The aim of the study is to development of an algorithm for managing pregnancy and childbirth by studying the functional state of the mother-placenta-fetus system in pregnant women who have undergone COVID-19 in different trimesters of pregnancy.
The object of the study was 105 pregnant women who, were treated at the Samarkand Regional Perinatal Center and a specialized maternity center for pregnant women with COVID-19
Тhe scientific novelty of the research consists of the followings: for the first time in pregnant women infected with COVID-19, a relationship was established between the course of pregnancy, childbirth, the postpartum period and the development of complications depending on the trimester and severity of the disease; a direct correlation has been established between the state of the vessels of the mother-placenta-fetus system (resistance and pulsation indices, Endothelin-1 indicators), disorders in the hemostasis system (D-dimer, platelet aggregation) and the clinical course of the disease in pregnant women who underwent COVID-19; it has been established for the first time that the developed scale for assessing risk factors for non-developing pregnancy in women infected with COVID-19 (age, BMI, obstetric history, gestation period, hemostasis system status, endothelial function and severity of the disease) can serve as a prognostic marker of the degree of risk of pregnancy complications; it was proved for the first time that the choice of effective therapy for restoring hemodynamics in the mother-placenta-fetus system, in women who underwent COVID-19 at different stages of pregnancy, leads to a decrease in the number of thrombophilic complications.
Implementation of the research results. The results of the scientific research were introduced into the practical activities of the Samarkand Regional Perinatal Center by Order No. 128/1 of 01.09.2022 and the Samarkand City Maternity Complex No. 1 by order No. 58/1 of 03.10.2022. In pregnant women who underwent COVID-19 at different periods of pregnancy, changes in the mother-placenta-fetus system were determined using simple and effective research methods, such as ultrasound and Dopplerography, and this saved 53,000 soums; obstetricians and gynecologists, as well as neonatologists and therapists, are needed to diagnose signs of complications in the echocartin, that is, it has been proven that there is no need for other highly qualified specialists for this, due to the lack of need to train new personnel, state budget funds have been saved. With early detection of disorders in the hemostasis system in pregnant women with COVID-19: the period of stay of patients in the hospital was reduced from 10.5 days to 7.5 days and the number of hospital bed days was reduced; due to the reduction of the period of stay in the hospital for several days, the number of necessary drugs was reduced (on average, drugs are used for 1 day in the amount of 130,000 soums). Examination of pregnant women infected with viral diseases using simple and effective research methods such as ultrasound and Dopplerography served to save 85,000 soums: in the early stages up to 16 (10-11 weeks. - fetometry), 19-21, 32-34, 38-40 weeks of pregnancy; due to the absence of the need to use other research methods, it was possible to reduce costs by 23.5%; early detection of changes in the hemostasis system and endothelial dysfunction using fast, budgetary and effective research methods, contributed to the prevention of possible pregnancy complications, as well as the absence of the need to use long-term and expensive research methods, and this saved 106 000 soums: the coagulogram was checked in 105 (100%) patients, time was saved and efficiency was increased; endothelin-1 was also determined in 105 (100%) patients, efficiency was increased by 78.6%.
Improving the functionality of blood circulation in the uteroplacental and fetal-placental systems, a comprehensive analysis of possible complications during pregnancy and childbirth in women who have had viral infections, improving diagnostic, preventive and prognostic measures for managing pregnancy and childbirth contributed to the birth of live, full-term and healthy newborns in women who experienced COVID-19 during pregnancy, as well as a decrease in maternal mortality and perinatal mortality, 43% of women underwent rehabilitation in the postpartum period, 23.8% of women who underwent severe COVID-19 improved their quality of life.
To introduce scientific novelty on the topic “The impact of COVID-19 on the state of hemodynamics in the mother-placenta-fetus system in pregnant women”, a letter was sent to the Ministry of Health from Samarkand State Medical University on November 9, 2022 under No. 4295 (Conclusion of the Ministry of Health No. 8 n-z / 679 of December 15, 2022).
The structure and volume of the dissertation. The content of the dissertation consists of an introduction, five chapters, conclusion, list of used references. The volume of the dissertation consists of 113 pages.
Coronavirus disease severe acute respiratory syndrome COVID-19 quickly spread throughout the entire dune at the pandemic level in 2019 year. Due to changes in the immune system and respiratory physiology, pregnant women are prone to severe viral pneumonia, which can lead to a number of obstetric complications, in particular, fetoplacental insufficiency. In this regard, the purpose of the study was to investigate the pathological changes of the placenta in pregnant women infected with coronavirus COVID-19.
Здоровье новорожденного в значительной степени определяется течением антенатального периода. В
настоящее время установлено, что наиболее частой причиной нарушений состояния плода во время
беременности является плацентарная недостаточность (Глуховец Б. И., 2002; Касабулатов Н.М., 2004;
Милованов А.П., 1999; Сидельникова В.М., 2006). Плацентарная недостаточность служит основной причиной
внутриутробной гипоксии, задержки роста и развития плода, преждевременных родов, поэтому очень важно
во время беременности правильно оценить функцию плаценты и провести адекватную терапию ее недостаточности с целью пролонгирования беременности до срока, с которого возможно выхаживание ребенка. Важным диагностическим критерием плацентарной недостаточности является уровень гормонов в крови беременной
Отслойка сетчатки (ОС) занимает одно из ведущих мест среди причин слабовидения и развития инвалидности по зрению у лиц детского возраста. По данным различных авторов, ежегодные показатели инвалидизации пациентов с ОС достигают 2-4%. При своевременно проведенном оперативном лечении с использованием новейших микроинвазивных методик анатомическое прилегание сетчатки обычно достигается в 90-95% случаев. Однако у 30% прооперированных детей острота зрения остается на достаточно низком уровне (0,4 или ниже), поэтому изучение вопросов, касающихся современных методов лечения отслойки сетчатки у детей являются актуальными
Obstetric hemorrhages, despite the global measures introduced to prevent them, still represent a real threat to the maternal health and life, and require a search for more effective measures for their prevention and treatment. The list of references which formed the basis for the present review will allow the reader to determine the vector of searching for modern information on obstetric hemorrhages, to compare the outcomes of labor with postpartum hemorrhage in different countries, and to understand the prognostically significant risk factors.