Патогенез, диагностика и тактика ведения первородящих женщин с преждевременной отслойкой нормально расположенной плаценты

Аннотация

The urgency and relevance of the theme of dissertation. The World Health Care Organization (WHCO), according to the process of pregnancy and childbirth each year about 550 thousand, obstetric hemorrhage is 125-150 thousand deaths each year 14000000 is observed in case of postpartum bleeding, 120000-140000 people die (24 hours), and 200,000 of them arc mothers with a disease. During the years of independence in the process of reforming the health care system special attention is given to the protection of motherhood and childhood, and achieved certain results in this direction. As a result, the premature detachment of normally located placenta in the streets increased by 31.2% in the early diagnosis and prevention of complications due to count readily achieved a reduction of 28.5%2. Particular attention is paid to the development in the world of modem methods for the diagnosis of premature detachment of normally situated placenta. The priority areas of modern methods for diagnosis arc the prevention of maternal mortality in obstetrics and gynecology, the study of the state of the utcro-placental fetal blood flow, changes in endothelium of placental vessels and the uterus, improving the methods of examination (clinical, laboratory and instrumental), massive obstetric bleeding in pregnancy, the development of hemorrhagic clinics shock, uterine tamponade women, women's disability (amputation and hysterectomy). The above researches determine the relevance of the dissertation topic. The present dissertation is aimed at achieving the objectives set out in the Decree of the President of the Republic of Uzbekistan Number PD-2133 on February 19, 2014 "On State program" Year of a healthy child, number P-4577 from December 10, 2015 "On measures aimed at the development and implementation of the" Year of the state program of maternal and child health. " the implementation of which will improve the quality of care for pregnant women, newborns, and reduce maternal and infant mortality in the country as a whole. The aim of research work: Identify the pathogcnctical mechanisms of development of premature abruption normally located placenta in nulliparous women to improve the diagnosis and management of pregnancy. Scientific novelty of the research work is as follows: For the first time an assessment of indicators of vascular endothelial and placental of growth factors, Willebrand factor, fibronectin, oxidative stress, pro-and anti-inflammatory cytokines in pregnant women with PDNLP without the presence of hypertensive syndrome; For the first time studied the state of uteri-placental-fetal blood flow in the PDNLP mild in pregnant women without hypertensive syndrome. On the basis of which shows the development of protective mechanisms of uteri-placcntal blood flow, contributing to the preservation of a certain time, quality of blood flow in the fetus when premature placental abruption; Estimated correlations between indicators of endothelial dysfunction, cytokine status and indicators of utcri-placcntal-fctal blood flow in pregnant women and their newborns; Complex studied morphometric, morphological, electron microscopic, immunohistochemical changes in the placenta in pregnant women with PDNLP without hypertensive syndrome; development plans of pathogenesis have been developed in PDNLP that hypertensive syndrome not observed. CONCLUSION 1. Risk factors for premature detachment of normally located placenta in nulliparous women without hypertensive syndrome arc infections, sexually transmitted infections (chlamydia, herpes simplex virus, cytomegalovirus, urcaplasma) (75%), inflammatory diseases of the pelvic organs (37.1%), threat of interruption I (86,7%) and II (83,4%) half of pregnancy, vomiting of pregnancy (22.7%), acute respiratory infection during pregnancy (59.1%), fctoplatscntranaya failure (45.0%) 2.Premature detachment of normally situated placenta is accompanied by blood circulation in fetoplatscntranom complex, which is accompanied by an increase in SDR to 1, 91 ± 0,064 andlR to 0,44 ± 0,014v uterine arteries on both sides. 3. Premature detachment of normally located placenta develops in the presence of endothelial dysfunction, characterized by an increase of VEGF, ET-1 and a decrease in PLGF. Also, an increase in vFW and fibronectin, which is evidence of damage to the vessel wall and increased thrombus formation. 4. The clinical picture of premature detachment of normally situated placenta develops due to an imbalance of pro - and anti-inflammatory cytokines. Thus, there is an increase in IL-ip - 3.0 times, 2,6 timcs-TNFa, IL-6 - 8.0 times and reduced IL-10 is 1.5 times 5. In the course of pregnancy (II-III trimester) when markers premature detachment of normally located placenta P observed destruction of decidual cells and lymphoid infiltration of plasma cells, syncytiotrophoblast vacuolization and destruction of organelles. Strom terminal villi has foci of sclerosis, capillary endothelium enlightened contains few organelles, basal membrane underneath loosened and thickened. Severe immunohistochemical reaction decidual cells, syncytiotrophoblast, and the basement membrane to the endothelium of the placenta tissue antigens to her at the end of II, and the beginning of III trimester of pregnancy is a morphological equivalent of violations of rcgularchanges in the mother-placenta and rejection of normally situated placenta. 6. Established correlations between markers in pregnant women and in cord blood. Determined a direct correlation between TNF-a and IL-6, r = +0,64; between NO and IL-6, r = +0.063; N02 and IL-6, r = +0.56; SOD and IL-6, r = +0,53 medium strength. 7. Predictor forecast the development of abruption placental arc the following parameters in the blood of pregnant women: ET-1 1,16 ± 0,07 fmol I ml and above; VEGF 13,8 ± 0,68 pg / mli above; IL-6- 53.1 ± 3.93 pg / ml and above; fibronectin. PLGF-8,2 ± 182.8 pg / ml or below; 8. The pathogenesis of premature detachment of normally located placenta in pregnant women with no hypertensive syndrome is associated with penetration into the mother's body and fetus infection (often chlamydia. CMV, HSV, urcaplasma) and activation of systemic inflammatory response, contributing to the development of endothelial dysfunction, hemodynamic and disruption of compensatory mechanisms in fetoplacental complex.