MANAGEMENT OPTIMIZATION OF WOMEN WITH FETAL LOSS SYNDROME ASSOCIATED WITH ENDOTHELIAL DYSFUNCTION

Abstract

Summary. Reducing perinatal morbidity is especially important in terms of improving demographics in Ukraine. In modern obstetrics, special attention is paid to the planning and preparation for pregnancy in women with fetal loss syndrome, the frequency of which is quite high and ranges from 10 % to 25 %.

The aim of the study – to develop an algorithm for treatment and prevention activities for women with fetal loss syndrome and endothelial dysfunction by pathogenically justified correction of changes detected during pregnancy.

Materials and Methods. To achieve our purpose, we examined 150 pregnant women, divided into 3 groups, of 50 women in each. In addition to the mandatory examination of pregnant women, the urinary albumin/creatinine ratio was additionally determined using Microalbuphan test strips. Determination of the concentration of nitric oxide in the blood was performed by colorimetric method. Studies of folic acid were determined by enzyme-linked immunosorbent assay, and the concentration of creatinine in amniotic fluid – on a certified photometer MBA-540. For further histological and micromorphometric examination of the provisional organs of the fetus, the selection of material carried out after the third period of labor.

Results. So, patients with fetal loss syndrome are diagnosed with preclinical gestational endothelial dysfunction, decreased folic acid content in the blood, high levels of creatinine in amniotic fluid. At morphological research of provisional organs of a fetus dystrophic and degenerative changes with signs of infection are noted. After prescribing L-arginine aspartate and folic acid to a donor of nitric oxide, endothelial dysfunction was not diagnosed and creatinine content in amniotic fluid was normalized. Compensatory-adaptive changes were observed during morphological examination of placenta.

Conclusions. Our proposed complex therapy, using a donor of nitric oxide and folic acid, significantly improved perinatal outcomes in women with fetal loss syndrome. Thus, in group 2 of observations the frequency of threatened abortion decreased three times, six times – fetal distress, twice – urgent cesarean section in comparison with group I.