scholarly journals Differential diagnosis of thrombocytopenia during pregnancy: clinical and diagnostic algorithms

2021 ◽  
pp. 28-40
Author(s):  
O.M. Naumchik ◽  
◽  
Iu.V. Davydova ◽  
A.Yu. Limanska ◽  
◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pregnant Women ◽  
Immune Thrombocytopenia ◽  
Clinical Laboratory ◽  
Treatment Algorithm ◽  
Laboratory Data ◽  
Diagnostic Algorithm ◽  
State Institution ◽  
Perinatal Complications ◽  
Pregnancy And Childbirth

Purpose — to create an algorithm for early diagnosis and differential diagnosis of conditions accompanied by thrombocytopenia (TP) during pregnancy, as well as an algorithm for the treatment of immune thrombocytopenia during pregnancy based on analysis of clinical, laboratory data and obstetric and perinatal results of such pregnant women. Materials and methods. We analyzed 155 histories of pregnancy and childbirth of women with TP, who underwent inpatient treatment and/or gave childbirth in the obstetric clinic of the State Institution «Institute of Pediatrics, Obstetrics and Gynecology named after Academician O.M. Lukyanova NAMS of Ukraine» from January 2008 to August 2018. According to the inclusion criteria, 111 histories were selected for further analysis. Pregnant women are divided according to the etiological principle of TP into three groups: with gestational thrombocytopenia, immune thrombocytopenia, secondary thrombocytopenia. The first group included 32 women (28.8%), the second — 65 (55.6%), the third — 14 (12.6%). During the selected period of time there were 99 births, 100 babies were born, 1 twin birth. Results and conclusions. The number of platelets progressively decreases during pregnancy with a minimum in childbirth. The algorithm of examination, the decision on the initiation or intensification of treatment, the choice of monitoring tactics for TP during pregnancy, the calculation of obstetric and perinatal risks, preparation for childbirth and the choice of method depend on the cause of TP and differ significantly. Developed «Algorithm for diagnosis and differential diagnosis in the detection of thrombocytopenia during pregnancy» and «Algorithm for the treatment of immune thrombocytopenia during pregnancy» are aimed at the prevention of obstetric and perinatal complications in pregnant women with thrombocytopenia. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of an participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: thrombocytopenia, pregnancy, diagnostic algorithm, treatment algorithm.

PERINATAL ASPECTS OF PREGNANCY AND CHILDBIRTH ON THE BACKGROUND OF VITAMIN D LACK IN PREGNANT WOMEN

2021 ◽  
Vol 74 (10) ◽  
pp. 2585-2587
Author(s):  
Vitaliy V. Maliar
Keyword(s):  
Vitamin D ◽  
Blood Serum ◽  
Pregnant Women ◽  
Perinatal Outcomes ◽  
Fetal Distress ◽  
Test System ◽  
Perinatal Complications ◽  
Pregnancy And Childbirth ◽  
Wide Range ◽  
Pregnancy And Delivery

The aim: To study the features of the course of gestation and perinatal outcomes of delivery in women with vitamin D lack. Materials and methods: The article presents the results of studies of the characteristics of the course of pregnancy and delivery outcomes in 50 patients with vitamin D lack compared with a group of 50 somatically healthy pregnant women with normal level of 25 (OH) D. In order to establish a lack of vitamin D in pregnant women in the 10-12, 20-22, 30-32 weeks of gestation electrochemiluminiscence method by using a test system EURIMMUN (Germany) in the blood serum level of 25-hydroxycalciferol (25 (OH) D) in pregnant women. Results: When analyzing the structure of complications in women with vitamin D lack during pregnancy and childbirth we found out that risk of premature birth and premature births dominated among all the complications, respectively (58.0% and 36.0%) against (12.0% and 16.0%), p <0.05. Vitamin D lack in pregnant women is often associated with a wide range of obstetric and perinatal complications, namely: preeclampsia, gestational diabetes, bacterial vaginosis , premature rupture of membranes, placental abruption, abnormal labor activity, fetal distress that required delivery by Caesarean section. Conclusions: An analysis of the course of pregnancy and childbirth in women of thematic groups proved the expediency of an individual approach to the therapy of obstetric pathology among women with vitamin D lack. Despite the level of 25 (OH) D in the blood serum of a pregnant woman of 30 ng / ml and below, it is advisable to prescribe vitamin D for prophylaxes and treatment of Vitamin D deficiency in mother and fetus.

Features of the genesial and somatic anamnesis at pregnant women with an undifferentiated dysplasia of connecting tissue

2017 ◽  
pp. 83-85
Author(s):  
A.L. Kostiuk ◽  
Keyword(s):  
Pregnant Women ◽  
Key Words ◽  
Clinical Laboratory ◽  
Perinatal Complications ◽  
Early Diagnostics

The objective: to study features of the somatic and genesial anamnesis at pregnant women with an undifferentiated dysplasia of connecting tissue for possibility of early diagnostics of the subsequent obstetric and perinatal complications. Patients and methods. 100 patients with clinical-laboratory signs an undifferentiated dysplasia of connecting tissue are surveyed. On the basis of the received results of the patient were divided into two groups: the main – 50 women (expression і6 points) regarded as patients with the expressed undifferentiated dysplasia of connecting tissue and group of comparison – 50 women (expression <6 points), regarded as patients without the connecting tissue expressed by an undifferentiated dysplasia. Results. Results of the conducted researches testify to an important role of the established features of the somatic and genesial anamnesis at pregnant women with clinical-laboratory and functional signs of an undifferentiated dysplasia of a connecting tissue. Conclusion. The received results need to be used for carrying out pregravidarny preparation and forecasting of possible obstetric and perinatal complications at pregnancy. Key words: undifferentiated dysplasia of connecting tissue, genesial and somatic anamnesis.

scholarly journals Modern views on the prevention of obstetric and perinatal complications in healthy pregnant women (Literature review)

2021 ◽  
Vol 1 ◽  
pp. 49-53
Author(s):  
Y.V.  Nevyshnа
Keyword(s):  
Pregnant Women ◽  
Birth Asphyxia ◽  
Obstetric Care ◽  
Married Couples ◽  
Positive Influence ◽  
Partner Support ◽  
Perinatal Complications ◽  
Preparation Methods ◽  
Pregnancy And Childbirth

This review article provides information on the role of different methods for pregnant women to prepare for childbirth according to the data regarding both foreign and domestic practices in obstetrics. The article highlights the issue of partner support starting from when pregnancy is established and gestation, through to childbirth and the postpartum period. According to the research, it is clear that the physiological course of the pregnancy directly depends on the psycho-emotional state of a pregnant woman, which impacts not only the course of pregnancy and childbirth, but also the condition of the fetus and newborn.The results of the research show that the method of psychophysiological preparation and partner support undoubtedly has a positive influence on the consequent childbirth: the duration of childbirth and the frequency of anomalies during maternity activity are reduced; surgery is performed less; the frequency of cervical and perineum ruptures, as well as the amount of blood loss, are decreased; intrauterine hypoxia and birth asphyxia are less common; and the manifestation of obstetric aggression decreases. Furthermore, the technologies of prenatal preparation are aimed at the demedicalization of childbirth and the minimization of the use of pharmacological drugs which have an ambiguous influence on a parturient, a fetus and a newborn.Therefore, the data mentioned above reveal the role of prenatal preparation methods of married couples for childbirth not only in the reduction of obstetric and perinatal complications in relatively healthy, pregnant women, but also in the choice of anesthesia methods, taking safety and efficiency into account.Unfortunately, the decreased interest toward psychophysiological preparation for childbirth by pregnant women and their partners, as well as medical institutions in general, was revealed while studying the issue of preparation for childbirth.Consequently, prenatal preparation of married couples must be obligatory in the system of obstetric care in Ukraine at all medical levels.

Management of born too soon preterm birth complicated by preterm premature rupture of membranes

2016 ◽  
pp. 58-64
Author(s):  
O.B. Malanchuk ◽  
◽  
V.P. Lakatosh ◽  
O.U. Kostenko ◽  
M.I. Antonuk ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Statistical Analysis ◽  
Pregnant Women ◽  
Neonatal Mortality ◽  
Perinatal Complications ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Mortality And Morbidity ◽  
Pregnancy And Childbirth ◽  
Preterm Premature Rupture

In Ukraine, each year born about 1,000 children ELBW, representing 0.3% of all newborns. The survival of infants with ELBW in our country has a slow upward trend and does not exceed 50%. Infants with ELBW have the highest risk of death and are the group most at risk for the development of chronic diseases of the respiratory and nervous systems and sensory apparatus and associated disability. Considering the growth of the number of children at private ELBW on the background PPROM, high perinatal morbidity and infant mortality, reduced health and reproductive capacity of women becoming urgency tactics of pregnancy and labor with premature rupture of membranes. The objective: perynatalniyh reduce complications in terms of 22-28 weeks of pregnancy complicated by premature rupture of membranes based on developing the tactics of pregnancy and childbirth. Patients and methods. To reduce perinatal complications analyzed the effect of different methods of pregnancy and childbirth on the state of newborns in gestational age 22-28 weeks against the backdrop of premature discharge of amniotic fluid. The control group consisted of 56 women who had less than a day anhydrous term. In the study group applied expectant tactics of anhydrous long term. Depending on the length of the term of anhydrous main group was divided into 2 subgroups. Sub-IA amounted to 86 pregnant women with anhydrous period of 5 days, and IP subgroup totaled 64 pregnant women with anhydrous period of 25 days. Statistical analysis of the results was performed using Microsoft Excel. Probability difference calculated by Student’s t-criterion. Results. Аnalyzing the structure and frequency of obstetric and perinatal complications in women in the period 22-28 weeks of pregnancy with different duration waterless terms, different terms of delivery proved the effectiveness of the tactics of delivery, which is used in perinatal centers m. Kyiv. This correlates with clinical data - statistical analysis of indicators of neonatal mortality and morbidity. Conclusion. Оf the research found that the rates of neonatal mortality and morbidity affecting: duration of anhydrous interval, gestational period, methods of delivery. Long expectant tactics leads to a real reduction of RDS, but an increase in the incidence of chorioamnionitis and neonatal infection. Therefore, wait-recommended tactics for 5 days, followed by delivery of women. At 22-27 weeks of pregnancy delivery path has no impact on rates of neonatal morbidity. The advantage in the delivery of women in the period 27-28 weeks, especially in the immature cervix and pelvic peredlezhenni fetal provided cesarean section. Key words: born too soon preterm birth, preterm premature rupture of membranes, pregnancy, method of delivery, birth with extremely low body weight.

scholarly journals COMPARATIVE ASPECTS OF PLACENTAL DYSFUNCTION IN WOMEN USING DIFFERENT METHODS OF CONTRACEPTION IN ANAMNESIS

2020 ◽  
Vol 5 ◽  
pp. 34-40
Author(s):  
Oleksandra Lubkovska
Keyword(s):  
Pregnant Women ◽  
Clinical Laboratory ◽  
Risk Groups ◽  
Oral Contraception ◽  
Pregnancy And Childbirth ◽  
Diagnostic Measures ◽  
Perinatal Pathology ◽  
Satisfactory Condition ◽  
Fetoplacental Complex ◽  
History Of

The aim. To reduce the incidence of perinatal pathology in women who have used various methods of contraception, based on the study of the functional state of the fetoplacental complex (FPS), as well as improving diagnostic measures and tactics of pregnancy. Materials and methods. 140 pregnant women were studied with their division into control and 3 test groups depending on the method of contraception in the anamnesis, using clinical, laboratory and instrumental research methods during pregnancy and childbirth. Results. The study found that women with a history of intrauterine contraception (IUC), in contrast to combined oral contraception (COC) and combined oral contraception containing folate (COC+F), had a higher incidence of complications during pregnancy and childbirth, as well as fewer newborns with a satisfactory condition at birth. Assessment of folic acid levels at 6-8 weeks of gestation showed significantly better results among women with a history of COC+F, compared with IUC and COC. In the group of women with IUC in the anamnesis, significantly worse mean endocrinological values prevailed, and there was also a greater number of pregnant women with disorders of fetal-placental blood flow. More pronounced dystrophic changes in the placentas of women in this group were pathomorphologically confirmed. Conclusions. The presence in the anamnesis of IUC is accompanied by a high proportion of pregnant women with various pathological conditions and is a risk factor for FPS dysfunction. The use of COC+F in the anamnesis is the best option for women of different risk groups.

scholarly journals Prevention of complications of pregnancy and childbirth of patients with a burdensome gynecological anamnesis

2021 ◽  
Vol 6 ◽  
pp. 56-60
Author(s):  
T. P. Andriichuk
Keyword(s):  
Pregnant Women ◽  
Fetal Distress ◽  
The Body ◽  
Prevention Measures ◽  
Perinatal Complications ◽  
Pregnancy And Childbirth ◽  
Placental Dysfunction ◽  
Treatment And Prevention ◽  
Prophylactic Measures ◽  
The Mean

The objective: determination of the effectiveness of prevention and medicinal correction of placental dysfunction in pregnant women with chronic salpingo-oophoritis.Materials and methods. The study included 100 pregnant women (basic group) with chronic salpingo-oophoritis, of these, I group (50 women) included patients who received proposed treatment and prevention approach, II group (50 women) received a common set of treatment and prevention measures. The proposed treatment-and-prophylactic approach included prophylactic administration to pregnant women with chronic salpingo-oophoritis from the 8th to the 10th and from the 16th to the 18th week inclusive of natural micronized progesterone at a dose of 100 mg intravaginally twice a day for two weeks. Venotonik and angioprotector were prescribed prophylactically at dose 600 mg from 18 weeks to 37-38 weeks of pregnancy. For therapeutic purposes (blood flow disorders in the uterine arteries and vessels of the umbilical cord that are determined by Doppler), the drug was prescribed at dose 600 mg twice a day for 3–4 weeks.Results. A lower frequency of obstetric and perinatal complications was found in the women in I group than in the patients in the II group. Thus, the rate of placental dysfunction was 6.0±3.36% vs. 34.0±6.7%, respectively, oligohydramnios – 6.0±3.36% and 12.0±4.59%, polyhydramnios – 10.0±4.24% and 22.0±5.86%, fetal distress during childbirth – 6.0±3.36% and 14.0±4.91%, cesarean section – 12.0±4.6% and 24.0±4.27%. In the group of patients with treatment-and-prophylactic approach, the mean of the body weight of newborns was 3486.7±312.71 g, and in women who received a common set of treatment-and-prophylactic measures – 3099.8±295.69 g. The mean of the assessment of the condition of newborns by the Apgar scale at the 1st minute – 7.92±1.54 and 6.81±1.16 points, respectively.Conclusions. The use of micronized natural progesterone and the drug diosmin 600 mg in pregnant women with a history of chronic salpingo-oophoritis reduces the rate of obstetric and perinatal complications during pregnancy.

Characteristics of markers of metabolic syndrome and features of the course of early gestation in pregnant women with the threat of miscarriage, depending on the body weight of the pregnant woman

2017 ◽  
pp. 69-76
Author(s):  
Yu.M. Duka ◽  
Keyword(s):  
Body Weight ◽  
Pregnant Women ◽  
Diagnostic Algorithm ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
The Body ◽  
Clinical Group ◽  
Perinatal Complications ◽  
Early Gestation ◽  
Perinatal Center

The article gives a scientific and practical justification for the expansion of the diagnostic algorithm in pregnant women with the threat of miscarriage, taking into account the woman’s phenotype. The objective: was to study the basic patterns of the formation and disruption of the reproductive system in pregnant women with overweight and obesity and to evaluate possible criteria for the formation of endocrine and metabolic disorders for the timely diagnosis and prevention of perinatal complications in pregnant women, depending on their phenotype. Materials and methods. Clinical groups comprised 175 pregnant women of different body weight (120 women with overweight and obesity, who were observed from a small gestation period on the basis of the department of fetal medicine and the pathology of early pregnancy of the communal institution «Dnepropetrovsk Regional Perinatal Center with a hospital» in the city of Dnepr (I clinical group) and 55 pregnant women with normal body weight (II clinical group – comparison group)). Results. The dependence of the detection of menstrual cycle disorders in women with overweight and obesity is 1.5 times more often than in women with normal weight. The course of early gestation was analyzed. The necessity of lipid and carbohydrate profile estimation in these patients is substantiated. Authentic criteria of violations of carbohydrate metabolism are specified. Сonclusion. It is necessary to move from the assessment of the effects of obesity to the «Body Mass Index-Oriented Approach» to the assessment based on the «complicity approach». This will make it possible to individualize therapeutic tactics in pregnant women depending on their phenotype and reduce the incidence of gestational complications and perinatal losses. Key words: phenotype, pregnancy, loss of pregnancy, obesity, phenotype, carbohydrate profile, lipid profile, hormonal characteristics.

Placental disfunction at pregnant women with concomitant pathology of cardiovascular system

2017 ◽  
pp. 88-92
Author(s):  
E.N. Gopchuk
Keyword(s):  
Pregnant Women ◽  
Clinical Laboratory ◽  
Vascular System ◽  
Varicose Veins ◽  
Peripheral Resistance ◽  
Placental Perfusion ◽  
Cardiovascular Pathology ◽  
Pregnancy And Childbirth ◽  
Placental Dysfunction ◽  
And Control

The objective: study of the effect of Tivomax on the parameters of utero-placental-fetal blood circulation in patients with placental dysfunction and concomitant extragenital pathology of the vascular system. Patients and methods. The study included 60 pregnant women diagnosed with the diagnosis «placental dysfunction», after 22 weeks of gestation and concomitant extragenital pathology of the vascular system, including varicose veins, thrombophlebitis and endarteritis. All patients were randomly divided into the main (30 patients) and control (30 patients) epidemically equivalent groups. During the survey, clinical, laboratory and instrumental (ultrasound) methods of examination were used. Observation of patients was carried out both during pregnancy and in the postpartum period. Results. The study of the efficacy of Tivomax, 4.2% solution for infusions, against the background of the generally accepted regimen for the treatment of placental dysfunction showed that under the influence of the proposed therapy, dopplerogram normalization occurs by decreasing peripheral resistance in the microvascular bed of the placenta, increasing placental perfusion, and optimizing blood flow in the vessels. The conclusion. The purpose of the drug Tivomax contributes to the normalization of the dopplerogram by reducing the peripheral resistance in the microvascular bed. The drug Tivomax has no adverse reactions, negative changes in laboratory blood counts. Timely correction of management of pregnancy and childbirth, drug therapy, conducted in accordance with dopplerometric indicators, can reduce perinatal morbidity and mortality. Key words: Tivomax, L-arginine, endothelium, obstetrics and gynecology, placental disfunction, cardiovascular pathology, extragenital pathology.

Diagnostic possibilities of investigation methods in acute destructive pancreatitis

2020 ◽  
pp. 26-30
Author(s):  
A. V. Mamoshin ◽  
A. V. Borsukov ◽  
Y. V. Ivanov
Keyword(s):  
Differential Diagnosis ◽  
Clinical Laboratory ◽  
Diagnostic Algorithm ◽  
Diagnostic Methods ◽  
Fine Needle ◽  
Crystallographic Study ◽  
Investigation Methods ◽  
Pathological Focus ◽  
Instrumental Methods ◽  
Diagnostic Puncture

The article demonstrates the diagnostic effectiveness of clinical, laboratory and instrumental methods for the differentiation of clinical and morphological forms of acute destructive pancreatitis. The importance of such promising methods as minimally invasive multi-frequency bioimpedancemetry of the pathological focus, the crystallographic study of aspirate performed during fine-needle diagnostic puncture and differential diagnosis of exudative complications of acute destructive pancreatitis is shown. The results obtained determine the necessity of a comprehensive approach with the expansion of the diagnostic algorithm by using fine-needle diagnostic puncture. A comprehensive assessment of diagnostic methods significance can increase the effectiveness of differential diagnosis of clinical and morphological forms of destructive pancreatitis, thereby allowing to timely determinate the tactical position in the treatment of this category of patients.

scholarly journals INFLUENCE OF THE TRANSFERRED SYPHILITIC INFECTION ON THE COURSE OF PREGNANCY, CHILDBIRTH AND THE STATE OF NEWBORNS

2019 ◽  
Vol 72 (2) ◽  
pp. 175-180
Author(s):  
Viacheslav M. Husiev ◽  
Daria S. Khapchenkova
Keyword(s):  
Pregnant Women ◽  
Vascular Wall ◽  
Main Group ◽  
The State ◽  
Control Group ◽  
Perinatal Complications ◽  
Pregnancy And Childbirth ◽  
Pathological Conditions ◽  
Intrauterine Hypoxia ◽  
History Of

Introduction: The article presents information about the peculiarities of the course of pregnancy and childbirth in women with a syphilitic infection in the anamnesis. The peculiarities of the state of newborn babies born from mothers who have suffered syphilis are described. To date, the incidence of syphilis in Ukraine has a clear tendency to decline, but still remains quite high. The maximum incidence of syphilis is observed in women aged 15-20 years. The combination of pregnancy and syphilitic infection in an anamnesis is an unfavorable factor in regard to high risk of perinatal complications, the frequency of which does not tend to decrease. The aim - study the features of the course of pregnancy and childbirth in women with a syphilitic infection in the anamnesis, the evaluation of the state of newborns. Materials and methods: A prospective examination of 57 healthy women and their newborns (control group) and 60 pregnant women with a history of syphilitic infection (the main group) had been conducted. All pregnant women had undergone ultrasound examination, including feto- and placentometry, an estimate of the amount of amniotic fluid. The effect of the transferred syphilis on the state of the newborn had been assessed in accordance with the results of the clinical examination of an anthropometric data, including an Apgar score. Results: It is stated that the incidence of latent (41,66%) and forms with a prolonged course (20,00%) of syphilitic infection. The threat of premature childbirth was almost 3,5 times higher than in women with syphilis, cases of an anemia in pregnant women – 2 times, hypertensive disorders of pregnant women were 2,4 times more common in women of the main group, fetal development retardation syndrome 6,4 times, while a greater percentage of this disorder was recorded among women in the main group who were ill with latent forms and suffered secondary recurrent syphilis (35%). In 20% of the cases, pregnancy in women with syphilis has been completed by the cesarean section, an abnormality of the contractile capacity of the uterus was significantly higher – 23,33%. The adaptive capacity of the newborns in the main group has been significantly lower, compared to the control group. Conclusions: Syphilitic infection in the anamnesis complicates the course of pregnancy with numerous pathological conditions. Syphilitic infection, borne before pregnancy, affects not only the course of pregnancy, but also the course of childbirth and the postpartum period. The pathological conditions in infants are due to a decrease in resistance to birth stress, early depletion of adaptive resources of newborns under the influence of a syphilitic infection of the mother. In children who have experienced chronic intrauterine hypoxia, the risk of hemorrhagic syndrome is significantly higher due to increased permeability of the vascular wall. Such children have a tendency to develop neurological disorders and respiratory system lesions.

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