Connective tissue dysplasia: new horizons of the problem

T. Fadeeva
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引用次数: 1

Abstract

The work raises questions of predicting the complications of pregnancy and childbirth and adverse conditions in the fetus in the presence of UCTD in the expectant mother, who also need to be studied, especially from the standpoint of mathematical modeling of the disease. It is also necessary to develop a common tactic for providing medical and social assistance and treatment and diagnostic services to pregnant women suffering from UCTD, which will make the outcome of childbirth more favorable and improve the subsequent prognosis for mother and newborn. In the literature there is practically no assessment of the course of pregnancy and the outcome of childbirth, depending on the severity of UCTD. Little is known about the role of a connective tissue metabolism marker - hydroxyproline, trace elements (magnesium) and vitamins (D3) in pregnant women suffering from UCTD, and the medical tactics regarding such patients are not clearly defined. Despite numerous successes in the study of the causes of complications during pregnancy and childbirth in women suffering from UCTD, a unified approach to their management during the prenatal stage has not yet been developed. Therefore, the search for possible predictors for the timely prediction of adverse pregnancy and childbirth outcome in such patients is becoming increasingly important. This will make it possible to develop an optimal organizational and methodological base and subsequently improve the prognosis for women and their offspring. Thus, in contrast to the existing standard approach, we have proposed a comprehensive management of patients suffering from UCTD, including the timely identification of patients from the risk group, clarification of their condition using such markers as magnesium and hydroxyproline, additional intake of magnesium and vitamin D preparations. Optimal plan managing the period of gestation, childbirth, and a pathogenetically reasoned set of treatment and preventive measures for women with UCTD, will not only improve the outcomes of pregnancy and childbirth, but also contribute to the health of the future generation. 1. UCTD affects the course of pregnancy, childbirth and the condition of the newborn. The degree of exposure is largely determined by the severity of the underlying disease. In severe UCTD, the prevalence of spontaneous miscarriage and preterm labor was significantly higher, and endometritis and severe anemia were more common in the postpartum period. Severe asphyxia on the Apgar scale at the 1st and 5th minutes, congenital heart defects, morphofunctional immaturity, conjugation jaundice and convulsive syndrome were more common in the fetus. 2. A low content of magnesium and hydroxyproline is associated with the occurrence of complications during childbirth and a decrease in the anthropometric characteristics of the newborn. Taking magnesium preparations reliably affects the concentration of this trace element and hydroxyproline in the blood of pregnant women suffering from UCTD. 3. Therapy with magnesium preparations is an effective tool in patients suffering from UCTD, as it helps to improve well-being during pregnancy, improves the course of the postpartum period and reduces the prevalence of chronic fetal hypoxia. 4. Vitamin D and magnesium supplements have a beneficial effect on pregnancy and the fetus, reducing the prevalence of pre-eclampsia and chronic intrauterine hypoxia of the fetus, reducing the incidence of morphofunctional immaturity and conjugation jaundice of the newborn. 5. The created computer program “STEP DST” can be applied in the clinical practice of obstetrician-gynecologists and health care organizers. The obtained individual forecast of the probability of development of complications of reproduction allows us to outline the optimal plan for managing the period of gestation, childbirth and the postpartum period, to prescribe a pathogenetically based set of therapeutic and preventive measures for women suffering from UCTD.
结缔组织发育不良:问题的新视野
这项工作提出了在孕妇患有UCTD的情况下预测妊娠和分娩并发症以及胎儿不利状况的问题,这些问题也需要研究,特别是从疾病的数学模型的角度来看。还需要制定一项共同策略,为患有UCTD的孕妇提供医疗和社会援助以及治疗和诊断服务,这将使分娩结果更加有利,并改善母亲和新生儿的后续预后。在文献中,几乎没有评估怀孕过程和分娩结果,取决于UCTD的严重程度。结缔组织代谢标志物-羟脯氨酸、微量元素(镁)和维生素(D3)在患有UCTD的孕妇中的作用知之甚少,针对此类患者的医疗策略也没有明确定义。尽管在研究患有UCTD的妇女妊娠和分娩期间并发症的原因方面取得了许多成功,但尚未制定出在产前阶段对其进行管理的统一方法。因此,寻找可能的预测因子,及时预测此类患者的不良妊娠和分娩结局变得越来越重要。这将有可能建立一个最佳的组织和方法基础,并随后改善妇女及其后代的预后。因此,与现有的标准方法相比,我们提出了对UCTD患者的综合管理,包括及时从风险组中识别患者,使用镁和羟脯氨酸等标志物澄清其病情,额外摄入镁和维生素D制剂。管理妊娠、分娩期间的最佳计划,以及针对UCTD妇女的一套病理合理的治疗和预防措施,不仅将改善妊娠和分娩的结果,而且有助于后代的健康。1. UCTD影响妊娠、分娩和新生儿的状况。暴露程度在很大程度上取决于潜在疾病的严重程度。重度UCTD自发性流产和早产的发生率明显较高,产后子宫内膜炎和重度贫血更为常见。胎儿在第1分钟和第5分钟严重窒息、先天性心脏缺陷、形态功能不成熟、偶联性黄疸和惊厥综合征多见。2. 镁和羟脯氨酸含量低与分娩并发症的发生和新生儿人体测量特征的降低有关。服用镁制剂可靠地影响患有UCTD的孕妇血液中微量元素和羟脯氨酸的浓度。3.镁制剂治疗是UCTD患者的有效工具,因为它有助于改善怀孕期间的健康状况,改善产后病程,减少慢性胎儿缺氧的患病率。4. 补充维生素D和镁对妊娠和胎儿均有有益作用,可降低胎儿先兆子痫和慢性宫内缺氧的患病率,降低新生儿形态功能不成熟和偶联性黄疸的发生率。5. 所创建的计算机程序“STEP DST”可应用于妇产科医生和卫生保健组织者的临床实践。获得的生殖并发症发展可能性的个体预测使我们能够概述妊娠期、分娩期和产后期的最佳管理计划,并为患有UCTD的妇女开出一套基于病理的治疗和预防措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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