Information
Registration Number
0215U004032,
Title
Develop a set of therapeutic, preventive activities in obstetric and perinatal complications and their prognostication in women with diabetes mellitus
Head
Avramenko T.V.,
Registration Date
29-01-2015
Organization
State organization "Institute of pediatrics, obstetrics and gynecology NAMS of Ukraine"
Description
Research is devoted to the problem of improving the pregnancy termination in patients with type 1 diabetes mellitus complicated by universal diabetic angiopathy. As a result of the study it was found for the first time that endothelial dysfunction leads to development of diabetic angiopathy and occurrence of the obstetric and perinatal pathology in this category of patients. Which results in predominance of biologically active substances with vasoconstrictor and aggregate effect, an imbalance in the system of pro- and anti-inflammatory cytokines on a background of reducing the amount of anhiopoetynu-1 that has a protective and stabilizing effect on the vascular endothelium. Changes in these systems adversely affect the structure of the placenta, including histochemical levels, which ultimately leads to violations of the utero-placental blood flow and fetal pregnant women with this disease. For the first time the highly sensitive and specific biochemical markers of obstetric and perinatal complications in diabetic patients with severe angiopathy in different stages of pregnancy are determined. For the first time it is shown that, an objective assessment of the functional state of the endothelium of microvessels in pregnant women with diabetes can be given by such a highly informative and non-invasive method of investigation as laser doppler flowmetry. Usage of this method in the dynamics of pregnancy allows predicting the development of complications in these patients and preventing their occurrence through pathogenetically grounded and individualized treatment. In order to improve the system of perinatal health care of the fetus in diabetic angiopathy, treatment and preventive activities are developed that include the usage of additional medicinal drugs - L-arginine and omega-3 polyunsaturated fatty acids, which are aimed to eliminate endothelial dysfunction, and their efficiency is proved. Women who received advanced therapy compared to those who were carried through generally accepted treatment, had almost twice lower frequency of preeclampsia and threatened abortion, had a significantly lower frequency of placental insufficiency (53.3% vs. 76.7%) and fetal distress (40.0% vs. 66.7%). Three times more likely children were born whose condition were assessed as satisfactory, and almost three times less - children in a state of severe asphyxia. Newborns had better course of the early neonatal period of adaptation, as evidenced by the reduction of the incidence disadaptation syndromes: 40 % of hypoglycemic, 30% of hemorrhagic and 20 % of respiratory distress syndrome. Also the use of insulin pump therapy is suggested, which provides a stable compensation of carbohydrate metabolism and low glycemic variability during gestation, which, in turn, positively affects the course of pregnancy, the fetus and newborn.