Abstract
Purpose of this review was to highlight the current and future possibilities of medicine in prevention of preeclampsia (PE) and placenta-associated complications (PAO). PE remains one of the most important causes of maternal and perinatal morbidity and mortality, and is responsible for the mass of premature births. The urgency of PE and PAO problem is primarily due to the lack of effective treatment for extensive clinical symptoms, as well as need to terminate pregnancy regardless of the gestational age and prognosis for fetus. In this regard, PE prevention is of great importance for clinical practice.This review presents the modern concept of PE pathogenesis, highlights the key points of hemostatic system disorders, leading to the clinical symptoms and PE. It was also shown that the imbalance between thromboxane and endothelial prostacyclin as well as between pro- and anti-angiogenic factors in pregnant women with PE can be considered as a therapeutic target in PE prevention and treatment; prescription of antiplatelet agents and anticoagulants for PE prevention is justified.Modern systematic reviews and meta-analysis have shown some effectiveness of antiplatelet agents and anticoagulants in PAO prevention. This review highlights the role of some nutrient deficiencies in the development of PAO and folate supplementation for their prevention. Presented data indicate that today there are methods for PAO prevention, which can significantly reduce their probability by 17–30% in pregnant women with a high risk of this obstetric pathology. However, a complete prevention and effective treatment of PAO at the stage of advanced clinical symptoms has not yet been developed, which leads to early termination of pregnancy, perinatal morbidity and mortality. Therefore, the development of new therapies that completely prevent or cure PE would be a major advance for practical obstetrics. This review presents the main scientific developments in this direction, in particular, clinical trials of drugs that can reduce sFlt-1 and soluble endoglin secretion, thus curing endothelial dysfunction in PE.
Highlights
ВВЕДЕНИЕ Преэклампсия (ПЭ) представляет собой серьезную нерешенную проблему современного акушерства, поскольку является одной из причин материнской и перинатальной заболеваемости и смертности, важным фактором риска развития сердечно-сосудистых заболеваний у матери и ее ребенка в отсроченном периоде [1, 2]
Это равновесие регулирует агрегацию тромбоцитов и периферическую вазореактивность во время беременности и поддерживает удовлетворительный маточно-плацентарный кровоток [5]
Dodd et al (2013) показано, что у беременных с риском плацентарной недостаточности по анамнестическим данным или с экстрагенитальными заболеваниями профилактическое применение гепарина было связано со статистически значимым снижением риска перинатальных потерь (ОШ = 0,40, 95% доверительный интервал (ДИ) – 0,2–0,78), досрочного родоразрешения до 34 недель (ОШ = 0,46; 95% ДИ – 0,29–0,73) и до 37 недель (ОШ = 0,72; 95% ДИ – 0,58–0,9), а также задержки роста плода (ОШ = 0,41; 95% ДИ – 0,27–0,61) [29]
Summary
ВВЕДЕНИЕ Преэклампсия (ПЭ) представляет собой серьезную нерешенную проблему современного акушерства, поскольку является одной из причин материнской и перинатальной заболеваемости и смертности, важным фактором риска развития сердечно-сосудистых заболеваний у матери и ее ребенка в отсроченном периоде [1, 2]. Применение антиагрегантов во время беременности, вероятно, немного увеличивает частоту патологической кровопотери в родах – более 500 мл (23 769 женщин, 19 исследований; ОШ = 1,06; 95% ДИ – 1,00–1,12), однако данные статистически недостоверны.
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