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The predictive and diagnosis value of serum fibronectin and the prophilactical role of aspirin in pregnancy induced hypertension and its complications


Author: Gheorghe Langa
Degree:doctor of medicine
Speciality: 14.00.01 - Obstetrics and Gynecology
Year:2004
Scientific adviser: Gheorghe Paladi
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution:
Scientific council:

Status

The thesis was presented on the 14 September, 2004
Approved by NCAA on the 14 October, 2004

Abstract

Adobe PDF document – 0.12 Mb / in romanian

Keywords

biological metabolites, serum FN, aspirin, hypertension, pregnancy

Summary

Keeping the belated gestosis incidence and increased severity to a high level, the lack of a biological method of precocious diagnosis to foresee the predictive value of serum fibronectin (FN) and that of the correlation between the biological metabolites’ and the serum FN’s values, the lack of an efficient prophylactic conduct and the drawbacks of the contemporary methods have justified the thorough study of this actual problem.

254 pregnant women were included in the study and distributed in 2 groups, in the purpose of estimating the diagnosis value of the biological metabolites, the predictive and diagnosis value of serum FN and to evaluate the prophylactic role of aspirin in pregnancy-induced hypertension (P.I.H.) and its complications.

The predictive value of serum FN (>5 ng/ml) permitted the selection of 52 pregnant women (from a lot of 75, with high obstetrical risk), liable to developing P.I.H. from 14-16 gestational weeks. P.I.H.’s pathogenetic mechanisms being already known, aspirin was used between 14-16 and 34-36, in a dose of 75 mg/day (higher than 60 mg/day, the previously used dose).

The second dosage of serum FN (in the weeks 34-36 for the 2nd lot, aspirin-controlled) proved not only the prophylactic value, but also the clinical efficiency of the prophylactic ingredient we used. In the 3rd reference lot - with no aspirin control and totalizing 40 pregnant women (28 with clinicallymanifested P.I.H. and 12 neglected ) - there was only one dosage of serum FN during 40 gestational weeks, proving certain diagnosis value in P.I.H.’s severe complications (similar to the biological metabolites, dosed in dynamics in the 1st and 2nd lot).The clinical results, birth method and perinatal results differ from the controlled lot -2- to the non-controlled one -3-, in the 2nd lot’s favour.

The study’s results have surely demonstrated the high predictive, diagnosis and correlation (r=1,00) value of serum FN, but, also, the sensitivity of retard outlining in hypotrophics (antepartum and postpartum). The high correlation between the serum FN and the biological metabolites’ diagnosis value (that reflected P.I.H.’s severity degree and proved to be more important for uric acid and proteinuria) allowed the elaborating of an efficient prophylactic and obstetrical conduct, while the prophylactic, precocious and long term usage of aspirin (in a dose of 75 mg/day for the liable to P.I.H. pregnant women) permitted the prevention of the belated gestosis severe forms and the improvement of the maternal and perinatal results (the 4 times decrease of the hypotrophy frequency and the Apgar score’s increase).