Method for treating toxicosis in pregnant women

FIELD: medicine, obstetrics, gynecology.

SUBSTANCE: at the background of therapy conducted one should introduce derinate immunomodulator into the body of pregnant woman additionally nasally per 1-2 drops of 0.25%-solution into each nasal canal 5-8 times daily for 3-5 d and - parenterally per 5.0 ml of 1.5%-solution once daily for 3-8 d along with preparation that improves microcirculation and along with antioxidant at a certain sequence, moreover, derinate should be introduced 30-40 min after application of microcirculation-improving preparation, and antioxidant - 20-30 min after derinate's introduction. The present innovation favors decreased edemas, decreased body weight, stabilization of Macluer-Aldrich test that in its turn enables to avoid perinatal losses, decrease the risk for the development of fetoplacental insufficiency and intrauterine fetal infection.

EFFECT: higher efficiency of therapy.

1 ex, 2 tbl

 

The invention relates to medicine, namely to methods of treatment of toxemia of pregnancy, and can be used in obstetric practice.

Late toxicosis of pregnant women - gestosis of pregnant is not a disease, and complications of pregnancy, due to the mismatch between the capabilities of adaptive systems of the mother to adequately meet the needs of the developing fetus. This is a complex neurohumoral pathological process, showing different functional disorders of the Central and autonomic nervous, cardiovascular and endocrine systems, as well as the violation of a number of metabolic processes, immune response and other functions of the body pregnant.

Preeclampsia is one of the leading causes of maternal mortality rate, which according to some authors range from 20 to 25%. Still to this pathology remains high perinatal mortality rate (from 18%to 30%), perinatal morbidity ranges from 64 to 78%. Amount, duration and effectiveness of treatment, as well as the tactics of the women during pregnancy and the postnatal period is largely dependent upon correct estimation of the definition of clinical forms and degrees of severity of preeclampsia.

According to some authors, the frequency of various clinical forms of preeclampsia very variable. Most often streicherserenade (average 60%), less monosymptomatic form of edema (15-20%), rarely pre-eclampsia and eclampsia.

The leading parts of preeclampsia are: generalized vasoconstriction, hypovolemia, violation of rheological properties of blood (changes in blood viscosity, aggregation properties of blood), the development of disseminated intravascular coagulation.

The point of application of all identified changes in pregnant and fetoplacental system are the basic parts of microcirculation disorders which underlie the pathogenesis of preeclampsia, leading to hypoxic, ischemic and necrotic changes in the vital organs.

Therapy of preeclampsia must consider all stages of pathogenesis, to be integrated and differentiated. Medications that are widely used for the treatment of preeclampsia, give mainly symptomatic effect in the form of a temporary reduction of the severity of hypovolemia, hypotensive and other actions. Conventional methods of treatment, including intensive infusion-transfusion therapy, sedative and hypotensive drugs in the best case can prevent the transition of mild forms of preeclampsia in more severe stage. And only the correct determination of the timeliness of the terms of delivery allows you to save the life of mother and newborn.

Known methods for the treatment of late toxemia of pregnancy (Anemonen. Modern aspects of diagnosis, therapy, prevention and rehabilitation of preeclampsia. Handbook, 1997), including compliance with health-protective mode, therapeutic diet, complex drug therapy aimed at eliminating hypovolemia, normalization rheological and coagulation properties of blood, normalization of vascular permeability, regulation of water-salt metabolism, normalization of metabolism, prevention and treatment of multiple organ failure; antioxidant, anti-hypertensive therapy; prevention and treatment of placental insufficiency, concomitant treatment of extragenital pathology.

The disadvantage of this method is its low stability and predictability of results that require frequent active adjustment of therapy. The method does not take into account the important role of immunologic component during normal pregnancy and in the pathogenesis of late gestosis. Immpressive, Twizlers consider late toxemia of pregnancy as a manifestation of secondary immunodeficita result in altered activity of a subpopulation of T-lymphocytes, which changes the activity of T cells and immunity. The mechanism is selective inhibition of T-cell immunity of the mother substances produced by the placenta. Violation of or and the rotation of this mechanism may be one of the factors of pathological pregnancy.

As the closest analogue of the adopted method for the treatment of late toxemia of pregnancy (Abu Nasser, Isabegova. Optimization of prenatal and childbirth, the combination of preeclampsia with iron deficiency anemia. Obstetrics and gynecology, No. 5, 2000, 31-34). The method includes the complex of therapeutic and preventive measures:

1. Adherence to health-protective mode (sleep, rest, creating physical and emotional rest).

2. The purpose of therapeutic diets.

3. The comprehensive drug therapy. It includes infusion therapy (ecocarrier, salt and glycosylamine solutions); hypotensive (antispasmodics, ganglio - blockers), antioxidant (Cytochrome C, Vitamin E), medications, normalizing vascular permeability, flow and coagulation properties of the blood, regulate water-salt metabolism, normalizes metabolic processes, sedative drugs.

4. Prevention and treatment of placental insufficiency, fetal hypoxia and fetal malnutrition.

5. Treatment of extragenital comorbidity.

6. Physiotherapy, reflexology.

But the long, often-patient treatment requires active correction, because it is not always possible to achieve a stable, predictable treatment outcome. This is due to the fact that h is of the known method does not take into account the need to restore and strengthen the immune system, enswathes activity of the immune system, stimulation In the level of lymphocytes, activation of T-helper cells, etc. due to the combination of properties and their mutual Supplement with a joint application technologies and products aimed at fast delivery and intensive penetration into tissue of biologically active substances with further restoration of the normal functions of organs.

The objective of the invention is to provide a method of treatment of toxemia of pregnancy, allowing you to get more pronounced and persistent therapeutic effect.

The essence of the invention is that in the treatment of toxemia of pregnancy, including the appointment of a health-protective mode, nutritional therapy, reflexology and complex drug therapy, therapy in the pregnant addition to impose immunomodulator Derinat nasal 1-2 drops of 0.25% solution in each nostril 5-8 times a day for 3-5 days and parenteral in 5.0 ml. of a 1.5% solution of 1 times a day for 3-8 days together with the drug, improves microcirculation, and an antioxidant in a certain sequence, with Derinat enter 30-40 minutes from the start of a drug that improves microcirculation and antioxidant 20-30 minutes after the introduction of Derinat.

The use of the invention allows to obtain the following technology in the economic result.

The method allows to obtain a pronounced and persistent therapeutic effect. The application of the method in patients with edema pregnant with the third day of therapy have enabled us to achieve: reduction in grade 2-3 and disappearance in the first degree of swelling of body weight reduction on average 1,775 kg, stabilization samples of Maclura-Aldrich and from 14.7 to 25.4 minutes At this reduced treatment time of 2.1 days.

In the group of pregnant women suffering from nephropathy, treatment efficacy depended on the severity of preeclampsia, In 15% of cases, no effect of the treatment, 10% received short-term improvement (these 25% were pregnant with severe and moderate nephropathy), 75% of patients (including 8.7% of pregnant women with moderate disease) received a lasting effect without recurrence. This approach to treatment, we did not observe perinatal losses of our pregnant women. This marked a positive trend: decreased and disappeared swelling, decreased body weight 1.8 kg, height HB of blood 10.3 g/l, the increase in the number of platelets in 1.9 times, erythrocytes by 10.8%, the decline and disappearance of proteinuria, normalization of hemodynamic parameters, decreased the average duration of treatment by 0.7 days and amounted to 6.1 K/A.

When treating pregnant women with monosymptomatic proteinuria normalization and is Alisov urine with 4-th day from the beginning of treatment, the average duration of treatment in this category pregnant women decreased by 6.9 days and amounted to 10, 3 to/A.

All pregnant, which was applied Derinat, childbirth were beneficial to both mother and fetus. Postnatal and early neonatal periods proceeded without septic complications. The average treatment time decreased to an average of 30.5%.

The developed method differs from previously used methods by the fact that for the first time in the regimen included immunoprotection Derinat.

Despite numerous studies both in our country and abroad, the exact etiology of preeclampsia is not installed. There are many theories of disease (hormonal, neurogenic, kidney, placenta, immunological, genetic). The fertilized egg is the main etiological factor in the occurrence of preeclampsia. In recent years an increasing number of studies showing the role of immune-allergic reactions in the pathogenesis of preeclampsia pregnant. Accumulated to date information, provide an opportunity to put that immunological component during normal pregnancy and in the pathogenesis of late gestosis plays an important role. Immpressive, Twizlers (Immunological aspects Pozna toxicosis of pregnancy. Methodical manual. Smolensk. 1980) late toxicosis pregnant the items considered as a manifestation of secondary immunodeficiency in the altered activity of a subpopulation of T-lymphocytes, that changes the activity of T cells and immunity. The mechanism is selective inhibition of T-cell immunity of the mother substances produced by the placenta. Violation or perversion of this mechanism may be one of the factors of pathological pregnancy (Anemonen Modern aspects of diagnosis, therapy, prevention and rehabilitation of preeclampsia. Methodical manual. Smolensk, 1997).

The technical result is achieved due to the ability of Derinat to restore and strengthen the immune system, enswathes activity of the immune system, stimulation In the level of lymphocytes, activation of T-helper cells, etc. or through a combination of properties and their mutual Supplement with a joint application technologies and products aimed at fast delivery and intensive penetration into tissue of biologically active substances with further restoration of the normal functions of the body.

Simultaneous activation of cellular immunity. Derinat has antioxidant property, which is manifested in the ability to remove from the body's free radicals, which reduces their negative impact on the organs and tissues.

Derinat has a high reparative and regenerative properties, is absolutely harmless, distributed in all organs and TKA is s, has no side effects. Contraindications to the use of the drug is not detected. It is very important that the action Derinat is implemented primarily at the cellular or tissue level.

It was noted that earlier than in the conventional treatment were included Derinat normalizes the immune status at the cellular and humoral levels, which is a universal metabolic modulator with non-specific General biological effects on all organs and tissues, which is a powerful stimulation cell repair, and regeneration of hematopoiesis, the faster and vyrazennie was achieved positive effect of therapy.

The authors found that Derinat, possessing immunomodulatory and anti-inflammatory properties, is able to normalize the condition of organs and tissues at the cellular and humoral level only if full peripheral tissue perfusion and no gross violations of the permeability of the capillary wall.

It is known that when toxemia of pregnancy capillary and cell permeability broken, and tissue perfusion is sharply reduced due to peripheral angiospasm. In such circumstances, the delivery of Derinat molecular weight 270000-500000 daltons to tissues requires additional measures.

A drug that improves microcirc is atiu, Derinat and antioxidant on the proposed scheme provides a full therapeutic effect. The maximum concentration of the drug, improve microcirculation, such as trental, is achieved in the blood after 30-40 minutes. At this time, on the background of his actions impose Derinat, and after 20-30 minutes, antioxidant, such as cytochrome C.

This sequential approach to the introduction of drugs, reducing circulation and normalizes metabolic processes in the cell, in combination with Derinat provides the most efficient stabilization of the immune status at the cellular and humoral levels, has seen the effect on organs and tissues, which leads to activation of cellular repair, regeneration and stabilization of hemopoiesis.

In the available literature, the authors have not found information about the usage of immunomodulators in the treatment of late toxemia of pregnancy.

The method is as follows.

Prevention and treatment of prestoza can be carried out in the antenatal clinic.

Treatment of pregnant women with clinically manifested forms of preeclampsia conducted in the obstetric hospital. After studying the history, clinical and other studies find adequate complex therapy depending on the form and severity of toxicosis.

B. the school recommended the creation of a therapeutic protective mode, providing for sleep, rest, creating emotional and functional rest. Prescribed therapeutic diet with restriction of salt, fluids, including fasting days. Conduct comprehensive medication therapy. Designate antisense funds (diphenhydramine, pipolphen); sedatives (tincture of motherwort, Valerian, seduxen, droperidol, phenobarbital, analgesic anesthesia - if indicated); anti-hypertensive drugs, taking into account individual sensitivity (aminophylline, nikoverin, no-Spa, papaverine, Dibazol, andipal, clonidine, magnesium sulfate, dopegita, inderal, benzogeksony, sodium nitroprusside); drugs that act on the normalization of vascular permeability (rutin, askorutin, ascorbic acid); regulation of water-salt metabolism (kidney tea, decoction of leaves of bearberry, diuretics on the testimony - verospiron, lasix); normalization of metabolic processes (vitamins b, E, methionine, folic acid, Panangin, asparkam); improved rheological and coagulation properties of blood (disaggregants - chimes, complain; reopoliglyukin, heparin, trental); the elimination of hypovolemia is performed with the use of infusion therapy using frozen plasma, albumin, gidroksietilirovannogo starch, glucose-procaine mixture. Spend antioxidant therapy day is (vitamin E, cytochrome C, glutamic acid, Essentiale), also implement the prevention and treatment of fetal hypoxia and fetal malnutrition, which impose additional nootropic drugs piracetam, nootropil, Ambrobene, hormones, tocolytic.

On the background of therapy in the pregnant woman's body in addition impose immunomodulator Derinat nasal or parenteral. When natalina route of administration in each of the fore entrance with medical

pipette enter immunomodulator Derinat nasal 1-2 drops of 0.25% solution in each nostril 5-8 times a day for 3-5 days and parenterally, for example intramuscularly, within 5-8 days once a day. Parenteral Derinat administered together with a drug that improves microcirculation, such as answered, and an antioxidant, such as cytochrome C, in sequence. Initially, intravenous drip solution trental based 5.0 ml, of 200.0 ml of physiological solution (0.9% NaCl), after 30 to 40 minutes from the beginning of its introduction intramuscularly Derinat in the form of injections of 5.0 ml of a 1.5% solution. Cytochrome C is injected through 20-30 minutes after the introduction of Derinat.

The method applied in the clinical setting for the treatment of late toxicosis in 50 pregnant women with different forms and severity of preeclampsia. Perfoermance made up 41.1%, monosymptomatic for preeclampsia is observed in 60% of patients, “combined” form (chronic or gestational pyelonephritis, iron deficiency anemia, hypertension, hepatitis C, and others) registered in 70% of cases.

Table No. 1.
The composition of the sick.
The nosology/ageUnder 18 years19-27 yearsAge 28
Groupgroup 1 counter.2 gr.group 1 counter.2 gr.group 1 rear2 gr.
Dropsy pregnant--109-1
Proteinuria11161534
Nephropathy--171535
Only114339610

The age of patients ranged from 17 to 41 years: up to 18 years - 1, 19-27 years - 39, age 28 - 10 patients. Clinical forms: swelling pregnant - 10 cases, including a light degree - 3, moderate - 5, heavy step the Ni - 2. Monosymptomatic proteinuria was observed in 20 pregnant women, in all cases, proteinuria did not exceed 1 g/l, but in 6 patients wore a protracted course. Nephropathy registered in 20 cases: first, the severity of 66.3 per cent, the second - 28,5%, the third with 5.2% (table 1).

Examination of pregnant women included the following standard methods: obshechelovecheskie the blood and urine biochemical studies, urine on Nechiporenko and zimnitsky tests, sample Rehberg, hematocrit and coagulation time, triglycerides, crops urine and vaginal contents for the presence of flora, ECG and FCG, CCS internal organs, heart and fetus, appointments and fundus.

The evaluation of the treatment results was performed at 3, 6, 12 days from start of therapy. Ultrasonic inspection of the condition of the fetus and its development was estimated at 12-14 days. The value of the proposed treatment of late gestosis of pregnant women is to obtain a rapid therapeutic outcome and sustained remission that can improve the functional outcomes of pregnancy, childbirth, and the postpartum period, shorten the period of temporary disability. All pregnant, which was applied Derinat, childbirth were beneficial to both mother and fetus. Postnatal and early neonatal periods proceeded without septic complications.

Clinches the first example.

Pregnant M, 23, parvovirinae, when admitted to the obstetric Department of pregnancy pathology complained of edema of the body within two weeks, poor sleep, increased AD to 130/90 mm Hg During examination: blood HB 108 g/l, eh - 3.1 hematocrit of 0.30, the clotting time 5 min 36 s, biochemical studies without pathological changes in the urine proteinuria 0,154 g/l, leukocyturia Nechiporenko 47500, fluctuations in specific gravity of urine 1,012-1,022, in the sample Rehberg reduction filter to 68.5%, seeded urine flora microorganisms were not detected; total weight gain during pregnancy was 11.4 kg, the original HELL 110/70 mm RT. Art.; ECG sinus rhythm, heart rate 72 beats./min, EOS normal; CCS fetal pregnancy 33 weeks (fetal weight 1920); CCS kidney - hypotension CLS on both sides; dabs and crops from the vagina without pathology. The objective of the study: normastenicheskom physique, satisfactory nutrition; skin pale, pure, swelling of feet and hands; HELL 140-130/90 mm Hg, pulse 72 blow in mins, satisfactory quality; heart sounds are clear, correct rhythm, breathing in the lungs vesicular, no wheezing; the abdomen is enlarged by the gravid uterus, VD - 31 cm, RC - 84 cm, the uterus is normal tonus, the position of the fetus longitudinal previa headache, palpitation to 146 beats./min; discharge from the genital tract mucous is e; symptom of Pasternack negative on both sides. Based on the above pregnant delivered clinical diagnosis: pregnancy 33 weeks. Nephropathy pregnant 1 degree. Gestational pyelonephritis pregnant. Symptomatic anemia 1 degree. Thus, this pregnant took place combined preeclampsia pregnant. From the first day of hospital stay pregnant initiated combination therapy in combination with Derinat. Assigned pruposely mode, salt-free diet. Conducted comprehensive medical therapy with the following drugs: seduxen 5 mg×3 times a day inside, suprastin 12.5 mg×2 times a day orally, vitamin E 100 mg 2 times a day inside, chimes 75 mg×2 times a day orally, furosemide 20 mg, a day inside, ascorbic acid 50 mg orally, piracetam 400 mg×3 times a day inside, penulis 1 caps. 2 times a day inside, aminophylline 2,4%-10,0 + physical aq 10,0/once per day, no-Spa 2.0 V/m, 2 times a day, the solution Philips 400,0, glucose 5% - 400,0/drip to alternate every other day, reopoliglyukin 400,0/drip daily, vitamins B1, B6 2.0 p/C, alternating every other day, ampicillin 500 mg/m 4 times a day, auriculariaceae daily (10 sessions). On the background of therapy was additionally introduced Derinat in the form of a 0.25% solution drip into the nose for 1 to 2 drops in each nostril up to 8 times a day for 5 days is intramuscularly injections of 1.5% to 5.0 ml once a day for 3 days together with the drug, improves microcirculation - answered, and antioxidant - cytochrome C in sequence. Initially injected intravenously trental, after 30 minutes from the beginning of its introduction - Derinat, and cytochrome C in 20 minutes after the introduction of Derinat.

Dynamics analysis and state of pregnant women is presented in table 2.

Table No. 2.
Dynamics analysis and status of pregnant M
DaysProteinuriaThe number of leukocytesThe number of red blood cellsHB bloodThe red blood cellsThe hematocrit of bloodThe dynamics of weightDynamics of blood pressureThe dynamics of the sample M - Aldrich
At0,154475005001013,10,3073,8140-12
receiptg/l  g/l   kg130/90 mm Hgmin
After 3 days0,042 g/l7000200108 g/l3,30,3272,6 kg130/90 120/80 mm Hg21 min
After 6 days0,021 g/l25000108 g/l3,30,3371,9 kg120/80 mm Hg25 min
At discharge025000115 g/l3,50,3471,9 (-1,9)

kg
110/70 mm Hg35 min

Childbirth in this pregnant took place in the period 39-40 weeks the male fetus weighing 3250, During childbirth and the postpartum period without pathology.

Thus, the analysis of results of treatment of late toxicosis of pregnant women using immunoprotective Derinat in complex therapy shows its high efficiency. The purpose of Derinat late toxicosis pregnant women to prevent perinatal losses, the mind is nishit the risk of placental insufficiency and intrauterine infection of the fetus, and reduce the average length of treatment is 30.5%.

A method of treatment of toxemia of pregnancy, including the appointment of a health-protective mode, nutritional therapy, reflexology and complex drug therapy, wherein therapy in pregnant impose additional immunomodulator Derinat nasal 1-2 drops of 0.25%solution in each nostril 5-8 times a day for 3-5 days and parenteral 5.0 ml of 1.5%solution of 1 times a day for 3-8 days together with the drug, improves microcirculation, and an antioxidant in a certain sequence, with Derinat enter through 30-40 min from the start of a drug that improves microcirculation, and antioxidant - 20-30 min after the introduction of Derinat.



 

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