronic obstructive pulmonary disease, obstetric complications, preventive therapy, L-arginineAbstract
The aim of the study - to develop a program for the preventive treatment of obstetric complications and diagnosis in pregnant women with chronic obstructive pulmonary disease.
Materials and Methods. A prospective cohort randomized study was carried out with 163 pregnant females, which were split into 3 groups. The main group included 54 pregnant women with COPD according to bronchial obstruction stage. The comparison group included 77 pregnant women with COPD with I and II degree of bronchial obstruction. The control group included 32 pregnant females without pathology. Pregnant women in the main group received, in addition to standard protocol treatment, an oral solution of L-arginine and a vitamins and mineral complex according to the preventive therapy of obstetric complications. The statistical analysis of the results was performed using Statistica 10.0 (StatSoft, Inc., USA) and Microsoft Office Excel 2010.
Results and Discussion. When analyzing the course of pregnancy in women with COPD compared with the control group of healthy pregnant women, a significantly higher incidence of obstetric and perinatal complications was noted, which depended on the degree of bronchial obstruction. Thus, placental dysfunction occurred 2.3 times more often in the IIA and 3.2 times more often in the IIB subgroup compared with the control group, intrauterine growth restriction - 11.6% in the IIA and 23.5% in the IIB subgroup, fetal distress during pregnancy (2.3% in the IIA and 8.8% in the IIB subgroup, respectively), anemia (20.9% and 32.4%, respectively). Also, in the subgroup with moderate bronchial obstruction the threat of preterm labor was detected in 17.6% of pregnant women (3.1% in the control group), and in 11.8% preterm labor happened. In the subgroup with a mild degree of bronchial obstruction the threat of preterm labor was observed in 9.3%. Disturbances in the redox system, which contributes to a systemic inflammatory response and endothelial dysfunction can cause these obstetric complications development. Clinical testing of the proposed drug complex as a preventive therapy for obstetric complications in pregnant women with COPD showed that under the influence of such treatment, obstetric and perinatal complications develop significantly less often (p˂0.05). Thus, in the main group of pregnant women under the influence of treatment the incidence of preeclampsia decreased by 2.3 times, the threat of early and late miscarriage - by 2.6 and 2.3 times, respectively, and preterm labor - by 2.3 times, placental dysfunction - by 2.5 times, that was accompanied by a significant decrease in the incidence of IUGR by 3 times, anemia by 1.8 times compared with the group of pregnant women who received basic protocol therapy (p˂0.05).
Conclusions. In pregnant women with COPD, clinical testing of the recommended drug complex for prevention of pregnant complications significantly improved the indexes of lipid peroxidation/antioxidant protection, endothelial function and systemic inflammation, which reduced the incidence of preeclampsia, the threat of early and late miscarriage, preterm labor, anemia, IUGR and placental dysfunction.
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