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Clinical and evolutionary aspects of pregnancy and delivery in women with pulmonary tuberculosis


Author: CAZACU Zoreana
Degree:doctor of medicine
Speciality: 14.00.01 - Obstetrics and Gynecology
Year:2021
Scientific adviser: Olga Cerneţchi
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific consultant: Constantin Iavorschi
doctor habilitat, professor, Public Medical Sanitary Intitution Institute of Phthisiopneumology "Chiril Draganiuc"
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 21 September, 2021 at the meeting of the Scientific Council and now it is under consideration of the National Council.

Abstract

Adobe PDF document0.99 Mb / in romanian

Thesis

CZU 618.2/.4:616.2-002.5(043.2)

Adobe PDF document 6.60 Mb / in romanian
167 pages


Keywords

pulmonary tuberculosis (TB), pregnant women, newborns, fetoplacental system, external respiratory system, placental morphology,algorithm, vaccination

Summary

Thesis structure. The thesis is laid out on 167 pages, consisting of introduction, 4 chapters, general conclusions, recommendations, and bibliographic index of 205 references, 39 figures, 9 tables, 2 formulas and 9 anexis. The results obtained are published in 17 scientific articles.

Purpose of the thesis. To study the evolution peculiarities of pregnancy and delivery; to optimize the management of women with pulmonary TB, under clinical monitoring. Objectives of the study. To assess the evolution particularities of pregnancy, delivery, incidence and structure of perinatal morbidity and mortality in women with pulmonary TB depending on the clinical form and the term of gestation when detecting the specific process; to evaluate the tuberculosis process, the respiratory function and chemotherapy tolerance in pregnant women with active pulmonary TB; to assess the functional state of the fetoplacental system and placental morphology in pregnant women with active pulmonary TB; to elaborate the algorithm of diagnosis and management of pregnant women with pulmonary TB, adapted to the character of functional and metabolic disorders of the mother and fetus.

Scientific novelty and originality. The study elucidated the evolution peculiarities of pregnancy, delivery and the postpartum period in women with pulmonary TB. The characteristics of tuberculosis, chemotherapy tolerance and the condition of the external respiratory system in pregnant women with active pulmonary TB were studied. The function of the fetoplacental complex, the antenatal condition of the fetus and the neonatal condition of the newborn were estimated in these patients. The method and correctness of vaccination of newborns of mothers with active TB were evaluated.

The important scientific problem resolved consists in elucidating the peculiarities of the evolution of pregnancy and delivery in pregnant women with various clinical forms of the respiratory tuberculosis process, by assessing the condition of the respiratory function and fetoplacental system, which will open new opportunities to optimize clinical behavior in these patients under dispensary monitoring.

Theoretical significance. The work, due to the results obtained, highlights and updates the data on particularities of pregnancy, specific process and antituberculosis treatment in pregnancy, criteria for breastfeeding and vaccination of newborns according to the clinical form of pulmonary TB in pregnant women.

Applicative value. The determinants of TB development in pregnant women were assessed, as well as the respiratory function and TB treatment in pregnant women with active TB. The algorithms proposed for diagnosis and management of pregnant women with pulmonary TB, and the algorithm for primary TB prophylaxis in newborns of mothers with active TB can be recommended in the practical activity of obstetricians-gynecologists and phthisiologists in specialized healthcare facilities.

Implementation of scientific results. The study results were implemented in the teaching process of Obstetrics and Gynecology and the Department of Phthisiopneumology of Nicolae Testemitanu PI SUMPh, as well as in the curative activity of PMI Gheorghe Paladi Municipal Clinical Hospital, PMI Mother and Child Institute and PMI Institute of Phthisiopneumology Chiril Draganiuc.