[Anticoagulant therapy in pregnant women with mechanical prosthetic heart valves. Review of international clinical guidelines].

Recently thromboembolic and hemorrhagic complications are main causes of maternal morbidity and mortality. Normal pregnancy is associated with ahypercoagulation. This condition is complicated if the patient has a mechanical prosthetic heart valve. Therefore an anticoagulant therapy in these patients is a challenging task. Effects of anticoagulant drugs on the fetus, pregnancy and delivery must also be taken into consideration. The review deals with international clinical guidelines. Diagrams of anticoagulant therapy in pregnant women with mechanical prosthetic heart valves using direct (unfractionated and low-molecular-weight heparins) and indirect (warfarin) anticoagulants are presented in the review.

[The choice of anesthesia during abdominal delivery in patients with severe forms of late pregnancy toxemias]. / Vybor anestezii pri abdominal'nom rodorazreshenii u bol'nykh s tiazhelymi formami pozdnego toksikoza beremennykh.

Sixty eight anesthesia procedures during abdominal delivery in patients with late toxemia of pregnancy have been analysed. In 32 cases the diagnosis was preeclampsia, in 8 cases--eclampsia, in 28 cases III degree nephropathy. Depending on the variant and method of anesthesia the subjects were divided into 3 clinical groups. Group I comprised 31 women to whom cesarean section was performed under general endotracheal anesthesia. In group II (24 pregnant women) analgesia was achieved by prolonged epidural anesthesia (PEA). In group III (13 patients) a combination of PEA and superficial endotracheal anesthesia was used. Analysis of the anesthesia techniques in patients with severe late toxemia of pregnancy has established that in endotracheal anesthesia it is sometimes impossible to block completely pathological and operation-induced nociceptive pulsation. PEA has a good analgetic effect but ensures no neuroautonomous protection, and upon discontinuation of action of the local anesthetic there is a danger of the onset of the convulsion syndrome and signs of preeclampsia or eclampsia. Taking into account the advantages and disadvantages of endotracheal anesthesia and PEA, a technique based on the combination of both variants has been selected, which ensures optimal anesthesiological protection in abdominal delivery.

[The characteristics of the hormonal interrelationships in a pregnancy stimulated with parlodel]. / Osobennosti gormonal'nykh vzaimootnoshenii pri beremennosti, stimulirovannoi parlodelom.

The study of hormonal balance in the presence of pregnancy and labor in females with a history of infertility treated with parlodel failed to reveal any negative effect of elevated prolactin levels on the fetoplacental system. No differences in the course of pregnancy and labor were revealed as compared to the untreated age-matched. Weight and height figures of neonates born to parlodel-treated mothers were similar to those from the control group. There was no evidence of malformations or developmental defects in the studied group of neonates.

[Central hemodynamics in pregnant women with pre-eclampsia]. / Sustoianie na tsentralnata khemodinamika pri bremenni zheni s preeklampsiia.

Radionuclidic method is used in women with preeclampsia to evaluate the state of the central hemodynamics. The examined women are divided into 6 groups. The results are presented on 2 tables with 23 investigated parameters as intergroup correlation is made. The obtained results show the presence of hypoglycemia, increased peripheral resistance, etc., which are in direct dependence on the degree, gravity and duration of the disease. It is possible to discover occurring changes quite early by this method and thus to begin timely proper therapy, which reduces perinatal morbidity and mortality. It is very important that data are obtained by this method, which could not be determined by other methods. However its usage should be performed electively by very strict indications after the possibilities of other methods are tried (ultrasound, rheography, ect.).