A method of treating pregnant women with placental insufficiency
The invention relates to obstetrics, in particular to the treatment of placental insufficiency with regard to the metabolic status of women. The method includes the introduction of a metabolic complex of vitamin E, folic acid and epithalamin. Epithalamin injected 10 mg intravenously daily for 5 days. Teach 1-2 courses of treatment. The method improves the quality of treatment due to the impact on the metabolic status of women with regard acetylation phenotype, namely acceleration acetylation in slow acetylators predisposed to severe placental insufficiency. table 2.
The invention relates to obstetrics, in particular to the treatment of NEF (placental insufficiency) with regard to the metabolic status of women. There are medical treatments NEF (Arzhanova O. A., Koshelev N. G., Gromyko, L. et al. Placental insufficiency: diagnosis and treatment. - St. Petersburg, 2001). However, a disadvantage of existing drug therapies NEF is the simultaneous appointment of a large number of drugs without consideration of their impact on the rate of metabolic processes and the source metabolize the directional actions may violate individual physiological gestational homeostasis and is unsafe for the mother and fetus. The closest analogue prototype is the treatment Actovegin disorders fetal-placental blood flow and metabolism in mother and fetus (Gromyko, L. Actovegin. Application experience in obstetric practice. - St.-Petersburg, 1997.). But the disadvantage of this method of therapy NEF is the possibility of allergic reactions and unidirectional impact aktovegin in the adjuvant therapy to increase the speed of reactions acetylation, which is not appropriate.
The task of improving the quality of treatment of pregnant women with NEF by applying them nonspecific peptide bioregulator - epithalamin as a means of monotherapy with regard to the source of the metabolic status of women. The problem is solved as follows. Pregnant women with NEF spend the definition of the phenotype acetylation method of Wallenberg-Grebennik and for normalization of the disturbed mechanisms in the system mother-placenta-fetus epithalamin appoint epithalamin courses within 5 days of 10 mg intravenously daily 1-2 course. Components of the basic therapy remain reduced metabolic complex, including vitamin E and folic acid. In the treatment of epithalamin noted its positive influence on the ion therapy, has subtle modulating effects on metabolic status. Under the influence of epithalamin is a statistically significant increase in the rate of acetylation reactions only in slow acetylators predisposed to severe forms of NEF. The acceleration of reactions acetylation at fast and intermediate acetylators in the application of epithalamin not happens in contrast to conventional therapy (table. 2).
The acceleration of reactions acetylation at fast and intermediate type acetylation is impractical. This is due to the fact that the intermediate phenotype acetylation is the most favorable, and acceleration of reactions in rapid acetylators may exacerbate the pathology of fetoplacental complex, because the rapid phenotype pathogenetically associated with hemodynamic form of NEF.
Shpak I. A. 28 years old was admitted to hospital Perinatal center with a diagnosis of pregnancy 35-36 weeks. OSA. Dlitelnosti combined OCG-eclampsia. IRR on hypertonic type. NEF. Sdfd II degree symmetrical shape. Chronic hypoxia.
Of gynecological diseases in anamnesis - cervical erosion, primary infertility.
The NASA pregnancy, plateletcrit OCG-eclampsia, NEF.
The study of the fetoplacental complex hospital revealed: ultrasound sdfd II degree, symmetric form, early maturation of the placenta; abnormal Doppler waveforms - impaired uteroplacental blood flow I And degree; CTG - fetal hypoxia. The number of active isoniazid in urine in the study of acetylation phenotype method of Wallenberg-Grebennik before therapy with epithalamin was 19%, which allowed to refer a woman to a slow acetylators.
Were treated with vitamin E and folic acid. At the same time was appointed an additional epithalamin 10 mg intravenously daily for 5 days. On the background of therapy noted positive dynamics in the fetus according to the machine (the increase in the variability of the basal rate, the number and amplitude of accelerate, the emergence of reactive actresslove test) and abnormal Doppler waveforms (reduction of the resistance index of uterine arteries), which helped to prolong pregnancy until 38 weeks.
Determination of acetylation phenotype after treatment revealed a shift in phenotype towards intermediate.
38 weeks - inducido the Noah 55 cm with estimation on Apgar scale 8-9.
Histological examination of the placenta revealed hypoplasia of the placenta, dissolvine maturation CVS, moderate involutive-dystrophic changes, expressed compensatory response (small syncytial knots, sinteticpersona membrane, vascularization CVS). Infectious changes in the placenta is not revealed.
Early neonatal period was uneventful. In neurosonography - dilatation of the lateral ventricles mild. The child was discharged on day 7 after birth in satisfactory condition with a diagnosis of IUGR II degree gipotermicescomu type, cerebral ischemia, first class.
Glushkov I. A. 34 years was admitted to hospital Perinatal center with a diagnosis of Pregnancy 34-35 weeks. The OAS. The uterine scar after Cesarean section. Co-OP preeclampsia. ICD. XP. pyelonephritis, remission. NEF. Sdfd first degree, asymmetric shape. Polyhydramnios. Chronic hypoxia.
History of Cesarean section regarding clinical narrow pelvis. The postoperative period was complicated by endometritis. This pregnancy was complicated by threatened abortion in the period of 7 and 22 weeks is nobodie; according to the CTG - fetal hypoxia; according to abnormal Doppler waveforms disorders uterine-placental-fetal blood flow is not detected. In the study of systems of polymorphic acetylation established that the woman is fast acetylation.
Were treated with vitamin E and folic acid. At the same time was appointed an additional epithalamin 10 mg intravenously daily for 5 days. Conducted therapy did not cause statistically significant changes in the rate of acetylation. During therapy, the improvement of the status of the fetus according to the machine and the normalization of the quantity of amniotic fluid. It helped to prolong the pregnancy to term 38-39 weeks. Given the presence of clinical signs of inferiority of the scar, the woman was rodorazresheniye by Cesarean section in a planned manner. Born live full term male fetus weighing 2750 g, length 52 cm, with rating on a scale of Apgar 7-8 points.
Histological examination of the placenta revealed pronounced involutive-dystrophic changes, expressed compensatory response (small syncytial knots and vascularization CVS), chronic placenta.
During the early neonatalogy hypoxia. Discharged 10 days with a diagnosis of IUGR first degree in gipotermicescomu type, cerebral ischaemia first degree of hypoxic Genesis.
Bessolitzina I. C. 34 years was admitted to hospital Perinatal center with a diagnosis of Pregnancy 36 weeks. The TAA. NEF. Sdfd first degree, asymmetric shape.
Somatic and gynecological anamnesis is not burdened. This pregnancy was complicated by the threat of termination, SARS, NEF.
The patient made a full survey of the status of fetoplacental complex. At the same time revealed: ultrasound sdfd first degree, asymmetric shape; CTG-fetal hypoxia; abnormal Doppler waveforms-disorders of the uterine-placental-fetal blood flow is not detected. The system of the polymorphic acetylation revealed the women belonging to the intermediate acetylators.
Were treated with vitamin E and folic acid. At the same time was appointed an additional epithalamin 10 mg intravenously daily for 5 days. Under the influence of therapy changes the speed of acetylation reactions were noted.
On the background of therapy improved the condition of the fetus (according to the machine marked Obelisco allowed to prolong the pregnancy to term 38-39 weeks.
38 weeks induced birth. Complications in childbirth was not observed. Gave birth to a live full-term fetus is female weight 2700 g, length 50 cm, with rating on a scale of Apgar 8-9.
Histological examination of the placenta revealed moderate involutive-dystrophic and compensatory responses.
Early neonatal period was uneventful. In neurosonography revealed no pathology. The child was discharged on day 7 after birth with a diagnosis of IUGR first degree in gipotermicescomu type.
Treatment with epithalamin does not require special training and equipment and can be done in any maternity ward and in the outpatient setting.
A method of treating pregnant women with placental insufficiency with metabolic complex, including vitamin E and folic acid, characterized in that it further includes epithalamin, which is administered 10 mg intravenously daily for 5 days, spend 1-2 course of treatment.