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UDC:[618.3-008.6-036.87:616.61-002.3]-036-084
RISK FACTORS FOR DEVELOPING PREECLAMPSIA IN WOMEN WITH
A HISTORY OF SEVERE PREECLAMSIA AND PYELONEPHRITIS
Saporbayeva I.R., Babadjanova G.S
Tashkent medical academy
Abstract.
Preeclampsia is one of the most pressing problems of modern
obstetrics, for which there is a lack of reliable early prognostic and diagnostic signs,
effective preventive and therapeutic measures. This disease is the main cause of
maternal and perinatal mortality, accounting for 12.1-23.2%. In addition, the number
of asymptomatic and atypical forms of preeclampsia has also increased [4,6,7].
Risk factors for the development of preeclampsia are: a history of preeclampsia,
genetic predisposition, chronic kidney disease, systemic lupus erythematosus,
autoimmune diseases such as antiphospholipid syndrome, diabetes mellitus, multiple
pregnancy, congenital and acquired thrombophilia, vascular diseases, the age of the
pregnant woman under 20 or over 35 years, obesity, drug use.
Despite numerous studies conducted around the world, the problem has not yet
been solved. Although the etiology and pathogenesis of preeclampsia are not fully
understood, there are many hypotheses (more than 40) regarding its etiology and
pathogenesis.
The most widely accepted pathogenesis hypothesis currently suggests that an
imbalance of angiogenic and antiangiogenic factors (e.g. VEGF, PGF, and their
tyrosine kinase-associated receptors) plays a key role in placental hypoxia [1,3,4].
Preeclampsia is a condition characterized by dysfunction of multiple organ
systems in a pregnant woman due to multiple organ failure. Preeclampsia is a classic
complication of pregnancy, with 6–8% of pregnant women in developing countries and
0.4% in developed countries suffering from preeclampsia. Preeclampsia affects 1.5–
8.0 million women in developing countries and 50–370,000 in developed countries
each year.
Keywords
: pregnancy with severe preeclampsia, combination of preeclampsia
with IUT , , recurrent cystitis, urogenital infections, pregnancy complications;
Introduction
. Preeclampsia is a condition resulting from the dysfunction of
several organ systems of a pregnant woman due to multiorgan failure. PE is a classic
complication of pregnancy, with 6-8% of pregnant women in developing countries and
0.4% in developed countries suffering from PE. According to the definition of H.D.
Kopsov and S. Anant Karumanchi: PE is a complex of pregnancy-specific diseases that
include genetic, immunological and environmental factors, characterized by the first
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appearance of gestational hypertension, proteinuria and edema after 20 weeks of
gestation.
The term "combined PE" is the presence of PE in combination with chronic
arterial hypertension. The incidence of secondary PE is 5.2%, and with moderate
arterial hypertension - 18.4%; with severe chronic hypertension - up to 100%. It is
known that secondary PE can persist for more than two years after delivery in patients
[7,8,10].
Eclampsia, as mentioned above, is the combination of PE with one or more
seizures that are not associated with neurological disorders. E. Norwitz and D. Sharge
(2003) suggest that eclampsia can also be considered a complication of stroke, DVS,
HELLP syndromes, and adult RDS. Eclamptic seizures are one of the clinical
manifestations of PE and its final stage. R.L. Goldenberg and E.M. McClure (2011)
consider eclampsia to be the main cause of death in pregnant women. Eclampsia is the
main cause of maternal mortality in 16% of cases.
Thus, a review of the literature shows that the development of PE during
pregnancy leads to serious complications and can lead to its recurrence in subsequent
pregnancies. Therefore, prevention of recurrence of PE in subsequent pregnancies in
the pre-pregnancy period is a pressing issue.
Objective:
To optimize the prediction and prevention of recurrence of
preeclampsia using clinical and laboratory signs and to determine the effectiveness of
pregravid preparation in women with a complicated obstetric history.
Material and methods
: The history of 110 deliveries of women with severe PE
was retrospectively reviewed to identify risk factors. 110 postpartum women with
severe preeclampsia were prospectively examined and divided into 2 groups: Group 1:
65 women with kidney disease that developed during pregnancy Group 2: 45 women
with chronic kidney pathology, Group 3: control group (n-40) practically healthy
pregnant women.
Results:
In women with a history of severe PE and pyelonephritis and no pre-
pregnancy preparation, according to clinical laboratory results, negative changes in the
hemostasis system were observed during subsequent pregnancies, including increased
platelet aggregation, reduced blood clotting time, decreased prothrombin index and
increased fibrinogen, reduced thrombin time, and increased alkaline phosphatase
concentration and liver transaminases according to the results of biochemical blood
tests.
In women with a history of severe preeclampsia and pyelonephritis, the risk
factors for pregnancy complications during subsequent pregnancies were determined
as follows in groups 1 and 2, respectively: chronic tonsillitis 6 and 4%, diffuse goiter
3 and 2%, NSD cardiological type 1.5 and 4%, chronic pyelonephritis in group 2 17%,
asymptomatic bacteriuria 12%, solitary kidney 4%, type II diabetes mellitus in both
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groups 2%, obesity 11 and 9%, chronic hypertension 5 and 2%, multiple pregnancy 6
and 4%Jadval 3.5
Social status of the patients examined
Social status
I group
n=65
II group
n=45
III group
n=30
Аbc
%
аbc
%
Аbc
%
1
Villager
12
18,5%
9
20%
2
7%
2
City dweller
53
81,5%
36
80%
28
93%
3
Housewife
38
58,5%
26
58%
14
47%
4
Worker
21
32,5%
15
33%
12
40%
5
Student
6
9%
4
9%
4
13%
Parity analysis of pregnant women showed that 16 (25%) in group I were pregnant
for the first time and 49 (75%) had repeated pregnancies. In group II, 14 (31%) were
pregnant for the first time and 31 (69%) had repeated pregnancies. Accordingly, in the
control group, these indicators were 12 and 18 (40.60%).
Age of women examined
Age groups
I group
n=65
II group
n=45
III group
n=30
Аbc
%
Аbc
%
Аbc
%
1
≤20 years
old
3
5%
2
4%
2
7%
2
20-24 years
old
19
29%
11
25%
7
23%
3
25-29 years
old
14
22%
9
20%
9
30%
4
30-34 years
old
15
23%
14
31%
8
27%
5
35-39 years
old
10
15%
7
16%
4
13%
6
≥40
4
6%
2
4%
-
-
7
Average Age
of Women
29
28
26
Analysis of hereditary diseases in women showed that diabetes mellitus was
detected in 4 (6%) parents of women in the main group, 3 (7%) in group 2, and 1 (3%)
in the control group. Hypertension was found in 3 (5%), 2 (4%), and 1 (3%) in the first,
second, and third groups, respectively. There were also women who completely denied
the above-mentioned conditions considered hereditary diseases, and these indicators
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were 10 (15%) in the first group, 12 (27%) in the comparison group, and 16 (53%) in
the control group.
Conclusion:
In women with a history of severe preeclampsia and pyelonephritis,
timely anti-inflammatory treatment for renal pathology, as determined by clinical
laboratory tests, and pre-pregnancy preparation that supports immunity lead to a 4.8-
fold reduction in complications associated with future pregnancies.
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