Features of prevention of fetal growth retardation in pregnant women with chronic hypertension
The lack of effective methods to prevent the development of fetal growth retardation in high-risk pregnant women remains a significant problem of modern obstetrics, which determines the relevance of the study. The aim of the study was to examine the effectiveness of monoprophylaxis of fetal growth retardation using aspirin at a dose of 150 mg, starting at 12-13 weeks of gestation, pregnant women with chronic hypertension. In order to apply and implement the proposed prevention of fetal growth retardation, all pregnant women with chronic hypertension were divided into two groups. The patients were divided into groups randomly. To prevent the development of fetal growth retardation, patients in group A received acetylsalicylic acid at 150 mg/day, patients in group B received acetylsalicylic acid at 100 mg/day. Primary examination of pregnant women in a prospective study was performed during pregnancy 11-12 weeks in all groups, which included: history taking, general clinical examination, blood pressure measurement, obstetric and gynecological examination according to clinical protocols of the Ministry of Health of Ukraine № 417 from 15.07.2011, № 676 dated 31.12.2004. Clinical and instrumental examination was performed: blood pressure and ECG monitoring, Doppler examination. Childbirth and initial assessment of the condition of newborns were performed in accordance with the current orders of the Ministry of Health of Ukraine with the assessment of the condition on the Apgar scale and the result of anthropometry (determination of mass and growth rate). It was found that the age characteristics of the group of pregnant women did not differ statistically significantly: the average age of patients in group A reached 27.3±1.6 years, group B – 28.1±1.8 years. According to the obstetric and gynecological history, the women did not differ. It should be noted that statistically significant differences between the main group and the comparison group by the degree of chronic hypertension (grade 1 and 2) were not detected: 30 % of women in group A and 35 % of group B had chronic hypertension grade 1, 70 % and 65 %, respectively – chronic arterial hypertension of 2 degrees. Among the concomitant lesions in pregnant women were determined: obesity 8 women of group A (26.7 %), 8 people (25.8 %) of group B; varicose veins in 3 women (10.0 %) of group A, 4 people (12.9 %) of group B; pathology of the urinary system – in 2 cases (6.6 %) in group A and in 2 people (6.45 %) of group B; pathology of the thyroid gland – 2 women (6.6 %) of group A, and 1 person (3.22 %) of group B, anemia of pregnant women – in 4 women (13.3 %) of group A, and 4 people (12.9 %) of group B; chronic viral hepatitis C in remission in 1 woman of group B (3.22 %). As a result of the analysis of pregnancies and complications of childbirth, we found that the appointment of acetylsalicylic acid in addition to standard treatment of chronic arterial hypertension in accordance with clinical protocols at a dose of 150 mg/day helped reduce the incidence of disorders of uteroplacental and fetal circulation by 2.7 times, fetal growth retardation – by 8,8 times and small to gestational age fetus – 4.8 times compared with the results of patients who received acetylsalicylic acid at a dose of 100 mg/day.
 Chang, Y., Chen, X., Cui, H. Y., Li, X., & Xu, Y. L. (2017). New Predictive Model at 11+ 0 to 13+ 6 Gestational Weeks for Early-Onset Preeclampsia With Fetal Growth Restriction. Reproductive Sciences, 24(5), 783-789. doi: 10.1177/1933719116669053
 Chistyakova, G. N., Remizova, I. I., Gazieva, I. A., & Ustyantseva, L. S. (2015). Assessment of the state of the cardiovascular system of children born from women with chronic arterial hypertension. Pediatrics. journal them. G. N. Speransky, (2), 8-12.
 Cornette, J., Buijs, E. A., Duvekot, J. J., Herzog, E., Roos‐Hesselink, J. W., Rizopoulos, D., ... & Steegers, E. A. (2016). Hemodynamic effects of intravenous nicardipine in severely pre‐eclamptic women with a hypertensive crisis. Ultrasound in Obstetrics & Gynecology, 47(1), 89-95. doi: 10.1002/uog.14836
 Guedes-Martins, L. (2016). Chronic hypertension and pregnancy. In Hypertension: from basic research to clinical practice pp. 395-407). Springer, Cham.
 Morgan, J. L., Nelson, D. B., Roberts, S. W., Wells, C. E., McIntire, D. D., & Cunningham, F. G. (2016). Blood pressure profiles across pregnancy in women with chronic hypertension. American journal of perinatology, 33(12), 1128-1132. doi: 10.1055/s-0036-1584581
 O'Gorman, N., Nicolaides, K. H., & Poon, L. C. (2016). The use of ultrasound and other markers for early detection of preeclampsia. Women’s Health, 12(2), 199-207. doi: 10.2217/whe.15.95
 Pineles, B. L., Crimmins, S., & Turan, O. (2020). Timing of delivery in pregnancies complicated by suspected fetal growth restriction without Doppler abnormalities. American journal of perinatology, 37(06), 647-651. doi: 10.1055/s-0039-1688470
 Potapov, V. А., Syusyuka, V. G., Zharkikh, A. V., & Plotnik, V. A. (2016). Mechanisms of adaptation of pregnant women with miscarriage in the dynamics of preserving therapy. Woman's health, 5(111), 77-82.
 Roos-Hesselink, J., Baris, L., Johnson, M., De Backer, J., Otto, C., Marelli, A., ... & Parsonage, W. (2019). Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC). European Heart Journal, 40(47), 3848-3855. doi: 10.1093/eurheartj/ehz136
 Sanghavi, M., & Rutherford, J. D. (2014). Cardiovascular physiology of pregnancy. Circulation, 130(12), 1003-1008. doi: 10.1161/CIRCULATIONAHA.114.009029
 Seguro, F., Duly, B. B., Chamontin, B., & Amar, J. (2016). Management of arterial hypertension before 20weeks gestation in pregnant women. Presse medicale (Paris, France: 1983), 45(7-8 Pt 1), 627-630.
 Sehgal, A., Murthi, P., & Dahlstrom, J. E. (2019). Vascular changes in fetal growth restriction: clinical relevance and future therapeutics. Journal of Perinatology, 39(3), 366-374. doi: 10.1038/s41372-018-0287-4
 Selvaraj, L. R., Rose, N., & Ramachandran, M. (2016). First trimester screening for pre-eclampsia and fetal growth restriction. Journal of Fetal Medicine, 3(2), 77-84. doi: 10.1007/s40556-016-0088-9
 Thompson, L. P., Pence, L., Pinkas, G., Song, H., & Telugu, B. P. (2016). Placental hypoxia during early pregnancy causes maternal hypertension and placental insufficiency in the hypoxic guinea pig model. Biology of reproduction, 95(6), 128-1. doi: 10.1095/biolreprod.116.142273
 Tsibulkin, N. A., Mayanskaya, S. D., & Abdrakhmanova, A. I. (2010). Arterial hypertension during pregnancy. Practical medicine, 5(44), 32-35.
 Veropotvelian, P. N., Veropotvelian, N. P., Guzhevskaia, I. V., Tamamsheva, A. A., & Tsekhmistrenko, I. S. (2013). Arterial hypertension in pregnant women and its correction. Women's health, (9), 58-65.
 Zamaleeva, R. S., Maltseva, L. I., Cherepanova, N. A., Frizina, A. V., Lazareva, V. K., Iupatov, E. Yu., ... & Fattakhova, F. A. (2016). State of the problem of treatment and prediction of fetal growth retardation. Practical medicine, 1(93), 41-44.
 Zamaleeva, R. S., Cherepanova, N. A., & Gafarova, E. A. (2018). Modern concepts of treatment, prevention, diagnosis and prediction of fetal growth retardation. Remedium. Volga region, 2(162), 18-21.
 Zhu, J., Zhang, J., Ng, M. J., Chern, B., Yeo, G. S., & Tan, K. H. (2019). Angiogenic factors during pregnancy in Asian women with elevated blood pressure in early pregnancy and the risk of preeclampsia: a longitudinal cohort study. BMJ open, 9(11), e032237. doi: 10.1136/bmjopen-2019-032237
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