Shamayeva O. Pregnancy and Parturition Course and Perinatal Fetus Damage Prophylaxis of Women from the Liquidators' of Chernobyl Disaster Consequences Families

Українська версія

Thesis for the degree of Candidate of Sciences (CSc)

State registration number

0499U003130

Applicant for

Specialization

  • 14.01.01 - Акушерство та гінекологія

23-11-1999

Specialized Academic Board

Д26.553.01

Essay

The clinical and laboratory examination of 112 women from the liquidators' families divided into groups with an account for the personal participation of their household members (mother, father or spouses) in liquidation of Chernobyl disaster consequences has provided evidences of the high frequency of complicated pregnancy and/or parturition course for most of the named women. The following complications were the most frequent: the threat of pregnancy interruption, anemia, fetoplacental insufficiency, early and late gestosis, uterine inertia, hemorrhage. The most severe complications were observed for those women who participated personally in liquidation of disaster consequences, especially in groups where both spouses were liquidators. The thyroid system state investigation has revealed morphologic and functional changes in thyroid gland showing themselves up as thyroid gland hyperplasia and various hormonal disturbances. The immune system state investigation has demonstrated the presence of a misba lance in T-lymphocyte sub-populations, including regulatory species, which was showing up in suppressory immunity unit inhibition and also in prevailingly as deficiency of the natural killers [CD16+]. Also, the depressed phagocitic activity ofneutrophyles was found, which was evidenced by decrease of the levels of A- and M-class immunoglobulins. The deficiency of oftrophoblastic glycoprotein being the main immunity regulator during the pregnancy period was found and the strong inverse correlative relation between its level and the level of ofradionuclides incorporated into the body of pregnant patient was revealed. Investigation of the functional state of fetoplacental complex presented the evidence of its substantial disturbances from the early pregnancy period. The functional tension of the fetoplacental complex was observed in the first and the second pregnancy trimesters, which was showed up by decreasing the levels of all its hormones and predominating the estrogen-type colpocytograms, while, on the cont rary, suppression of the fetoplacental function, such as the steady decrease ofplacental lactogen level in blood and estriol level in urine, as well as augmentation of changes in colpocytogram, was observed in the third trimester. The strong inverse correlation between criteria showing the level of radionuclides incorporated into the body of a pregnant patient (over 629 Becquerels) and the blood level of placental lactogen was revealed. The intrauterine hypoxia and fetus development arrest were found while using the cardiographic and ultrasonic methods of investigation corroborated the progress of placental insufficiency. The morphological placental study provided the evidence of both placental insufficiency and the increase of activity of compensatory and adaptive reactions inside of placenta. The electronic microscope study has revealed the clear compensatory and adaptive reactions and dystrophic changes in the cytoplasm of villus epithelium, smoothening of microvilli, nuclear chromatin condensation and ede matic nucleus. Placenta damages were recorded all the cases of patients that participated personally in liquidation of the consequences of Chernobyl disaster, in all the observations, while the degree of such damages depended on the 137Cs level in placenta. The connection between the level of 137Cs in placenta and the level of placental lactogene in blood was estimated. The set of curative and preventive measures aimed at preparation of spouses to the scheduled pregnancy and optimization of the functioning of fetoplacental complex during the period of pregnancy (in the 1st, 2nd and 3d trimesters) were worked out. Efficiency of the developed set of measures including administration of enterosorbents, phytotea, pectin, vitamins and antioxidants was collaborated by normalization of the mothers' homeostasis and functioning of the fetoplacental complex. It was observed clinically as a reduction of the frequency of weak generic activity, hemorrhages in the early postnatal period and threat of fetal intrauterine hyp oxia, as well as in increase of the frequency of physiological run of the early postnatal period and in improvement of the state of newborns

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