The way of doing the first half of pregnancy induced

 

(57) Abstract:

The invention relates to medicine, namely to obstetrics, and can be used for doing the first half of the induced pregnancy. Offered to patients with hypertonicity of the uterus since 5-6 weeks of pregnancy to hold the percutaneous electrical nerve stimulation with a frequency of 60 Hz, a pulse duration of 0.6 MS, when the intensity of the sensation pleasant painless vibration 1-2 times a day with an interval of 2-3 hours, 25-30 5-10 minutes each day procedures, to determine the value of the index thrombotic potential and soluble complexes of monomers, fibrin, and with increasing index thrombotic potential of more than 15.E. and/or the appearance of a positive indicator of soluble complexes of monomers of fibrin spend 3 sessions intermittent plasmapheresis to remove 30-50% of the volume of circulating plasma and elasmotherium in relation to the remote plasma volume of 1.5:1 with a 2-3-fold serial repetition of these procedures during pregnancy.

The invention relates to medicine, in particular to obstetrics.

It is known that induced pregnancy is characterized by a higher frequency of threats of spontaneous termination - 61,3-78%, about,2,3,4,5).

Feature induced pregnancies compared with spontaneous is the development against the background of non-physiological conditions of gestation in the early stages, expressed in a high level of sex hormones, giperandrogenii due to the functioning of several hyperstimulating yellow bodies (4). These inadequate hormonal parameters can lead to severe disorders of hemostasis, accompanied by disorder of the uterine-placental blood flow, low detachment located placenta, bleeding in the early stages, non-developing pregnancy, and miscarriage in the 1st trimester. High risk of disruption induced pregnancies requires measures aimed at correcting these violations.

A known way of doing induced pregnancies, consisting in the administration of medications: hormones progesterone number (Turina, Duphaston, utrogestan, progesterone) at a dose of 10-50 mg to 12 weeks of pregnancy; glucocorticoids (prednisone, dexamethasone, metypred) at a dose of 2.5-10 mg to 20 weeks of pregnancy; the readings up to 20 weeks - antispasmodic (no-Spa 2 tablets 3 times a day, bar (5 ml 25% solution of magnesium sulfate, 2 times a day, partusisten 1 tablet 4-6 times a day, ginipral 1 tablet 4-6 times a day); evidence - anticoagulants ( heparin 5000-15000 per day, Fragmin 5000-10000 units per day, the chimes 2 tablets 3 times a day, trental 1 tablet 3 times a day, Actovegin 1 tablet 3 times a day) throughout pregnancy (1).

Lack of drug therapy is systemic exposure and the possible damaging effect on the mother and fetus, especially in the early stages of pregnancy, the possibility of allergic reactions, the length of treatment. For example, tuinal not only has progesterone, but andrographolides effect, causing virilization of the female fetus. Tocolytic have a negative effect on the cardiovascular system. Antispasmodic can contribute to the development of isthmic-cervical insufficiency. Long-term use of anticoagulants can cause bleeding, development of thrombocytopenia (6). Despite ongoing drug therapy, there is still a high frequency of threats of termination induced pregnancy - 61,3%, preeclampsia - 61,3%, non-developing pregnancy - 27%, placental insufficiency by 19.3%, intrauterine development of the fetus - inducirowannoj pregnancy, allowing to reduce the frequency of reproductive loss, reduce medication burden on the mother and fetus by reducing doses of hormones, cancellation antispasmodic, tokoliticheskoe and anticoagulant funds to improve the function of the uterine-placental complex.

This task is solved in that, starting from 5-6 weeks of pregnancy patients with hypertonicity of the uterus and in the absence of bleeding from the genital tract is assigned to percutaneous electrical nerve stimulation (tens) zone of innervation of the uterus with a frequency of 60 Hz, a pulse duration of 0.6 MS, when the intensity of the sensation pleasant painless vibration 1-2 times per day with a 2 hour break, 25-30 minutes each day to 10 treatments, then determine the index chromodynamics potential (ITP) and soluble complexes of monomers of fibrin (RCMP), and ITP for more than 15 in.E., the emergence of positive indicator RCMP with a view to their correction with early pregnancy consistently held 3 sessions intermittent plasmapheresis (PA) to remove 30-50% of the volume of circulating plasma and the subsequent elasmotherium in relation to the remote plasma volume of 1.5:1.

Almost CHENS were carried out as follows. The electrodes roslinah vertebrae in the area of innervation of the uterus. The density of the adhesion of the electrodes to the skin surface and fixing them at a given level was carried out by two rubber bands attached around a woman's body. How intermittent PA was carried out, taking into account contraindications and individual tolerance as follows: 1) the dotted line in the cubital vein; 2) begin intravenous saline; 3) produce exposio blood in small portions to 500 ml, 2 times in plastic containers "Gamecon 500/300"; 4) separating the formed elements from the plasma in the refrigerator type centrifuge OS-6M, CPR-01 or CR-412; 5) the plasma is removed, the formed elements is re-infused to the patient. Volume remote plasma is 500-600 ml per session PA. Volume plasmodesmata for one session is 800-1000 ml of physiological solution; (6) session PA produced with double blood sampling. Each patient performed 3 sessions PA. Volume remote plasma on average 30-50% of the volume of circulating plasma (1200-1800 ml). Courses CHENS and PA carried out sequentially according to the testimony 2-3 times throughout the pregnancy.

The method reduces the contractile activity of the uterus and to contribute to the normalization of the utero-placental circulation, cancel Spa is dose drugs progesterone actions to avoid allergic reactions and to reduce the damaging effects on the fetus, reduce allergic reactions, reduce the time of treatment.

EXAMPLE 1.

Patient O. C. C. , 28 years old, came to the Center with complaints of lower abdominal pain and lower back. History of secondary infertility for 3 years, oligomenorrhea with menarche PCOS. In 1998. produced laparoscopy, wedge resection of the ovaries, in subsequent ovulation induction with recombinant FSH ended the pregnancy. Gynecological examination the uterus is increased to 6-7 weeks of pregnancy, tight, sensitive in the study. Selecting bright. Diagnosis: Pregnancy 6-7 weeks stimulated. The threat of spontaneous abortion. When ultrasound from 19.10.99, identified hypertonicity of the uterus. Clinical blood analysis, biochemical blood analysis, gemostaziogramma without features. Before entering the hospital received 2 tablets of metered per day, 20 mg Duphaston, vitamins, but, silos 2 tablets 3 times a day, baralgin 5 ml overnight. After receiving a course of tens zone of innervation of the uterus with a frequency of 60 Hz, a pulse duration of 0.6 MS, when the intensity of the sensation pleasant painless vibration 1 time a day for 25-30 min daily 7 treatments politico completely abandoned, dose Duphaston for 3 days was reduced to 10 mg (as hormones cannot be canceled simultaneously), even after 3 days the drug is cancelled. 29.10.99, repeated ultrasound - pregnancy 9-10 weeks. In the survey from 15.12.99, - ultrasound - pregnancy 17-18 weeks without pathology. According to gemostaziogramma from 15.12.99, revealed changes - ITP 16,6.E., RCMP - weakly positive. Conclusion: Hypercoagulation. The patient was conducted 3 sessions intermittent plasmapheresis to remove 30-50% of the volume of circulating plasma and elasmotherium saline solution in a ratio to the remote plasma volume 1.2 to 1.5:1. During the control study from 11.01.00, - ITP to 11.7 in.E., RCMP - negative. Conclusion: isomerase. 24.01.00 were doplerometriya of the uterus, in which uteroplacental and Feto-placental blood flow is not compromised. The pregnancy ended in a period of 40 weeks birth vaginal delivery at term girl weighing 3150 g, 52 see Apgar 8-9.

EXAMPLE 2.

Patient K. I. N., 32 years old, was admitted to the Center 27.09.99, with complaints of lower abdominal pain. History of primary infertility for 3 years, external genital endometriosis. In 1987 and 1988). produced laparoscopy, coagulation lesions Enrica in June 1999. the onset of this pregnancy. Gynecological examination the uterus is increased up to 7-8 weeks of pregnancy, tight, sensitive to palpation. When an ultrasound revealed hypertonicity of the uterus. Diagnosis: Pregnancy 7-8 weeks stimulated. The threat of termination. Clinical blood analysis, biochemical blood analysis, gemostaziogramma without features. The complex of therapeutic measures before entering consisted of taking metypred 1 tablet per day, Duphaston 2 tablets, shpy 2 tablets 3 times a day, pregnavit 1 tablet per day. From the first days of hospitalization the patient spent tens zone of innervation of the uterus with a frequency of 60 Hz, a pulse duration of 0.6 MS, when the intensity of the sensation pleasant painless vibration 1 time a day for 25-30 minutes daily 10 treatments with a positive effect, which is manifested by the absence of complaints of pain, normalization of uterine tone according to the gynecological examination and monitoring ultrasound. On the background of the first 5 procedures CHENS baralgin was cancelled dose shpy reduced to 1 tablet 3 times a day, Duphaston - to 1 tablet a day (because of the hormonal drugs cannot be canceled simultaneously). After the 5th treatment, the chance of taking antispasmodics completely abandoned, after 10 treatments Dofasco who were. Discharged with progressing pregnancy. With the re-examination in the period of 15 weeks 25.10.99, the patient revealed changes of hemostasis - ITP at 18.E., RCMP - positive. Conclusion: Hypercoagulation, the activation of intravascular coagulation. The patient performed 3 sessions intermittent plasmapheresis to remove 30-50% of the volume of circulating plasma and elasmotherium saline solution in a ratio to the remote plasma volume 1.2 to 1.5:1. During the control study from 9.12.99, - ITP to 14.1 in.E., RCMP - negative. Conclusion: minor hypercoagulation. From 16.12.99, - ITP to 11.1 in.E., RCMP - negative. Conclusion: isomerase. 22 December 1999. in the period of 22 weeks was doplerometriya of the uterus, which is not revealed violations of the Feto-placental and uterine-placental blood flow. The pregnancy ended in a timely birth 5 may 2000. by cesarean section at term girl, weighing 3264 g, height 50 cm, Apgar 8-9.

EXAMPLE 3.

Patient H. T. N., 26 years old, was admitted to the Center 29.04.99, with complaints of lower abdominal pain. History of primary infertility for 2 years, the hypothalamic-pituitary dysfunction. Took the course of ovulation induction with recombinant FSH, which sawest, dense, sensitive to palpation. When an ultrasound revealed hypertonicity of the uterus. Diagnosis: Pregnancy 7-8 weeks stimulated. The threat of termination. From the first days of hospitalization the patient spent tens zone of innervation of the uterus with a frequency of 60 Hz, a pulse duration of 0.6 MS, when the intensity of the sensation pleasant painless vibration 1 time a day for 25-30 minutes daily 10 treatments with a positive effect, which is manifested by the absence of complaints of pain, normalization of uterine tone according to the gynecological examination and monitoring ultrasound. Hemostasiogram from 12.05.99, - isomerase, ETC -12 in.E., RCMP - negative. Hemostasiogram from 29.06.99, - isomerase, ITP - 9,0.E., RCMP - negative. 26.09.99, in the period 26-27 weeks was doplerometriya of the uterus, which is not revealed violations of the Feto-placental and uterine-placental blood flow. The pregnancy was completed timely delivery through the birth canal 29.12.99, Mature girl, weight 3800 g, height 50 cm, Apgar 8-8 points.

The way of doing the first half of the induced pregnancy can reduce reproductive loss to 10.3%, to reduce the treatment time, reduce medication burden on the mother and the fetus, to improve the functionality is the LITERATURE

1. Tyutyunnik C. L., Sotnikova E. I., Nazarenko, I. A., Shmakov the hydrographic Features of the flow induced pregnancy in patients with gipogonadotropny form of amenorrhea depending on the severity of the source of the hypothalamic-pituitary disorders. Akush. and Hynek., 1997, 4, S. 30-32.

2. Chechneva M. A., Logutov HP, Levashov, I. I. Features of the flow induced pregnancy and delivery in women with infertility in history. Herald of the Russian Association of obstetricians and gynecologists, 1998, 3.

3. Vityazeva And. And. For the conduct and outcome of pregnancies after treatment with assisted reproduction methods. Abstract of Diss. ... candles. the honey. Sciences, 1999.

4. Nazarenko, I. A. Female infertility due to ovulation disturbance. Abstract of Diss. ... Prof. the honey. Sciences, 1998.

5. Kheifets, S. N., Hitova M. B. Perinatal pathology in the offspring of women treated for about endocrine infertility and ways of its reduction. Akush. and Hynek., 1991, 4, S. 52-55.

6. Kirushenko A. P. Influence of harmful factors on the fetus. M.: Medicine, 1978, 215 S.

The way of doing the first half of the induced pregnancy, including the appointment of antispasmodics, characterized in that patients with hypertonicity of the uterus, since 5-6-th time the intensity until you feel a pleasant painless vibration 1-2 times a day with intervals of 2-3 h, 25-30 min daily 5-10 procedures, determine the value of index thrombotic potential and soluble complexes of monomers, fibrin, and with increasing index thrombotic potential of more than 15.E. and/or the appearance of a positive indicator of soluble complexes of monomers of fibrin spend 3 sessions intermittent plasmapheresis to remove 30-50% of the volume of circulating plasma and elasmotherium in relation to the remote plasma volume of 1.5:1 with 2-3 fold serial repetition of these procedures during pregnancy.

 

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