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Течение физиологических родов у женщин с сахарным диабетом при различных видах анальгезии

Течение физиологических родов у женщин с сахарным диабетом при различных видах анальгезии

Abstract

Prevalence of all DM forms at pregnant women reaches 3,5 %. The expressed hyperglycemia on early terms of pregnancy can be accompanied by spontaneous abortion, and on later terms premature birth. Pregnancy makes heavier DM current (especially IDDM) and promotes early development of complications retinopathies, a nephropathy and a neuropathy as in itself in a certain degree is a diabetogenic factor. At pregnancy, even at the women who are not suffering from DM, glucose level in plasma on an empty stomach decreases because of its absorption by a placenta and braking gluconeogenesis. In the second half of pregnancy under the influence of placental hormones (the progesterone, an estrogen, prolactin and lactogen) is formed a physiological insulinresistence that also promotes a hyperinsulinemia. Under the influence of placental lactogen amplifies lipolysis. It leads to increase of level of glycerin and free fat acids in plasma and to strengthening ketogenesis. The last circumstance is promoted by action of placental hormones on hepatocytes to mother therefore at the pregnant women suffering from any DM form, the risk of emergence ketoacidosis is high.

Распространенность всех форм сахарного диабета (СД) у беременных достигает 3,5 %. Выраженная гипергликемия на ранних сроках беременности может сопровождаться самопроизвольным абортом, а на более поздних сроках преждевременными родами. Беременность утяжеляет течение СД (особенно инсулинзависимого СД) и способствует раннему развитию осложнений ретинопатии, нефропатии и нейропатии, поскольку сама по себе в определенной степени является диабетогенным фактором. При беременности, даже у женщин, не страдающих СД, уровень глюкозы в плазме натощак снижается из-за ее поглощения плацентой и торможения глюконеогенеза. Во второй половине беременности под влиянием плацентарных гормонов (прогестерон, эстрогены, пролактин и лактоген) формируется физиологическая инсулинрезистентность, что также способствует гиперинсулинемии. Под воздействием плацентарного лактогена усиливается липолиз. Это приводит к повышению уровня глицерина и свободных жирных кислот в плазме и усилению кетогенеза. Последнему обстоятельству способствует действие плацентарных гормонов на гепатоциты матери, поэтому у беременных, страдающих любой формой СД, высок риск возникновения кетоацидоза.

Keywords

ЭПИДУРАЛЬНАЯ АНАЛЬГЕЗИЯ, САХАРНЫЙ ДИАБЕТ, САМОПРОИЗВОЛЬНЫЕ РОДЫ

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
Average
Average
Average
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