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.
В настоящее время при изучении механизмов развития и прогрессирования хронической болезни почек большое влияние уделяется нарушениям функции сосудистого эндотелия локально в почке и в системном русле. Степень выраженности эндотелиальной дисфункции связана с прогрессирующим падением функции почек и развитием склероза, являясь предиктором неблагоприятного прогноза ХБП. Одним из маркеров эндотелиальной дисфункции являются семейство селектинов, повышение в крови которых отмечено при различных сердечно-сосудистых и воспалительных патологиях. Несмотря на большое количество зарубежных работ, в которых указывается немое течение атеросклероза у больных с ХБП с одной стороны, и высокий уровень смертности больных с ХПБ от сердечно-сосудистой патологии, с другой, делают очевидной необходимость раннего выявления дисфункции эндотелия у больных с ХБП уже на ранних стадиях заболевания. Изучение клинических характеристик больных с ХБП во взаимосвязи с уровнем Р-селектина является новым направлением нефрологии и медицины в целом
Оксидативный стресс, синтез вазоконстрикторов, факторов воспаления и цитокинов, подавляющие продукцию оксида азота основного вазодилататора, влияют на возникновение и развитие дисфункции эндотелия (ЭД). ЭД всегда предшествует повреждению или нарушению функционирования любого сосуда независимо от его органной локализации. Оценить функциональное состояние эндотелия можно косвенно. Для этого необходимо исследовать в крови содержание факторов воспаления, повреждающих эндотелий – С реактивного белка (CRP), провоспалительных цитокинов и др. Уровень содержания данных факторов связан со степенью выраженности ЭД. Провоспалительные цитокины способствуют синтезу эндотелина-1 (ЭТ-1), уменьшают вазодилатацию, индуцированную ацетилхолином, дестабилизируют мРНК эндотелиальной синтазы NO, вызывая ЭД.
Основная цель данного исследования направлена для оптимизации профилактики и лечения тромборезистентности эндотелия сосудов у больных хронической генерализованной пародонтитом сочетанной кардиоваскулярной патологией в развитие периимплантита при подготовке их к дентальной имплантации.
Atherosclerosis is a chronic lesion of the arteries caused by the growth of multiple dense nodular thickenings of the walls of the artery (plaques), narrowing its lumen and contributing to the formation of a blood clot - a thrombus, which can clog the vessel. Atherosclerosis develops as a result of complex structural changes that occur in the intima (inner layer) and in the media (muscle layer) of the arteries, and it is associated with the accumulation of lipids and mucopolysaccharides in the blood vessels, the growth of connective tissue and the deposition of calcium. Cardiovascular pathology, and this is ischemic heart and brain disease, occlusive diseases of peripheral arteries, is the most common cause of morbidity, mortality and disability in the population of industrialized countries. According to the statistics of the World Health Organization, in the structure of total mortality in Russia, cardiovascular diseases account for 57%. Most of these cases are associated with diseases caused by atherosclerosis [3]. The development of atherosclerotic lesions of the vascular wall is a complex multi-stage process. It has now been established that even before endothelial damage, blood components begin to interact with the endothelial surface. In particular, low-density lipoprotein cholesterol (LDL-C) and their active component apolipoproteins are able to penetrate into the subendothelial space and, being oxidized, affect endothelial cells. In this regard, the initial stage of atherosclerosis is characterized as a response to the retention of atherogenic particles [2]. The main risk factors that play a significant role in endothelial damage are smoking, arterial hypertension and hypercholesterolemia. It has been shown that with an increase in cholesterol levels of more than 8.5 mmol/l, the risk of fatal cardiovascular complications increases by 4 times, when combined with arterial hypertension by 9 times, with smoking, the presence of hypercholesterolemia and arterial hypertension by 16 times [1]. The problem of primary and secondary prevention of ischemic stroke is not only medical, but also of great social importance, since patients who have had it become disabled in more than 80% of cases and often need outside help. Statins are considered highly effective drugs with the greatest evidence in reducing the risk of cardiovascular events in patients with coronary artery disease.
На сегодняшний день удаление зубов является распространенной операцией, при которой происходят геморрагические повреждения, в особенности у больных вирусным гепатитом. Как известно, после удаления зуба повреждение эндотелия кровеносных сосудов является началом для формирования кровяного сгустка.
Атипичный гемолитико-уремический синдром (аГУС) – ультраредкое генетически детерминированное заболевание, обусловленное неконтролируемой активацией альтернативного пути комплемента. Органом мишенью при аГУС являются почки из-за высокой чувствительности к активации и дисрегуляции комплемента за счет фенестрированной архитектуры эндотелия клубочков, отсутствия поверхностно связанных регуляторов комплемента в гломерулярной базальной мембране и высокой зависимости эндотелиальных клеток клубочков от фактора роста эндотелия сосудов. В 20% случаев у пациентов с аГУС могут диагностироваться внепочечные симптомы, которые могут быть как проявлениями, так и осложнениями заболевания.
Tooth extraction is the most common operation, after which hemorrhagic complications often occur, especially in patients with chronic viral liver disease. This condition is caused by damage to the endothelial lining of blood vessels. Based on this, the purpose of this study was to study the features of endothelial dysfunction before tooth extraction in patients with viral hepatitis. 58 patients with hepatitis B and C with different prescription periods of the disease were examined. In patients with viral hepatitis, an increase in platelet aggregation activity on the effect of an ADP inducer (Tma) by 45% was noted before tooth extraction. The lengthening of the activated recalcification time (AVR) by 37% observed by us in patients with viral hepatitis reflects a deficiency of plasma factors (XII,XI,XIII) of the blood coagulation system and indicates a state of hypocoagulation. Against this background, high values of alpha-2 macroglobulin in the blood (4 times) and Willebrand factor (15%) and a significant decrease (by 35%) in the content of protein C in the blood of the examined patients were noted. The obtained results of the study indicate that these patients have a narrow band of maintaining hemostatic balance, and the existing balance can easily be transformed into hypo- or hypercoagulation, which requires preventive measures to prevent complications after tooth extraction.
Aim of the study.To assess the degree of endothelial dysfunction and renal function in experimental ischemic stroke (EIS) in rats on the dynamics of pharmacotherapy.Materials and Methods.The subject of experimental studies were 105 adult mongrel white male rats. The object of the study were the serum and urine of rats. The model of cerebral circulation reproduced by temporary clipping of the left common carotid artery. The controls were 20 intact animals. Results. The results indicate to the development of endothelial dysfunction with EIS with the activation of neoangiogenesis in experimental animals. Pharmacotherapy with suksinasol for 7 days caused reduction of the level of ET-1 with respect to the values of untreated animal group and was still significantly higher than control group of rats in 2.5 times. At the same time, the level of VEGf A (vascular endothelial growth factor A) significantly decreased respectively to untreated group of rats in 1.65 times (p<0.01), but was still higher than control values in 1.74 times (p<0.01). development of proteinuria, microalbuminuria and creatininuria in rats with EIS apparently was due to the development of hemodynamic changes in the kidney and glomerular basal membrane permeability, and due to the enhanced excretion of toxins and protein degradation products.Conclusion. The endothelial and renal dysfunctions with activation of neoangiogenesis develop on the model of EIS. Pharmacotherapy corrects the identified changes to some extent. Tivortin and choline alfosceratewere more effective, possibly, because of decrease of hemodynamic disturbances and neurotrophic effects.
Эндотелиальная дисфункция может быть определена как неадекватное образование в эндотелии (дисбаланс) различных биологически активных веществ.