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Estimating of risk factors in the evolution of pregnancy and birth in pregnant women with rheumatic mitral valvulopathies

Author: Stepan Ecaterina
Degree:doctor of medicine
Speciality: 14.00.01 - Obstetrics and Gynecology
Scientific adviser: Anatol Serbenco
doctor habilitat, professor, Public Medical Sanitary Intitution Scientific Research Institute of Mother and Child Health Care
Scientific consultant: Aurel Grosu
doctor habilitat, professor, Medical-Sanitary Public Institution Institute of Cardiology
Institution: Public Medical Sanitary Intitution Scientific Research Institute of Mother and Child Health Care


The thesis was presented on the 16 December, 2014
Approved by NCAA on the 9 April, 2015


Adobe PDF document1.25 Mb / in romanian


CZU 618.3+616.1-022.77-008

Adobe PDF document 4.35 Mb / in romanian
159 pages


pregnant women, rheumatic mitral valvulopathy, risc factors, maternal and fetal complications in pregnancy and childbirth, central hemodynamics, plant natriuretic peptide.


Thesis structure: thework is done in 128 pages of printed text, consists of Introduction, 5 chapters, conclusions, practical recommendations, summary in Romanian, Russian, English and bibliographic index with 171 references, including 14 figures, 18 tables and 2 annexes. The results obtained were published in 16 scientific papers, including in 3 without co-authors, 9 articles published in nationals iournalas and 2 articles in international proceeding.

Area of the study: medicine.

The aim of the thesis: consists in assessing of risc factors in the development of maternal and fetal complications in pregnancy and delivery in gravidas with rheumatismal mitral valvulopathies, based on a study of functional state of central haemodynamics and natriuretic peptide, in working out of an algorythm of behaviour directed to diminish the morbidity and maternal perinatal mortality.

Objectives of the thesis were: the study of clinical features evolutions of pregnancy, labour, post-partum periods and precocious neonatal; assessment of risk factors and determination of prognosis criteria in the development of maternal and fetal complications in pregnancy and delivery; in establishing of functional reserves of cardiovascular, utero-placental and feto-placental systems, of specific “gestation area” of protein; the study of pathomorphological changes of placenta and the assessment of placental insufficiency prognosis; working out of the algorithm concerting the risk of cardiac, maternal complications development in pregnancy.

Scientific innovation and originality: There were determined risk factors сoncerning the development of complications in pregnancy and childbirth in women with rheumatic mitral valvulopathy depending on NYHA functional class. It was introduced the determination of natriuretic peptide precursor NT-proBNP an excellent tool for the screening of the left ventricle disfuncions to diagnose and stratify the risk in DCV including the pregnant women. According to electronic formula (Gardosi J., Frencis A., 2009), there were implemented the criteria of maturation of the foetus. There were evaluated the changes of the central and regional blood flux in mother-placenta-fetus complex in patients with VMR at rest physical effort and in relation with intrauterine condition of the fetus. There was estimated the relation between central and regional hemodynamic changes and the content of peptide hormones and the steroids within mother-placenta-fetus system and placental morphological changes.

The scientific important problem solved: Consistsin working out of a ”Cardiac Disease in Pregnancy” (CARPREG) score based on the central hemodynamic study and of a natriuric protein profile, of an algorithm to diagnose and conduct in pregnancy and labor of cardiac insufficiency in patients with VMR, which would allow to reduce maternal and perinatal morbidity and mortality.

Theoretical significance: There was elaborated and reasoned scientifically the diagnosing algorythm and conduct of cardiac insufficiency and of maternal and foetal complications in pregnant women with VMR.

The applied value of the work: It is significant by the fact that the implimentation of this algorythm in medical practice will allow to reduce maternal complications in pregnancy and childbirth of the fetus and of the new-born’s complications, the diminution of maternal and perinatal morbidity and mortality.

The iplementation of scientific results: The main reultats of the study are applied in the teaching process of the Departament of Obstetrics and Gynecology of the SMPhU „N. Testemitanu” in curative work of the perinatal Center of the II level (Orhei), and perinatal Center of the III level (the MSPI Mother and Child Health Institute).