• Pregnancy tactic optimization in women with previous perinatal losses

Pregnancy tactic optimization in women with previous perinatal losses

HEALTH OF WOMAN. 2017.3(119):41–45; doi 10.15574/HW.2017.119.41

L.I. Vorobey
National Medical Academy of Postgraduate Education P. L. Shupyk, Kyiv
Kyiv City Center for Reproductive and Perinatal Medicine

The objective: to improve the effectiveness of gestational complications prevention in women with a previous perinatal losses (PL) by diagnostic methods optimization.

Patients and methods. 85 pregnant women with previous perinatal losses were examined. Group II (control group) included 89 pregnant women without PL. The relationship between neurovegetative violations and pregnancy complications in women with adverse obstetric history were found using the heart rate variability method and determination of mother–placenta–fetus system status.

Results. The overbalance of the sympathetic effects, mostly in the third trimester, was observed in pregnant women with previous perinatal losses, unlike the control group (p<0,05). This may be explained due to depletion of compensatory reserves of autonomic nervous system.

In the second trimester increased sympathetic tone was established after stress tests in women of the main group, probably, because of the compensatory-adaptive reactions of all parts of the autonomic nervous system realization.

Conclusion. Vegetative homeostasis violations with increased sympathetic tone cause placental dysfunction with metabolic changes, fetal growth retardation and other gestational complications. The dominance of sympathetic tone in pregnant women with previous perinatal losses and hormonal function of mother–placenta–fetus system indicate an imbalance of neurohumoral regulation and can be the diagnostic and prognostic sign of pregnancy complications.

Key words: neurovegetative regulation, perinatal losses, placental dysfunction, cardiointervalography.

REFERENCES

1. Avramenko TV, Shevchenko AA, Lapko PV. 2013. Otsenka psihoemotsionalnogo sostoyaniya s izmeneniem vegetativnogo reagirovaniya v nevrologicheskom profile beremennyih s vrozhdennoy patologiey TsNS ploda. Zdorove zhenschinyi 2(78):83–90.

2. Ayhozhaeva MT i dr. 2015. Izmenenie gormonalnogo statusa v platsente zhenschin s sindromom zaderzhki vnutriutrobnogo razvitiya ploda. Mezhdunarodnyiy zhurnal eksperimentalnogo obrazovaniya 3–4:499–501.

3. Veyn AM. 2003. Vegetativnyie rasstroystva: klinika, diagnostika, lechenie. Pod red. AM Veyna. M, MIA:752.

4. Dovzhikova IV. 2010. Fermentyi steroidogeneza (obzor literaturyi). Byulleten fiziologii i patologii dyihaniya 37.

5. Igitova MB, Dmitrienko KV. 2014. Prognozirovanie neblagopriyatnyih perinatalnyih ishodov na osnove opredeleniya faktora rosta platsentyi. Mat i ditya v Kuzbasse 4:38–41.

6. Kleschenogov SA. 2012. Rannie priznaki zaderzhki razvitiya ploda po dannyim variabelnosti kardioritma materi. Sibirskiy nauchnyiy meditsinskiy zhurnal 32;2:99–104.

7. Makatsariya AD, Bitsadze VO. 2001. Trombofilicheskie sostoyaniya v akusherskoy praktike. M, Russo:28–33.

8. Sidorova IS, Makarov IO. 2000. Fetoplatsentarnaya nedostatochnost. Kliniko-diagnosticheskie aspektyi. M, Znanie-M:127.

9. Hvorostuhina NF i dr. 2011. Gormonalnyie narusheniya v patogeneze reproduktivnyih poter. Mezhdunarodnyiy zhurnal prikladnyih i fundamentalnyih issledovaniy 12:118–120.

10. Homenko VA, Bezuglaya OA, Mogilevkina IA. 2012. Antenatalnaya gibel ploda: chem otlichayutsya takie beremennosti? Tavricheskiy mediko-biologicheskiy vestnik 15;2; 2(58):201–203.

11. ShkIryak ZA. 2012. Efektivniy antenatalniy doglyad. Navchalniy posIbnik. K, «Zdorov’ya materI ta ditini».

12. Sholohov LF i dr. 2009. Zakonomernosti razvitiya adaptivnyih i dezadaptivnyih reaktsiy sistemyi neyroendokrinnoy regulyatsii organizma v dinamike beremennosti u zhenschin s razlichnoy stepenyu riska razvitiya perinatalnoy patologii. Zdorove. Meditsinskaya ekologiya. Nauka 39;4–5.

13. Ando T, Davies TF. 2004. Self-recognition and the role of fetal microchimerism. Best Practice & Research Clinical Endocrinology & Metabolism. 18;2:197–211.

14. Aragгo VMF et al. 2005. Risk factors for intrauterine growth restriction: a comparison between two Brazilian cities. Pediatric research 57:674–679. https://doi.org/10.1203/01.PDR.0000156504.29809.26; PMid:15718360

15. Hellhammer D, Hellhammer J ed. Stress: the brain-body connection. Karger Medical and Scientific Publishers, 2008. https://doi.org/10.1159/isbn.978-3-8055-7969-8

16. Li YL et al. 2006. Angiotensin II enhances carotid body chemoreflex control of sympathetic outflow in chronic heart failure rabbits. Cardiovascular research 71;1:129–138. https://doi.org/10.1016/j.cardiores.2006.03.017; PMid:16650840

17. Osborn JW, Jacob F, Guzman P. 2005. A neural set point for the long-term control of arterial pressure: beyond the arterial baroreceptor reflex. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 288;4:R846–R855. https://doi.org/10.1152/ajpregu.00474.2004; PMid:15793038

18. WHO Recommended interventions for improving maternal and newborn health. 2009. World Health Organization. Geneva 6. 

Содержание журнала Full text of article