Method for managing pregnancy in females suffering from overweight

FIELD: medicine.

SUBSTANCE: managing pregnancy in females suffering from overweight on their 26-30 weeks of pregnancy involves measuring an S-wave velocity in the hepatic tissue by acoustic pulse-wave elastometry. If an average value is 1.41 ms or more, hepatic protectors are administered.

EFFECT: reducing a rate of obstetric complications in the pregnant women suffering from overweight.

3 ex

 

The invention relates to medicine, namely to obstetrics.

Changes in metabolism during pregnancy, especially if you have the original of obesity and abnormal weight gain, body on the background of insulin resistance, contributes to the formation of structural changes in the liver (Borsukov A.V. Elastography in clinical Hepatology (special issues). - Smolensk: Smolensk city printing house, 2011. - 276 C.). In connection with the growing energy needs of the organism in the second half of pregnancy under the influence of placental lactogenic increases lipolysis and mobilization of fats. This leads to increased levels of free fatty acids and ketones, which leads to hepatic steatosis. In the same period of pregnancy most women with excessive body weight has increased levels of transaminases in 2-4 times compared to the norm. Therefore, in the second half of pregnancy creates conditions conducive to the accumulation of fat in liver tissue, which further increases dystrophic changes in the liver due to excessive body mass, contributing to the development of transient stefanakos liver. Especially important in the pathogenesis of this condition is a strengthening of the processes of free radical oxidation of lipids with the accumulation of peroxide oxidation, which in turn participate in metabol is the PCA of nitric oxide, and excessive consumption, which provokes the appearance of endothelial dysfunction and is a cause of pre-eclampsia and placental insufficiency (Drapkin O.M., Korneev, O., Ivashkin V.T. Therapy of non-alcoholic steatohepatitis in metabolic syndrome: focus on essential phospholipids // Attending physician. - 2010 - №2. - S.43-45).

Gold standard for the diagnosis of degenerative liver disease is a biopsy with subsequent morphological study (Loginov A.S., Erwin LI, Shepeleva S.D., Tkachev E Needle biopsy in the diagnosis of chronic liver disease // Ter. Arch. - 1996 - C, No. 2. - P.5-8). However, this diagnostic procedure is invasive.

There is a method of management of pregnancy in women with metabolic syndrome (Peredereeva E.B. Basic principles of pregnancy and safe delivery in women with metabolic syndrome // abstract. diskn - Moscow, 2006). In the work focused on abnormalities of biochemical tests, characterizing liver functions in the regulation of its main types of metabolism. Indicated that the observed changes can be explained by the presence of pregnant women with obesity fatty infiltration of the liver. However, in this work, mainly the study was conducted thrombophilic complications in pregnant women with MS: bilionaire a direct correlation between plasma levels of an inhibitor of plasminogen activator (PAI-1), plays an important role in the violation of implantation of the ovum, as well as an independent factor of thrombophilia, and steatosis of the liver. The findings of that research was done mainly on the results obtained hemostasiogram. The author developed the principle of preparation for pregnancy and pathogenetically substantiated prevention of thrombosis and thromboembolism with the use of low molecular weight heparin, vitamins and antioxidants. However, therapy of dystrophic changes in the liver in this work was not conducted.

The known method of prevention of pregnancy complications in women with metabolic syndrome (Burianova P.P. Features of pregnancy, childbirth, the postpartum period in patients with metabolic syndrome // abstract. diskn - Volgograd, 2009). The disadvantage of this method is that the condition of the liver during pregnancy are encouraged to judge only on the changes in lipid metabolism, even without the use of routine ultrasound research method, as well as the fact that in the study group was not included pregnant women with overweight (body mass index before pregnancy more than or equal to 25 kg/m2but less than 30 kg/m2). Significant changes in lipid metabolism was the indication for Essentiale-Forte, the effectiveness of those who FIPA were also assessed solely on the normalization of lipid metabolism.

The objective of the invention is a method of management of pregnancy in women with excessive body weight, allowing to reduce obstetric complications.

The problem is solved by way of pregnancy in women with excessive body mass, which consists in the fact that in the period 26-30 weeks to determine the speed of propagation of transverse waves in liver tissue by means of acoustic pulse-wave elastometry and when the value of the average of 1.41 m/s or more is prescribed hepatoprotectors.

The essence of the claimed method consists in the following: pregnant women with overweight (body mass index before pregnancy BMI ≥25 kg/m2in the period 26-30 weeks is acoustic pulse-wave elastometry (ARFI) liver (Simona Bota, Ioan Sporea Acoustic Radiation Force Impulse Elastography // Hepatic Elastography Using Ultrasound Waves. - 2012. - P.52-84). From the obtained 8-10 values calculate the average and if the indicator takes a value of ≥1,41 m/s, this group of patients assigned to treatment with hepatic (Essentiale Forte N, Heptral) according to the standard scheme for a period of 3-4 weeks. In this case, the percentage of complicated deliveries, terminated by Cesarean section due to acute hypoxia, significantly lower than in patients with overweight, not receiving this therapy during pregnancy (27,3% and 54.6% of sootvetstvenno is, p<0,05).

Clinical example 1

Patient S., 31. The body mass index before pregnancy 28 kg/m2. In the period of 29 weeks the patient was performed acoustic pulse-wave elastometry (ARFI) of the liver. The average speed of propagation of transverse waves amounted to 1.86 m/s, which suggests the presence of transient stefanakos liver and served as the basis for assigning Essentiale Forte N dosage of 300 mg 2 capsules 3 times a day for a period of 4 weeks. Delivery ended spontaneously, evaluation of the child by a neonatologist on Apgar scale was 8/9 points.

Clinical example 2

Patient I., 28 years. The body mass index before pregnancy 29 kg/m2. In the period of 29 weeks the patient was performed acoustic pulse-wave elastometry (ARFI) of the liver. The average speed of propagation of transverse waves was 2,12 m/s, which suggests the presence of transient stefanakos liver and served as the basis for the drug Heptral 400 mg 2 times a day for 3 weeks. Delivery ended spontaneously, evaluation of the child by a neonatologist on Apgar scale was 8/9 points.

Clinical example 3

Pregnant, and 30 years. The body mass index before pregnancy 27 kg/m2. At 28 weeks the patient was performed acoustic pulse-wave elastometry (ARFI) of the liver. Average is a measure of the speed of propagation of transverse waves amounted to 1.89 m/s, that suggests the presence of transient stefanakos liver, however, the patient from treatment refused. Delivery ended by Cesarean section because of acute hypoxia on the background of chronic, evaluation of the child by a neonatologist on Apgar scale was 7/8 points.

Thus, the proposed method allows to reduce the frequency of obstetric complications in pregnant women with overweight.

The method of management of pregnancy in women with excessive body mass, which consists in the fact that in the period 26-30 weeks to determine the speed of propagation of transverse waves in liver tissue by means of acoustic pulse-wave elastometry and when the value of the average of 1.41 m/s or more is prescribed hepatoprotectors.



 

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