Butenko L. Prophylactics of obstetric and perinatal complications in women with congenital heart diseases with heart failure and anemia.

The thesis covers the issues of a new approach to solve the actual problem of modern obstetrics - improvement the quality of life and reduction of the obstetric and perinatal complications in women with congenital heart diseases with heart failure and anemia by developing an algorithm for therapeutic and prophylactic measures. The incidence of obstetric and perinatal complications in women with congenital heart diseases (CHD), heart failure and anemia is significantly higher in comparison with womenof reproductive age. There is significant risk of increased maternal mortality and morbidity by 30%, if the pregnancy in women with CHD and anemia is complicated with preeclampsia and by 18-25%. with progression of heart failure. All of the above mentioned affects the increase in the rate of termination of pregnancy and iatrogenic preterm birth by 18%, which is caused by impaired early stages of embryo and choriogenesis with manifestation of manifestations in the second and third trimesters. As a result of the research, a correlation was found between the severity of anemia in women with congenital heart diseases and anemia considerably the heart failure and prematurity, IUGR and fetus in hypoxia (r = 0.8, r = 0.75 and r = 0, respectively , 85). The results of our research prove that the presence of latent iron deficiency is diagnosed in 69 surveyed pregnant women and creates in general 81%. It is revealed that the most sensitive markers of iron deficiency in pregnant women with congenital heart diseases are the logarithm of soluble transferrin receptor and serum ferritin. These rates are significantly reduced in pregnant women with heart failure and moderate anemia. It is proved that the combined analysis of the values of iron metabolism and NTproBNP allows us to determine precisely the likelihood of the occurrence or progression of heart failure and the need to include antianemic drugs in the scheduled treatment of such patients. According to our research, it was established that the distance in the 6-minute walk test is inversely correlated with the degree of heart failure and the severity of anemia. An increase in the degree of anemia in pregnant women with congenital malformations on the background of heart failure significantly worsens the subjective state of the woman, manifested in a decrease in the quality of life. Also, it is important to timely study the state of the uteroplacental circulation in order to determine the presence of fetal distress and to establish terms of parturition in the studied groups of patients. The immunohistochemical analysis revealed changes in the expression of placental growth factor in various structures of the placental barrier in studied groups, which reflected the effect of heart failure and anemia on angiogenesis and endothelial dysfunction, which confirms the intensity of the early stages of choriogenesis and requires preconception diagnosis and pregravidary preparation for all pregnant women with HBC prevent the pathological course of early gestation. The practical implementation of the worked-out complex of treatment-and-prophylactic measures made it possible to avoid progression of heart failure, to reduce the rate of parturition before 37 weeks by 45%, to reduce the probability of having children in a state of severe hypoxia by 37% and in the absolute absence of perinatal losses.