Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality worldwide, accounting for more than 70,000 maternal deaths each year. Of all maternal deaths, 10–15% are directly associated with preeclampsia (PE) and eclampsia. The new version of the Ukrainian National Clinical Guideline and Clinical Protocol «Hypertensive disorders during pregnancy, childbirth and the postpartum period» 2022 presents a synthesis of the scientific evidence that is relevant to the concerning severe PE treatment strategies. It was presented the new algorithm of clinical management for severe pre-eclampsia «CALM DOWN» that implemented to the new Ukrainian clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care. CALM DOWN is the special mnemonic that means «step by step strategy» for the medical teamwork. Conclusions. The algorithm «CALM DOWN» have been proposed for the optimal timing of severe PE, offers to systematize the participation of each member of the team in the provision of emergency care and should be implemented in clinical practice based on the peculiarities of the specifics of work, resources, functioning and localization of the maternity facilities when forming personal route of the patient.
Annotation. For the cases of cardiovascular pathology during pregnancy include hypertensive disorders, hypercholesterolemia, myocardial infarction, cardiomyopathy, arrhythmias, valve disease, thromboembolic diseases, aortic disease and cerebrovascular pathology. Cardiovascular disease (CVD) is the leading cause of death from pregnancy in the world. Raising maternal age and comorbid diseases contribute to increased maternal mortality, also. When searching for literature, we used Medline systems from PubMed (2011). The search was adapted for Embase (2015 - 2021) and Scopus (2017 - 2021). Inclusion criteria were as follows: the impact of diseases of the cardiovascular system on pregnancy; the impact of pregnancy on the course of cardiovascular disease; features of diagnosis and prevention of women with CVD at the stage of preconception and during pregnancy; safety of drugs for the treatment of cardiovascular pathology during pregnancy; choice of drugs to prevent perinatal pathology in women with CVD; features of antenatal observation in CVD. We excluded from the study: references to 2011 (more than 10 years); not English; all methods that were not directly related to the pathology of the cardiovascular system during pregnancy; concomitant diseases that can lead to aggravation of pregnancy; animal studies. As a result, 76 studies were identified that were subject to final inclusion in the systematic review. Analysis of the identified literature sources showed that the preconception reproductive strategy to be developed by a multidisciplinary cardio-obstetric team is becoming important for women with a history of cardiovascular disease or for those with a history of familial preeclampsia. Cardio-obstetrics has become as an important multidisciplinary industry that requires a team approach to optimizing the clinical management of cardiovascular disease during pregnancy. Timely involvement of the cardio-obstetric group is crucial to prevent maternal morbidity and mortality during pregnancy and 1 year after delivery. A general understanding of the importance of the impact of cardiovascular disease on pregnancy and the impact of pregnancy on existing CVD should be a basic area of expertise for family medicine professionals, cardiologists, obstetricians and gynecologists. The given scientific and clinical review of sources of evidence-based medicine contains certain features of predictor diagnosis, prevention and treatment of manifested forms of cardiovascular diseases during pregnancy.
The problem of gestational hypertension (GH) remains to be of current concern in obstetric practice. The purpose of this study, therefore, was to determine the risk factors for GH development. We examined 53 pregnant women and allocated them to 2 groups: the main group -pregnant women with gestational hypertension (n = 30) and the control group -pregnant women without the pathology (n = 23). The selection of persons for the study was carried out on the basis of detailed history taking, examination and complaints, using standard clinical, laboratory and instrumental methods of investigation. The data was processed on a PC (standard statistical package Statistica 6.0). Our results show that the gestational hypertension development is closely linked with such risk factors as: age ≤ 18 years old and over 35 years old, unmarried status, living in a city/town, post-secondary education, unemployment, obesity, first labor in consecutively pregnant women, the threat of pregnancy termination, cardiovascular system diseases, urinary tract pathology, varicose veins, as well as ABO-sensibilization.
Recurrent miscarriage is one of the main problems of obstetrics, gynecology and reproductive medicine. The incidence of recurrent misscarriage is fairly high, with most cases of abortion occurring at I trimester, and the true cause is difficult to establish. The aim of the work is to find out the predictors of early reproductive losses in women with a history of habitual miscarriage. The study included 88 women with a habitual miscarriage (the main group) and 50 women with a physiological course of I trimester of gestation (control group). The study was carried out on the basis of the Vinnitsa maternity hospital No. 2. The following research methods were used: clinical, instrumental, mathematical-statistical. Methods of research: clinical, laboratory, biochemical, instrumental, fluorescence spectroscopy, mathematical and statistical methods. According to the results of the retrospective analysis of women with the usual miscarriage during the period from 2009 to 2016 it was found that their number is approximately the same every year. Although in 2015, the proportion of non-pregnancy cases was the smallest (10.68%) compared with 2013 (18.29%) (p=0.008), the share of women with this pathology continued to increase. During the ultrasound assessment of the blood flow in the uterine vessels, it was found that the index of resistance and pulsation index in women of the main group was lower than that of control group women. It was also found that there was a strong direct correlation between certain blood flow parameters in uterine arteries and spiral arteries. So, conducting an ultrasound study for all women with a history of unexplained pregnancy and detecting changes in the blood flow in the uterine vessels will enable us to predict the pathology of placenta in the early stages, and to timely correct the findings.
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