Hygiene of populated placesISSN: 2707-0441 eISSN: 2707-045X
Issue 69, 2019   -   Pages: 250-260
V.S. Krutko1, P.I. Poteiko1, O.I. Popov1, E.M. Khodosh1, O.S. Shevchenko1, L.T. Boiko1, V.A. Khodakovska2, N.G. Semko2, T.O. Popova2

: 502.11: 618.2]: 616.13-002.7-036.87

The impact of the environment on a pregnant woman is of great value and its positive emo-tions affect beneficially the course of pregnancy, even with such a disease as Wegener's granulomato-sis, which is rare and unusual in this situation. The fetus is also a subject to environmental impact. The first 2 months of pregnancy are the most vulnerable and, at the same time, important in the life of the fetus. Just in this period, the nucleation of its main organs and systems takes place. And precisely at this time, the fetal organism, as never before, completely depends on the mother's organism, which is the external environment for the fetus. Among the external factors affecting the pregnancy of a woman are smoking, alcohol, drugs, environmental factors.
Objective. We analyzed the course of pregnancy in a patient with a relapse of Wegener's granulomatosis.
Materials and methods. Wegener's granulomatosis prevails at the age of 40 and older; its combination with pregnancy is a rare and unusual situation. Several dozen of cases of pregnancy and childbirth in such patients have been described in world literature. Due to the rarity of this combina-tion, recommendations for pregnancy management during and after pregnancy were not developed. The impact of pregnancy on the course of Wegener's granulomatosis is unpredictable, the onset or exacerbation of the disease can occur at any time of pregnancy, but the trimester, in which it occurs, affects the outcome of the treatment and pregnancy outcome. Based on the established cases, there are data in literature: 16 cases of detection during pregnancy, 14 cases of exacerbation of the disease during pregnancy, and 11 cases of the disease in remission during pregnancy. The combination of Wegener's granulomatosis and pregnancy resulted in 2 maternal deaths, 8 cases of fetal death and 35 healthy newborns, including 2 pairs of twins. In the analysis of these cases, it was found that if the onset or relapse occurred during the first trimester of pregnancy, then despite treatment, this led to fetal death (3 of 3, i.e. 100%). At the onset or relapse during the second or third trimester of pregnan-cy, 3 of 18 fetuses died (17%). During pregnancy in remission, fetal death occurred in one case of 11 (9%). Based on these data, it has been suggested that to improve the chances of a successful outcome, women should plan a pregnancy during the period of remission, in ideal, with minimum treatment.
Results and discussion. The consultation, consisting of a perinatologist, gynecologist, rheu-matologist, pulmonologist, nephrologist and pediatrician, made a conclusion: pregnancy II, 26 weeks. Wegener's granulomatosis, the active phase with a damage of the upper respiratory tract, lungs, kidneys and liver. Mild anemia. Low location of the placenta, scar on the uterus. The threat of premature birth. Pregnancy management was recommended according to the protocol, an operative delivery in term of 38 weeks.
Conclusion. Recommended course of treatment affected the normal course of pregnancy and operative delivery in which the healthy baby was born. However, the consequences of childbirth worsened the health state of the patient and after repeated hospitalization she continued to take medi-cations prescribed by medical commission to maintain a satisfactory state of health.

environment, pregnancy factors in relapses, Wegener's granulomatosis.

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Krutko V.S., Poteiko P.I., Popov O.I., Khodosh E.M., Shevchenko O.S., Boiko L.T., Khodakovska V.A., Semko N.G., Popova T.O. Okruzhaiushchaia sreda kak faktor uspeshnoi beremennosti bolnoi s retsidivom hranulematoza Vehenera [Environment as a factor of successful pregnancy in the patient with relapses of Wegener's granulomatosis]. In : Hihiiena naselenykh mists : zb. nauk. pr. [Hygiene of Populated Places]. Kyiv ; 2019 ; 69 : 250-260 (in Russian).