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114
УДК: 616.155.194
TREATMENT EFFICIENCY ANALYSIS PREGNANT,
WITH ANEMIA OF VARYING SEVERITY
L. V. Sarkisova, N. N. Umidova
Bukhara state medical institute, Bukhara, Uzbekistan
Key words:
iron deficiency anemia, ferrokinetics, erythropoietin.
Таянч сўзлар:
темир танқислиги камқонлиги, феррокинетиклар, эритропоэтин.
Ключевые слова:
железодефицитная анемия, феррокинетики, эритропоэтин.
Iron deficiency anemia (IDA) is the condition that most often complicates the course of pregnancy and arises as
a result of insufficient satisfaction of the increased need of the mother and fetus for iron necessary for hematopoiesis.
Iron deficiency anemia (IDA) is an urgent problem in modern society, since it affects a significant private population
of the world.
ҲОМИЛАДОР АЁЛЛАРДАГИ АНЕМИЯНИНГ ТУРЛИ ДАРАЖАЛАРИНИ ДАВОЛАШ
САМАРАДОРЛИГИНИ ТАҲЛИЛ ҚИЛИШ
Л. В. Саркисова, Н. Н. Умидова
Бухоро давлат тиббиѐт институти, Бухоро, Ўзбекистон
Темир танқислиги камқонлиги (ТТК) ҳомиладорликнинг ривожланишини мураккаблаштирадиган ҳолат
бўлиб, она ва ҳомила гематопоез учун зарур бўлган темирга бўлган эҳтиѐжининг етарли даражада
қондирилмаслиги натижасида юзага келади. Темир танқислиги камқонлиги (ТТК) ҳозирги кунда долзарб
муаммо ҳисобланади.
АНАЛИЗ ЭФФЕКТИВНОСТИ ЛЕЧЕНИЯ БЕРЕМЕННЫХ,
С АНЕМИЕЙ РАЗЛИЧНОЙ СТЕПЕНИ ТЯЖЕСТИ
Л. В. Саркисова, Н. Н. Умидова
Бухарский государственный медицинский институт, Бухара, Узбекистан
Железодефицитная анемия (ЖДА) – это состояние, наиболее часто осложняющее течение беременно-
сти и возникающее в результате недостаточного удовлетворения повышенной потребности организма матери
и плода в железе, необходимом для кроветворения. Железодефицитная анемия (ЖДА) является актуальной
проблемой современного общества, поскольку затрагивает значительную часть населения мира.
Оригинальная статья
Relevance.
The main criteria for IDA are a decrease in the level of hemoglobin and a color
index reflecting the hemoglobin content in the erythrocyte. Morphologically determined hypochro-
mia, erythrocytes, microcytosis, anisocytosis and poikilocytosis. The content of reticulocytes in
the blood, as a rule, remains within the normal range. An important diagnostic value is a decrease
in the level of serum gland and ferritin and an increase above the standard values of transferrin and
the total iron binding capacity of the serum. Recently, the importance of determining the level of
transferrin receptors in blood plasma, which is a sensitive indicator of the degree of tissue iron de-
ficiency. According to the WHO recommendation, the lower limit of normal hemoglobin concen-
tration for a pregnant woman is reduced to 110 g/l (outside pregnancy
-
120 g/l), hematocrit
-
to
33% (non
-
pregnant
-
36%). Laboratory criteria: In addition to hemoglobin (Hb), as a parameter of
the functional fund, other hematological parameters are determined: red blood cell count (RBC)
and hematocrit (Ht). The reserve fund is estimated by the level of serum ferritin (SF), and iron –
regulatory
-
by erythrokinetic indicators: erythropoietin (EPO) and the coefficient of adequacy of
EPO products.
Research objectives:
To study the parameters of ferrokinetics in the dynamics of pregnan-
cy, taking into account the severity of anemia.
Material and research methods.
For the period from 2017
-
2019. We examined 90 preg-
nant women with anemia, 50 of them were untreated, received in the maternity ward with a kind of
activity, and 40 were treated in the department of pathology of pregnant women. The control
group consisted of 40 conditionally healthy pregnant women. Under our supervision and examina-
tion, there were 40 pregnant women with anemia, aged 17–35 (28 ± 0.1) years, who were regis-
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115
Table 1.
Distribution of pregnant women depending on the severity of anemia (M ± m).
tered in female consultations and were treated in the department of pathology of pregnant urban
maternity complex No.1. Bukhara. Hemoglobin content 95 g/l and below, serum iron 15 μmol/l
and below, gestational age of 20 weeks or more, and absence of other blood diseases were the cri-
teria for selection of pregnant women into groups. The main complaints of pregnant women with
anemia were general weakness, fatigue, shortness of breath with mild physical exertion, flickering
of "flies" before the eyes, dizziness, nasal hemorrhages, sleep disorders and mood for no apparent
reason, decreased appetite, memory loss. Depending on the type of antianemic therapy, the pa-
tients were divided into 2 groups: the comparison group — 18 pregnant women — received ferron
100 mg, 1
-
2 capsules daily for 2
-
3 months, until normal hemoglobin level in the blood was
reached; the main group
-
22 pregnant women, received ferron100 mg 1
-
2 capsules daily for 2
-
3
months, until normal hemoglobin level in blood and REPO 2000 MED are achieved subcutaneous-
ly after 3 days 2
-
3 injections depending on the severity anemia. The distribution of pregnant wom-
en, depending on the severity of anemia, is presented in table 1.
L. V. Sarkisova, N. N. Umidova
The degree of anemia
(Hb g/l)
The main group (n = 22)
Comparison Group (n = 18)
Абс
%
Абс
%
Mild (110—91)
7
32
6
33,3
Moderate
(90–71)
10
45
9
50
Serious/severe (<70)
5
23
3
16.7
Among the examined in the groups, recurrent and multiparous women with a second or third
pregnancy, which did not differ in significantly significant limits, prevailed. In the obstetric and
gynecological history, women had: honey. abortion
-
13 women (15.6%), spontaneous miscarriag-
es
-
8 women (9.6%), non
-
developing pregnancy
-
4 women (4.8), antenatal fetal death – 2 (3.6)
(Table 2).
Outcomes of Past Pregnancies
Pregnant groups
I comparison group
(n = 18)
II group main
(n = 22)
Абс
%
Абс
%
Medical abortion
2
11.1
4
18
Spontaneous miscarriages
1
5.6
2
9
Non
-
developing pregnancy
2
11.1
2
9
Antenatal fetal death
7
38.9
1
4.5
Table 2.
Outcomes of previous pregnancies in surveyed women.
The health index of the examined women, taking into account the presence of extra
-
traumatic diseases, was relatively satisfactory. As can be seen from table 4, ARVI and anemia oc-
cupied the leading place in all groups, the remaining extragenital diseases were found in a small
number of patients (Table 3).
The contingent of pregnant women was subjected to a thorough clinical and laboratory re-
search. The clinical examination included a study of complaints, life, obstetric and gynecological
anamnesis, taking into account the diseases suffered before and during this pregnancy. A general
and special obstetric study was conducted: external palpation, auscultation of the fetus, examina-
tion in the mirrors with a prenatal rupture of the membranes and discharge of water, vaginal exam-
ination, determination of the degree of cervical dilatation. The mothers underwent a general analy-
sis of blood, urine, discharge from the cervical canal, vagina, urethra. The group and Rh affiliation
of the blood, the blood test for HBsAg, RW, by agreement of the woman to HIV/AIDS were deter-
mined. Some biochemical parameters of peripheral blood were also determined: total protein,
ALT, AST, coagulogram. According to the testimony conducted tests on Zimnitsky, Nechiporen-
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Оригинальная статья
Table 4.
Classification of anemia by severity.
Table 3.
Extragenital diseases in the history of the examined women.
ko, ECG was taken. The localization of the placenta and the size of the fetus were determined by
ultrasound. All pregnant women are consulted by the therapist . The diagnosis of IDA was set on
the basis of complaints, anamnestic data and clinical data, as well as the content of HB, erythro-
cytes, color index and indicators of iron metabolism (serum iron, OZHSS and ferritin). The severi-
ty of anemia was assessed by the WHO classification (1999) (Table .4).
Pregnancy
Comparison group (n=18)
Basic group (n=22)
Абс
%
абс
%
Respiratory diseases:
Chronic. Tonsillitis
1
5.6
1
4.5
Chronic. Sinusitis
1
4.5
Chronic. Bronchitis
ARVI
8
44.4
10
45.4
CCC diseases:
Hypertonic disease
1
5.6
1
4.5
Vegetative
-
vascular dystonia
Varicose veins
1
5.6
1
4.5
Kidney disease
Chronic pyelonephritis
Blood diseases:
Anemia
18
100
22
100
Gastrointestinal Disorders:
Gastritis, colitis
1
4.5
Chronic. Hepatitis
Metabolic pathology:
Thyroid disease
3
16.7
9
41
Obesity
1
5.6
1
4.5
Diabetes
Severity
Hemoglobin (g/l)
Red blood cells (x10
12
/l)
I – Mild
II – Moderate
III –
Serious/severe
110 – 91
90 – 71
70 and below
3,6
-
3,2
3,2
-
3,0
3,0 – 1,5
Quantitative determination of hemoglobin in the blood was carried out with such hemoglo-
bin cyanide method, and a method was used to determine the concentration of iron in the blood
serum, and the determination of ferritin in the blood serum. The results obtained for the iron me-
tabolism indicators of the examined pregnant women indicated that anemia in the examined preg-
nant women was jellied. Deficiency of iron in the depot and serum progressed as the severity of
anemia and gestational period increased, which indicates an increased need for the maternal organ-
ism.
It was established that the progression of mild anemia in every second, the development of
PE and prenatal discharge of water in every third was a distinctive feature of the course of preg-
nancy. Births were often complicated by bleeding during pregnancy (PONRP
-
6.3%) and after
delivery (13.5%) and injuries of the soft birth canal (70%). Syndrome of delayed fetal develop-
ment and the birth of low
-
weight babies was observed in 30% of patients.
The findings showed that anemia is a high risk factor for the development of pregnancy
Доктор ахборотномаси № 4—2019
117
complications and rhodes, which dictated the need to optimize complex therapies for pathology
throughout the entire gestation period, which will prevent complicated pregnancy and childbirth
and will be one of the antenatal measures fetal protection.
Findings:
a study of ferrokinetics in the dynamics of pregnancy has shown that anemia is
iron deficient, with the degree of reduction of iron content, KNTZh and ferritin and increase of
transferrin level depends on the severity of the disease. Treatment of IDA with iron
-
containing
drugs only is not effective enough. Hb level <90g/l and resistance of anemia to treatment with Fe
preparations is an indication for REPO therapy, especially when preparing for delivery. Com-
bined ferrotherapy with REPO is an effective and relatively fast method for stopping the IDA of
pregnant women that allows to replace blood transfusion.
References:
1.
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L. V. Sarkisova, N. N. Umidova
