[The dynamic importance of proteinuria and arterial pressure for detecting late toxicosis in pregnant women with chronic kidney diseases and hypertension]. / Znachenie dinamiki proteinurii i arterial'nogo davleniia dlia vyiavleniia pozdnego toksikoza u beremennykh s khronicheskimi zabolevaniiami pochek i gipertonicheskoi bolezn'iu.

Time course of 187 pregnancies was followed up in 103 females with chronic renal diseases (CRD), 76 females with essential hypertension (EH) and 14 posteclampsia females. Three variants of arterial pressure (AP) and 5 types of proteinuria changes were recognized in CRD and EH patients. The pattern of these changes was compared to that in posteclampsia patients, the eclampsia being an absolute criterium of late toxicosis. It is shown that neither elevated AP and proteinuria nor their absolute values can serve reliable signs of late gestosis in CRD and EH patients. Only the trend in these parameters is significant. CRD and EH females with late gestosis exhibit rapidly growing proteinuria in line with the onset or exacerbation of EH. Retrospective analysis of the pregnancies has confirmed association of late gestosis in 15% of EH and 7% of chronic glomerulonephritis patients. These estimates are lower than commonly accepted. Early diagnosis of late gestosis in pregnant females with CRD and EH requires not only regular AP registration, but also dynamic, in some cases hourly, evaluation of proteinuria.

[The diagnostic characteristics of late toxicosis in pregnant women with hypertension and chronic kidney diseases]. / Osobennosti diagnostiki pozdnego toksikoza u beremennykh s gipertonicheskoi bolezn'iu i khronicheskimi zabolevaniiami pochek.

A study was made of diagnostic significance (sensitivity and specificity) of early (precritical) signs of late gestosis (LG). A total of 179 females (187 pregnancies) with essential hypertension (EH) and chronic renal diseases (CRD) were examined. EH women are at high risk of LG when they have proteinuria above 0.3 g/s, of relative prognostic importance are severe hypertension and marked hyperuricemia. Severe hypertension, fetal growth inhibition, positive roll-over test may indicate LG in CRD. Primiparas with EH or CRD are especially at risk of LG. As all the above LG signs in its precritical stage are not specific and indicate only probability, they can be used primarily for screening of patients with high risk of LG onset. The diagnosis of LG in EH and CRD should be based on follow-up changes in the clinical and laboratory indices.

[Management strategy for pregnant women with portal hypertension syndrome]. / Taktika vedeniia beremennykh s sindromom portal'noi gipertenzii.

The authors describe their management policy with pregnant patients suffering from portal hypertension syndrome, based on the results of comprehensive examinations and deliveries in 44 women. Principal indications for abortions in such patients are active liver cirrhosis, third-degree varicosity of esophageal and gastric veins, dilatation of the esophagus. Natural labor is permitted when there are no threatened bleedings. Therapy is administered in accordance with obstetrical indications. In case esophagogastric bleedings develop emergency measures to arrest the bleeding are taken, rapid delivery and, if necessary, emergency surgical intervention. Knowledge of risk factors helps the problem of pregnancy maintenance and delivery mode to be solved by obstetricians and specialists in portal hypertension. This management policy promoted successful deliveries in 42 of 44 cases.