INSTRUMENTAL AND DIAGNOSTIC CRITERIA OF HEMODYNAMIC DISORDERS AND ENDOTHELIAL DYSFUNCTION CORRECTION IN PREGNANTS WITH ARTERIAL HYPERTENSION
DOI:
https://doi.org/10.11603/ijmmr.2413-6077.2015.1.2853Abstract
Background. According to the WHO, hypertension is associated with 20-33 % of maternal death during pregnancy within extragenital pathology statistics. There are complications of the fetus and newborn associated with hypertension at 140/90 mm Hg and higher.
Objective. A comparative analysis of antihypertensive therapy effectiveness in pregnants with arterial hypertension was performed using modern clinical and instrumental methods of endothelial function diagnostic, central and utero-placental hemodynamic estimation.
Methods. We examined 63 pregnant women with hypertension at 28 to 32 weeks of gestation. Women were randomized into three groups:group I (control group – 20 women), that included pregnant women with hypertension treated with basic antihypertensive therapy as recommended by Health Ministry of Ukraine standards (metildofa and nifedipin); group II – 21 pregnant women receiving metildofa and metoprolol; group III (22 pregnant women) receiving metildofa and nebivolol.
Conclusions. It was found that the brachial artery ultrasound measuring and occlusive plethysmography procedure by Dietz is an early and safe method of endothelial dysfunction diagnostic in pregnants with hypertension. Doppler ultrasound of blood flow in uterine, umbilical arteries, and middle cerebral arteries of the fetus allows timely diagnosis of the side effect of antihypertensive drugs on the fetus. The therapy of choice for pregnants with Stage II Arterial Hypertension should be based on methyldopa and calcium channel antagonists or selective beta-blockers combination. Highly selective beta-blockers with vasodilative effect (nebivolol hydrochloride) and L-arginine (Tivortin) allow to prevent perinatal adverse effects of antihypertensive therapy, to correct hemodynamic disorders and endothelial dysfunction in pregnants with arterial hypertension.
KEY WORDS: arterial hypertension, uterine-placental hemodynamics, endothelial dysfunction
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