Method for pregravidic training in women with abortion syndrome

FIELD: medicine, obstetrics.

SUBSTANCE: at the first stage of pregravidic training one should introduce leukinferon per 10000 IU intramuscularly every other day 10 times, at the second stage it is necessary to perform 3 seances of discrete plasmapheresis. The present innovation enables to decrease the frequency in developing gestosis and the risk for abortion due to normalized activity of female immune system, that in its turn, enables to stop virusemia and virusuria, prevent fetoplacental failure and intrauterine fetal infectioning.

EFFECT: higher efficiency of training.

3 ex, 1 tbl

 

The invention relates to medicine, in particular to obstetrics and Perinatology, and can be used for pregravidarnoy training for women with complicated obstetric history due to recurrent miscarriage (PNB), cases of perinatal mortality due to latent enterovirus monoinfection.

There are ways pregravidarnoy training women with the syndrome fetal loss. Thus recommend to use the correction endocrine disorders, treatment of sexually transmitted diseases, multivitamin complexes, intrauterine correction Poludan (Oiiiaua, Obestin. Intrauterine system and modulation in the preservation and restoration of reproductive function in miscarriage. New technologies in obstetrics and gynecology: Materials science forum. M., 1999. - P.178; Rustamaliev. Programadora training for women with complicated obstetric history. AG-info. 2001. No. 4. P.16-17.).

But the disadvantages of these methods are:

- review of business continuity plan and cases of perinatal mortality independently from each other without considering the common pathogenesis of these conditions;

- lack of individual approach to the reasons causing PPF and perinatal mortality;

the lack of data about the effectiveness of these methods pregravidarnoy training for women who plan future pregnancy and its outcome.

The closest analogue prototype is integrated pregravidarnoy training women with PPF infectious Genesis (Vmesatelistve and co-authors. Actual problems of miscarriage: a series of clinical lectures. M, 2001; Vmesatelistve Usual loss of pregnancy. M: Triada-X, 2002.).

Because patients with PPF cytomegalovirus find in 60.8% of cases, herpes simplex virus - 56.9%and enteroviral viruscure is present in 98% of patients prescribed the study of the immune and interferon status. Identify the imbalance of the immune system and suppress interferonogenesis. When enteroviral infection ascertain the presence of immune disorders, but their unambiguous focus not find.

As pregravidarnoy training in the prototype offer 2-step preparation for pregnancy planning without regard to whether the infection was the cause of habitual abortion.

At the 1st stage of preparation used antibiotics, antimycotics, trichopol, systemic enzyme therapy. Then the 8th day of the menstrual cycle when the reduction of all parameters of T-cell immunity designate immunomodulators, such as T-activin, on the background of metabolic therapy. The imbalance of T-cell immunity appoint inducer of interferon - Imunofan.

At the 2nd stage with the purpose of gain is of antiviral protection is recommended to assign 5 days of the menstrual cycle interferon inducers (Radostin, laifan, Imunofan, cycloferon) in combination with Viferon and enzyme therapy. The method of choice for enteroviral infection consider metabolic therapy.

The disadvantages of the method pregravidarnoy training prototype is:

- the unification of all kinds of bacterial and viral infection as the cause of the business continuity plan without regard to the individual causes of this pathology;

- the lack of a 100% improvement in immunological parameters;

- viruscure still observed in 68% of patients;

as a result of antibiotic use is compounded by viruspositive the immunosuppression that may be the cause of adverse pregnancy outcomes;

the purpose of immunomodulators on the 1st stage pregravidarnoy training and inducers of interferon on the 2nd stage can lead to distortion and imbalance of immunological parameters, which requires repeated follow-up research of the immune status.

The objective of the invention is improving the quality pregravidarnoy training women with the syndrome fetal loss due to latent enterovirus monoinfection and improving the outcomes of subsequent pregnancy by applying individual species immune.

The problem is solved as follows.

Conduct specialized examination to detect latent enterovirus mo is infektsii.

To do this, define the antigens of enteroviruses in autopsy material lost pregnancies (chorion, placenta, fetus and died newborn), then examine the urine and blood of a patient outside of pregnancy is not less than 2 times by growing in tissue culture. If you detect enterovirus virasami and virusray, the absence of other viral and bacterial infections, then put the diagnosis of latent enterovirus monoinfection, which is the cause of the syndrome fetal loss in 16.6% of cases.

Then examine the indicators of immune status. Because latent enteroviral infection is characterized by ulterior reduction of immunological parameters (a slight decrease of T-helper cells and immunoregulatory index, increased immunoglobulin M), assign 2-stage pregravidarnoy training.

At the 1st stage prescribe lacapere 10,000 intramuscularly ME 10 times a day. After a month carry out stage 2 - extracorporally detoxification, namely medical discrete plasmapheresis 3 sessions. Even after 1 month after completion of pregravidarnoy training allow the offensive planned pregnancy by cancellation of contraception.

In the proposed method of treatment lacapere (mixture of natural leukocyte interferons and interleukins) designate then that he allowed the body from regulirovanie the defective parts of the immune system does not cause sharp fluctuations in immune status, which allows treatment without studies of immunological indexes (V.P. Kuznetsov, Aviroop. Lacapere mechanisms of therapeutic action and tactics immune. International journal of immunorehabilitation. 1998, No. 10. P.66-74; V.P. Kuznetsov, Belyaev DL, Babayants A.A. principles of the strategy of integrated therapy lacenterra and interferon type 1 immunopathological conditions and infections//Modern problems of Allergology, clinical immunology and immunopharmacology: Collection of scientific works. - M., 1998. - S).

Violated the parameters of the immune system are aligned in 100% of cases.

The second stage pregravidarnoy preparation - discrete plasmapheresis is prescribed to stop the enterovirus viraemia and reduce virusfree.

Surveyed 780 women with PPF and 204 patients with cases of perinatal mortality in history. In 280 patients only reason for the formation of the syndrome fetal loss was latent viral infection (28,5%). While 16.6% of patients revealed a latent enterovirus monoinfection.

The advantages of the proposed method:

- 100% immunocorrective effect;

- termination of viraemia in 100% of cases and virusfree in 75% of cases;

- reduction in the incidence of preeclampsia in 3 times, threatened abortion 5 times, fetoplacental is not what echnosti 8 times, intrauterine infection - 0;

- pregnancy outcomes and the lack of reproductive loss in 100% of cases;

EXAMPLE 1: Patient N., 25. History in 1998 was an urgent normal delivery. Newborn weight 3400 g died on the 2nd day of life. At postmortem examination the cause of early neonatal death was intrauterine infection in combination with decompensated fetoplacental failure. In the organs of the fetus and the placenta revealed enteroviruses. Outside of pregnancy were examined. In the urine by growing in tissue culture revealed Coxsackie virus A. In the immunological there was a decrease in T-helper cells and immunoregulatory index. Outside of pregnancy pregravidarnoy training fails. The unplanned pregnancy occurred in 1999 and ended in miscarriage at 8 weeks.

EXAMPLE 2: the Patient So, 26 years. History in 1995 premature pathological delivery, complicated antenatal death of a fetus weighing 2400, the Diagnosis of PSC: intrauterine infection. In 1997 there was a miscarriage in pregnancy 27-28 weeks a fetus weighing 800, the Diagnosis of PSC: intrauterine infection. After 1 year came to be examined. Double-identified virosome and viruscure the enterovirus group Coxsackie Century In the immunological there was a decrease in T-helper cells, T-lymphocytes, and nanoregulation index increased immunoglobulin M and reduced immunoglobulin G. Was pregravidarnoy training: Imunofan 1 ml intramuscularly every other day 10 times, metabolic therapy for 3 menstrual cycles. Planned pregnancy was accompanied by a chronic threat of miscarriage. Ultrasound examination in the period of 22 weeks revealed multiple congenital malformations of the fetus, the pregnancy was terminated at 23 weeks. Diagnosis ultrasound confirmed PJSC.

EXAMPLE 3: Patient D., 34 years. History in 1999, the first pregnancy ended in miscarriage in the period of 8 weeks. In abortion material detected enteroviruses. The second unplanned pregnancy terminated in the period of 13 weeks in connection with the detected congenital malformation of the fetus (giant hygroma of the neck, early oligohydramnios). Surveyed outside of pregnancy. Found repeated viruscure and immune system disorders. Other infectious factors were rejected. Conducted pregravidarnaya training: lacapere 10,000 intramuscularly ME 10 times a day. 1 month after the immunocorrective therapy conducted plasmapheresis 3 sessions. 1 month pregnancy is planned. The pregnancy was complicated once threatened miscarriage at 16 weeks. 39 weeks produced the planned surgical delivery by cesarean section on sachetana the indications (complicated obstetric history, the first birth in 34 years, large fruit). A girl was born weighing 4400 g, length 59 cm, with rating on a scale of Apgar scores 8 points/9 points. In satisfactory condition of the mother and baby were discharged on the 8th postoperative day. Comprehensive examination showed satisfactory condition of the newborn.

The method can be applied to any female consultations, on a special reception on miscarriage, gynecological wards, since it does not require special training of doctors and specialized examination and significantly reduces the treatment of patients with a syndrome of fetal loss.

The analyzed parameters

GROUP
The main group n=37The comparison group(traditional - bedroom therapy) n=9The comparison group (without holding pregravidarnoy training)n= 29
Alignment of immunological parameters (%)100,050,0-
The absence of viraemia (%)100,0--
No virusfree (%)75,032,7-
The frequency of threats of terminationof 17.572,5of 87.3
pregnancy(%)   
The frequency of preeclampsia (%)16,232,348,6
The rate of fetal 87,581,2
infection (%)-  
Frequency NEF (%)9,981.677,8
Delivery on time (%)100,092,068,7
Spontaneous or early termination of pregnancy on obstetric indications (%)-8,031,3

The way pregravidarnoy training women with the syndrome fetal loss, consisting of two stages, wherein in women with syndrome fetal loss due to latent enterovirus monoinfection at the first stage prescribe lacapere 10,000 intramuscularly ME 10 times a day, and the second stage is conducted discrete plasmapheresis three sessions.



 

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