Clinical effectiveness of prevention of great obstetrical syndromes

Abstract

The objective: development of a method of prevention of great obstetrical syndromes (GOS) from the standpoint of a single genesis determined by morphofunctional disorders in the fetoplacental system (FPS) and evaluation of its clinical effectiveness.Materials and methods. 155 women of the high-risk group for the development of GOS were examined. I group – 32 pregnant women who had GOS prophylaxis with low doses of acetylsalicylic acid (ASA) 100–150 mg per os once a day from the 12th to the 36th week of pregnancy; II group – 31 pregnant women who from the 6th to the 16th week had prophylactically progesterone according to the scheme: 200 mg once a day per vaginally every day; III group – 36 pregnant women who received prophylactic monotherapy, consisting of the use of magnesium with a complex with vitamin B6 for three courses of 6 weeks each; IV group – 56 pregnant women who refused any preventive measures.To assess the effectiveness of preventive therapy a dynamic examination of the pregnant women of the study groups, their fetuses and newborns was carried out. Statistical processing of research results was carried out using standard Microsoft Excel 5.0 and Statistica 6.0 programs.Results. The analysis of obstetrical and perinatal outcomes in women of the high-risk group for the development of GOS showed that the development of placental insufficiency (PI) in the IV group was realized in 100% (56 cases), including severe forms in 51.8% (29 cases); the frequency of PI in I, II and III groups was 12.5% ​​(4 cases), 29.0% (9 cases) and 36.6% (11 cases), respectively, and was significantly lower (p<0.05); premature births were in 3 cases each in I and III groups, which amounted to 9.3% and 8.3%, respectively (р<0.05), in II group – 2 cases (6.5%); p<0.05.In general, the realization of GOS (preeclampsia, fetal growth retardation syndrome, premature birth) in I group was 25.0% (8 cases), including severe form – 3.1% (1 case); in the II group – 29.0% (9 cases), severe forms – 2 cases (6.3%); in the III group – 30.6% (11 cases), severe forms – 3 cases (8.3%) versus 100.0% (56 cases) realization of all clinical manifestations of GOS in the IV group of the study (р<0.05).Conclusions. A promising direction for the prevention of vasculitis in the high-risk group for their development is the consistent, early gestational appointment of low doses of ASA according to the developed method, which demonstrates the greatest effectiveness: a significant reduction in the frequency of preeclampsia, placental insufficiency with fetal growth retardation, premature birth, severe forms of preeclampsia according to optimized by the standards of evidence-based medicine: the number of pregnant women who need prophylaxis is 1.4; 95% confidence interval (CI): 1.1–1.7; odds ratio 5.3; 95% CI: 4.7–5.8.