Prevention of Placental Dysfunction in Women with Local Non-Progressive Abruption of a Normally Positioned Placenta

M. I. Rymarchuk

Abstract


In the scientific sources of recent years one can find statements about the role of connective tissue dysplasia with placentation disorders one of the manifestations of which is a local abruption of chorion and placental tissue. At present it is important not only to search for sensitive tests to control the effectiveness of treatment of retrochorionic hematomas and local forms of premature placental abruption but also to develop and implement treatment-and-prevention programs.

We analyzed the course of pregnancy and labor in 80 women between 20 – 40 years of age with local non-progressive abruption of chorion and a normally positioned placenta, who were divided into two groups depending on the suggested complex of treatment and prevention in the program of optimization of pregnancy management. The control group included 20 relatively healthy women with a physiological course of pregnancy. It was reasonable and pathogenetically justifiable to start applying complex treatment of disturbed homeostatic processes from the pregestational stage. This accounted for the introducing a complex of vitamin agents, polyunsaturated fatty acids and angiogenic inductors into the treatment program. To achieve this goal, the pregestational preparation of this category of patients was complemented with a polyvitamin complex with folic acid, nitric oxide inductors and polyunsaturated fatty acids, which influenced not only the total effect of treatment but also increased the effectiveness of each component of the treatment program.

The analysis of the prevalence of undifferentiated connective tissue dysplasia (UCTD) identified a constantly high percentage of women with a clinically significant dysplastic phenotype – 63 women (78.75 %), providing convincing evidence of the fact that uteroplacental apoplexy was associated with congenital weakness of connective tissue (ОR -18.17; 95% DІ; 6.3-36.5, р<0.001).  According to the analytical research, 54 out of 80 pregnant women (67.5%) with local non-progressive abruption of chorion and placenta developed various complications in the course of pregnancy – preeclampsia, placental dysfunction, threat of premature labor, uterine hemorrhage, etc. One should also note a considerable number of cases of fetal distress, which was to a certain extent associated with the existing complications in the course of pregnancy and labor and fetoplacental dysfunction.

The analysis of the results of pregnancy completion showed a significant reduction in the prematurity rate. For instance, in women of the basic group, spontaneous abortion was observed 3.5 times less often and premature labor 2 times less often than in the comparison group (р<0.05). Thus, in 80 % of pregnant women of the basic group the necessary conditions were created to develop and prolong their pregnancy and complete it with term labor whereas in the comparison group the percentage was 55 % (р<0.05). Besides, the use of the agents suggested by us enabled a decrease in the development of such gestational complications as chronic placental insufficiency by 2 times, late gestosis and hydramnion by 2.5 times. Modification of the basic complex treatment by introducing the suggested membrane-stabilizing and antioxidant agents as well as the use of the indicated preventive measures at the stages of placentation and probable development of placental insufficiency helped decrease the percentage of abortions and the development of negative reproductive and perinatal losses.


Keywords


pregnancy; undifferentiated connective tissue dysplasia; placental abruption; vitamins and polyunsaturated fatty acids

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