Popovych O. Improvement of prevention of gestational complications in women with idiopathic arterial hypotension

The thesis is devoted to reducing the frequency of gestational complications in women with idiopathic arterial hypotension (IAH) by establishing the features of pathogenesis and improving the diagnosis of complications, developing a pathogenetically based algorithm of therapeutic and preventive measures.Studies of the level of nitrites and nitrates, stable metabolites of NO, confirmed the recognized fact of hyperoxidazotemia in IAH, 4.67±0.32 μmol/g in comparison with the control group – 3.12±0.36 μmol/l (p<0.05), associated with the predominance of parasympathetic influence and stimulation of NO synthesis by acetylcholine. The role of cervical hemocirculation disorders in its insufficient reconstruction before delivery at the 39th week of pregnancy has been shown: RI SAC was significantly higher in patients of the main group compared to the control group: 0.66±0.05 vs 0.47±0.04, respectively (p<0.001). Clinically, this was manifested by the presence of an "immature" and "insufficiently mature" cervix in 71.4% of pregnant women with IAH. It has been proven that the presence of IAH significantly increases the risk of coagulopathic bleeding in the early postpartum period (CEPP) due to changes in the stage of the vascular-platelet link of hemostasis caused by an increased concentration of NO – a powerful inhibitor of adhesion and aggregation of platelets and, as a result, the development of secondary hyperfibrinolysis. The results of the analysis of the platelet function in the form of inhibition of aggregation activity with adenosine diphosphate (ADP) indicate a pronounced disruption of the platelet function in parturients with IAH: aggregation with ADP occurred, on average, for 26.7±4.30 s in parturients of the main group compared to the control group – 17.7±2.30s (p<0.001). The developed and implemented algorithm for providing medical care with the use of preinduction of labor, correction of hemodynamic disorders in LPPLP and prevention of CEPP in parturients of the main group contributed to the shortening of the latent phase I of the labor period, on average, by 2.0±0.4 hours in primiparous women and 1.6 ±0.3 hours in multiparous women; ensured a satisfactory progress of labor in 85.4% of parturients, which led to a decrease in the frequency of cesarean section by 1.8 times; reduction of perinatal morbidity by 8.5%; reduction in the frequency of postpartum bleeding by 7.3%.