The current state of the problem of pathogenesis and pharmacotherapy of varicose disease in obstetrics

Abstract

The article provides an overview of modern Ukrainian and foreign publications on the etiopathogenesis and pharmacotherapy of varicose disease (VD) during pregnancy. The issues of the prevalence of VD in pregnant women, the peculiarities of the venous system in the physiological and pathological course of pregnancy, modern views on the mechanisms of venous hemodynamic disturbance and its influence on the state of the fetoplacental complex are considered. Attention is paid to the local activation of the hemostasis system in case of damage to the endothelium in the presence of venous hypertension under the influence of activated neutrophilic granulocytes and monocytes. The analysis of extragenital pathology in pregnant women with VD was carried out. The role of connective tissue dysplasia in the genesis of VD and the necessity for timely diagnosis and prevention of complications of pregnancy and the development of placental disorders in women with VD, and for the determination of the endothelial dysfunction markers were established. The emphasis is made on the role of the state of the reproductive system and chronic foci of vaginal and cervical infection in the progression of VD and obstetric complications, which is explained by the development of oxidative stress and tissue hypoxia and deterioration of preimplantation conditions and a promising scenario for gestation. The modern classification of VD by morphological changes in the venous bed and the consequences of phlebohemodynamic disorders and the clinical class of lower extremity vein disease used in obstetric practice are presented. The main directions of diagnostics and conservative treatment of pregnant women with VD in Ukraine (compression therapy, systemic pharmacotherapy and local topical therapy) according to the international standards are presented. The attention is paid to the special effect of diosmin on the reduction of the symptoms of VD and endothelial dysfunction in the presence of immune-inflammatory damage of the endothelium and vein walls on the background of oxidative stress. This effect is confirmed by the improvement in the state of the intrauterine fetus and perinatal outcomes in pregnant women with placental disorders.