The dissertation is devoted to the optimization of pregnancy management tactics, treatment and prevention of obstetric complications in women with undifferentiated connective tissue dysplasia (UCTD) and mitral valve prolapse (MVP), complicated by extrasystolic arrhythmia, through the differentiated use of complex drug treatment including the vitamin-mineral, L-arginine-L-carnitine complexes and the selective beta-adrenergic blocker nebivolol. New confirmation of the concept was obtained that the course of pregnancy in women with MVP on the background of UCTD complicated by EA is accompanied by a significantly higher frequency of development of obstetric and perinatal complications of pregnancy throughout the entire period of gestation. It was established for the first time that in pregnant women with UCTD and MVP syndrome complicated by EA, the disease is clinically manifested by the development of both arrhythmic symptoms and signs of a violation of the vegetative-vascular status, electrophysiological changes in the heart and are associated with an increase in the heterogeneity of repolarization and hyperfunction of the heart (increase Resting heart rate, duration and dispersion of the P wave, QRS complex and a simultaneous decrease in the duration of diastole), which significantly shortens the time of blood supply and worsens metabolic processes in the myocardium and placenta. These can be considered as the direct causes of placental dysfunction, fetal growth retardation, the development of labor abnormalities and complications in the early postpartum period. It has been shown that EA in pregnant women with MVP on the background of UCTD is associated with hypo- and dyselectrolytemia of ↓Mg2+, ↓K+ and hypercalcemia, imbalances in the LPO/AOS, the severity of endothelial dysfunction, and manifestations of structural and geometric remodeling of the heart with deterioration of contractile function (reduction of EF) and relaxation properties of the myocardium, signs of myxomatous degeneration of mitral valve leaflets and the amount of prolapse and regurgitation of blood, an increase in the frequency of daytime heart rate and the syndrome of early repolarization of the ST segment, which were detected against the background of vegetative-vascular dystonia. The syndrome of systolic-diastolic myocardial dysfunction in pregnant women contributed to the development of uteroplacental blood flow disorders, which was confirmed by dopplerometry data. It was shown that in pregnant women with UCTD and MVP under the influence of the recommended treatment with arginine-carnitine and vitamin-mineral complexes, the level of electrolytes, electrophysiological and functional indicators of systolic-diastolic function of the myocardium were normalized to the level of healthy pregnant women due to the restoration of metabolic processes in the myocardium and improvement of peripheral hemodynamics, which was accompanied by a satisfactory utero-placental-fetal blood flow (according to dopplerometry), a decrease in the frequency of miscarriage, preeclampsia, fetal gross retardation and complications during childbirth and the postpartum period. It has been proven that in pregnant women with UCTD and MVP complicated by EA the addition of combined treatment with arginine-carnitine, vitamin-mineral complexes in combination with the selective beta-adrenergic blocker nebivolol to the standard medical care of pregnants with UCTD and MVP with EA contributed to the elimination of extrasystole, reduction of the size of the left chambers of the heart and manifestations of post-arrhythmic left ventricular remodeling, which manifested by a reliable improvement of electrophysiological parameters and systolic-diastolic function of the heart. The obtained hemodynamic, antiarrhythmic and metabolic effects of the proposed complex therapy in pregnant women with UCTD and MVP complicated by extrasystolic arrhythmia were accompanied by a significant decrease in the frequency of pregnancy and childbirth complications.
