NEW APPROACHES TO DIAGNOSTIC AND CORRECTION OF DISORDER IN PREGNANT WOMEN WITH PLACENTAL DYSFUNCTION

Abstract

Introduction. Placental dysfunction causes perinatal morbidity and mortality. One of the main methods that allows to reduce perinatal morbidity and mortality is timely diagnosis of pathological conditions that affect the life and health of the child. Impaired growth and development of the fetus is a complication of the prenatal period that can lead to extremely adverse consequences. Studying the role of activation of lipid peroxidation processes in the pathogenesis of damage to the placenta in dysfunction is important in modern medicine. Also, the development of new methods of treatment of placental dysfunction will allow to reduce perinatal losses and complications.

The aim of the study – to investigate changes in lipid peroxidation and indicators of the antioxidant defense system, to evaluate the role of these processes in the pathogenesis of placental dysfunction, to develop a comprehensive method of placental dysfunction therapy and to evaluate its effect on changes in the POL and ADS system, the intrauterine state of the fetus, and the effectiveness of reducing perinatal losses.

Research Methods. An examination of lipid peroxidation and indicators of the antioxidant defense system was conducted in pregnant women with placental dysfunction. A study was conducted in 50 pregnant women who, depending on the treatment method, were divided into two groups: Group I – 25 pregnant women who received conventional therapy, Group II – 25 pregnant women who received the developed therapy, in which the gestation period was 32–36 weeks during ultrasound examination revealed placental dysfunction. The control group consisted of 30 pregnant women with a physiological course of pregnancy, who gave birth to live full-term children with weight and growth characteristics according to the gestation period. A clinical and statistical analysis of the course of pregnancy, childbirth, and the condition of newborns in pregnant women with placental dysfunction after complex treatment with the inclusion of the drug "Tivorel" (1 ml of 42 mg of arginine hydrochloride and 20 mg of levocarnitine) in the form of a solution for infusions of 100 ml once per day for a course of 7 days intravenously.

Results and Discussion. Based on the results of the research, it was established that in the pathogenesis of placental dysfunction, the activity of lipid peroxidation increases and the indicators of the antioxidant protection system decrease. The proposed therapy corrected the imbalance of lipid peroxidation and the antioxidant protection system, had a positive effect on the condition of the fetus according to the cardiotocogram and ultrasound examination.

Conclusions. Dysregulation of the ratio of lipid peroxidation and the indicators of the antioxidant protection system leads to the accumulation of active forms of oxygen metabolites, which at the molecular level are pathogenetic links of placental dysfunction in pregnant women. The activation of indicators of the antioxidant protection system affects not only the molecular mechanism of cell damage, but is also directed at the formation of compensatory and adaptive reactions. Depending on the severity of oxidant stress, changes occur in the fetoplacental complex of pregnant women in the compensation or decompensation phase. Our research shows that placental dysfunction in pregnant women is accompanied by significant hemodynamic changes in the feto-placental complex. The use of arginine hydrochloride and levocarnitine in the therapy of placental dysfunction in pregnant women effectively stabilized the functional condition of the fetus.