RU2149592C1 - Method for preventing and treating placenta insufficiency - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves administering traditional complex of vitamins (thiamine pyrophosphate, riboflavin, mononucleotide, calcium pantothenate, lipoic acid, alpha-tocopherol acetate), stimulators of biosynthesis processes (inosine, pyridoxal phosphate, folic acid, phytin, potassium orotate), sedative preparations like motherwort tincture to pregnant women from placenta insufficiency development risk group in generally accepted way with additional enterosorbent like sodium and calcium alginate each taken at a dose of 2 g of pure substance as aqueous gel solution once in the morning on the empty stomach 30-40 min before the meals during 21 days in two courses: the first one to 12- 14 pregnancy weeks and the second one 4-6 weeks later after finishing the first course. Morning dose of metabolic complex preparations is given 2-4 h later after giving sodium and calcium alginate dose. EFFECT: enhanced effectiveness of prophylaxis and therapy; reduced frequency of pregnancy and labor complications and perinatal fetus injuries. 8 tbl

Description

 The invention relates to medicine, in particular to obstetrics and perinatology, and can be used for the prevention and treatment of placental insufficiency in pregnant women in antenatal clinics, gynecological departments, pathology departments of pregnant maternity hospitals.

 Object of the invention: to develop etiotropic pathogenetically substantiated prophylaxis and therapy of placental insufficiency in pregnant women.

 A known method of treatment and prevention of placental insufficiency (G. M. Saveliev, M. V. Fedorova, P. A. Klimenko, L. G. Sichinava. Placental insufficiency. M.: Medicine, 1991, S. 208-256) using oxygen therapy, physiotherapy (diathermy of the perinephric region in combination with ultraviolet radiation), drugs that affect energy metabolism (methionine, folic acid, glutamic acid, ferroplex, galascorbine, cocarboxylase, α-tocopherol acetate), vasoactive drugs (trental, partusisten, eufufil, eufufil -shpa), intravenous administration of reopoliglyukin, native plasma, albumin, heparin, glucose with corglycon.

The disadvantages of this method are:
- the symptomatic orientation of the method without taking into account the effects of adverse environmental and geochemical environmental factors, as an etiological risk factor for the development of placental insufficiency;
- a lot of side effects (as mentioned by the authors of the prototype) included in the scheme of synthetic pharmacological preparations;
- the need for expensive equipment for physiotherapy;
- the invasiveness of the method, since it provides for the intravenous administration of drugs;
- the impossibility of treatment "at home", since the appointment of intravenous drip medications and physiotherapy requires the conditions of a hospital or clinic;
- the introduction of blood products, causing the risk of a pregnant woman becoming infected with a number of parenteral infections (HIV, hepatitis B and C, Hbs antigen);
- polyprogram, that is, the appointment of a large number of medications at the same time, which increases the load on the gastrointestinal tract of the pregnant woman and causes a decrease in the effectiveness of therapy;
- the high cost of drugs included in the complex of preventive therapy (blood products, microcirculants, vasoactive drugs).

 Placental insufficiency is the main cause of gestational complications and perinatal injuries. Currently, the dependence of the occurrence of placental insufficiency on the impact of adverse environmental factors in the urbanized region has been proved (E.V. Koskina, T.I. Bonashevskaya, L.V. Barkov, 1992; O.A. Ataniyazova, L.S. Ezhova, N. I. Kondrikov, 1994).

 In an urbanized region, environmental poisons (heavy metals and other toxic industrial waste) are constantly ingested by the pregnant woman through the gastrointestinal tract, respiratory tract, and skin. In this regard, a violation of the microelement homeostasis of the pregnant woman determines the etiotropy of enterosorbent therapy, which promotes the binding and elimination of toxic foreign substances from the body through adsorption, absorption, ion exchange and complexation.

 The purpose of the invention: increasing the effectiveness of the prevention and treatment of placental insufficiency and reducing the frequency of complications of pregnancy and childbirth, perinatal damage to the fetus.

 The goal is achieved in that, along with the traditional purpose of a complex of vitamins (thiamine pyrophosphate, riboflavin mononucleotide, calcium pantothenate, lipoic acid, α-tocopherol acetate), stimulators of biosynthetic processes (riboxin, pyridoxalphosphate, folic acid, phytin, potassium orotate (sedative), sedative motherwort) according to generally accepted schemes approved by the Ministry of Health of the Russian Federation, pregnant women at risk of developing placental insufficiency are additionally prescribed enterosorbent sodium alginate, calcium, 2 g of pure substance and per day in the form of an aqueous solution-gel simultaneously in the morning on an empty stomach 30-40 minutes before meals for 21 days, in two courses: the first - up to 12 weeks of pregnancy, the second - 4-6 weeks after the end of the first. Morning intake of metabolic complex preparations is carried out 2-4 hours after taking sodium alginic acid-calcium.

The advantages of the proposed method:
- etiotropic prophylactic treatment with sodium alginate-calcium (Na-Ca alginate);
- the availability and low cost of Na-Ca alginate: the price of 1 package is 17 rubles (2 packages are required for the course);
- non-invasiveness of the method (internal administration of enterosorbent);
- ease of use of enterosorbent (1 time per day - in the morning);
- long-term aftereffect (alginates tend to persist in the human intestines even after the cessation of their intensive use and have an effect of another 1-2 weeks);
- correction of microelement homeostasis disorders in pregnant women as a risk factor for placental insufficiency;
- preservation and increase of immunological tolerance in the mother-placenta-fetus system;
- reducing the pathological activity of the procoagulant link in the pregnant hemostasis system and reducing intravascular thrombosis in the placenta microcirculation system;
- a decrease in the intensity of catabolism processes: an increase in the activity of redox and a decrease in the activity of hydrolytic enzymes of blood leukocytes; this helps to increase the nonspecific reactivity of the pregnant woman;
- a decrease in the level of endogenous intoxication of the pregnant woman;
- reducing the frequency of immaturity of the villous chorion of the placenta, involutive-dystrophic, circulatory and inflammatory lesions of the placenta, improving the compensatory-adaptive reactions of the placenta at the tissue and cellular levels;
- reduction of complications of the gestational period and childbirth;
- a decrease in the frequency of perinatal damage to the fetus;
- improvement of neonatal adaptation of newborns;
- a positive effect on the gastrointestinal tract: antispasmodic, antiseptic, enveloping, anti-inflammatory and antibacterial effects of Na-Ca alginate.

 To disclose the invention, the following are the results of experimental studies on the clinical efficacy of the proposed method for the prevention and treatment of placental insufficiency.

 1. Laboratory diagnostic criteria for the effectiveness of the use of Na-Ca alginate in pregnant women at risk of developing placental insufficiency.

 We used Na-Ca alginate manufactured by NPK Triada (Vladivostok) with the commercial name Sorbenthal, TU 9284-010-00472012-93. Alginic acids are polyanions and are linear molecules built of two monomers - residues of β-mannuronic and α-L-guluronic acids, linked by 1-4 bonds. The most important sources of alginate production are Macrocystis pyrifera, Laminaria cloustoni, L.sacchirina, L. japonica, L. digitata, Noreocystis luetkeana and Ascophyllum nodosum. Alginic acid forms insoluble salts with ions of various metals, the affinity for metals is distributed in the following order: Pb> Cu> Cd> Ba> Sr> Ca> Co = Ni = Zn = Mn> Md.

 Evaluation of the effectiveness of prophylactic therapy of placental insufficiency using Na-Ca alginate was carried out using two groups of pregnant women at risk of developing placental insufficiency. Group 1 included 48 pregnant women who received Na-Ca alginate as part of conventional prophylactic therapy. Group 2 consisted of 47 pregnant women who received traditional metabolic therapy without the inclusion of Na-Ca alginate to prevent placental insufficiency.

 The first course of preventive therapy was carried out by pregnant women at risk of developing placental insufficiency when they were registered (up to 12 weeks of pregnancy), the second course - 4-6 weeks after the end of the first. Each course of correction was 21 days. The daily dose of Na-Ca alginate was 2 g of pure substance per day in the form of an aqueous gel solution at the same time in the morning on an empty stomach 30-40 minutes before meals. In addition to Na-Ca alginate, the prophylactic complex included: sedatives (motherwort tincture), Krebs cycle cofactors (thiamine pyrophosphate, riboflavin mononucleotide, calcium pantothenate, lipoic acid, α-tocopherol acetate), biosynthetic stimulants (riboxin, phyridoxynophosphate potassium orotate) according to generally accepted schemes approved by the Ministry of Health of the Russian Federation. Morning intake of metabolic complex preparations was carried out 2-4 hours after taking Na-Ca alginate.

 Correction control was carried out by determining in pregnant comparison groups before and after 7-10 days after the preventive treatment the content of toxic and essential metals in the blood serum, indicators of the immune system and hemostasis, the level of molecules of average mass (an indicator of the level of endogenous intoxication of the pregnant woman), dynamics indicators of utero-placental and fetal-placental blood flow in the mother-placenta-fetus system. In order to assess the effect of the therapy on the placenta after delivery of pregnant women, a morphometric study of the placenta was performed.

 A decrease in the concentration of toxic lead (p <0.001) and cadmium (p <0.001) in the blood serum of pregnant women of group 1, a decrease in the high concentration of copper (p <0.01) and manganese against the background of a tendency to an increase in essential zinc and conditionally essential lithium indicates the normalizing microelement homeostasis action of alginate Na-Ca (table. 1). Zinc is a cofactor of cell growth, catalyzes protein synthesis, therefore, an increase in the zinc content in the blood of pregnant women is a good prognostic sign for the growth and development of the fetus.

 In the comparison group, at the end of the prophylactic course without the inclusion of Na-Ca alginate, the blood levels of toxic lead (p <0.01) and cadmium (p <0.05) increased, a tendency to increase the concentration of copper and manganese, a decrease in the concentration of zinc and lithium . Therefore, preventive therapy without the inclusion of enterosorbents does not normalize microelement homeostasis and is not etiotropic for women at risk of developing placental insufficiency.

 A decrease in the number of T-helpers (p <0.05) and a decrease in the immunoregulatory index (IRI) in pregnant women of group 1 indicate an immunotropic effect of Na-Ca alginate and the restoration of immunological tolerance in the mother-placenta-fetus system (Table 2).

 In addition, the IgG content in the blood of pregnant women of group 1 increased (p <0.01) and the level of circulating immune complexes (CIC) decreased (p <0.001), which is a consequence of the sorption properties of Na-Ca alginate. A significant decrease in the concentration of CEC will lead to a decrease in the damage to the vascular endothelium of the microcirculation system of the placenta and reduce the incidence of micropolythrombosis in the uteroplacental circle of blood circulation.

 In women of group 2, at the end of the course of prophylactic treatment, an increase in IRI was observed due to an increase in the number of T-helpers (p <0.05) with an almost unchanged number of T-suppressors, which indicated the insufficiency of the suppressor dominant in the mother-placenta-fetus system, and therefore the absence of an immunotropic effect of metabolic therapy without the inclusion of Na-Ca alginate (Table 2). The increase in the number of T-helpers can be associated with the effect of toxic metals on the mother’s body as an autoimmune process in which heavy metals play the role of haptens. Confirmation of this assumption is the absence of a decrease in the concentration of CEC in the blood of pregnant women of group 2 during prophylactic treatment without the use of enterosorbents.

 A decrease in the activity of acid phosphatase (CF) and alkaline phosphatase (ALP) and an increase in the activity of myeloperoxidase (MP) of peripheral blood leukocytes was noted in both groups of pregnant women, however, the metabolic effect of prophylactic therapy with the inclusion of Na-Ca alginate was higher (Table 3).

 The presence of a significant decrease in the activity of hydrolases (ALP, CF) of blood leukocytes as a result of the use of Na-Ca alginate to remove toxic metals from the body confirms the enzymatic theory of environmental maladaptation, which provides for the effect of toxic metals on enzyme systems in the direction of their activation associated with damage to membrane structures cells and exit ("leak") of cellular enzymes into the intercellular space.

 The data obtained (Table 4) prove the positive effect of Na-Ca alginate on the hemostatic system in pregnant women at risk of developing placental insufficiency, in particular, on a decrease in the activity of factors “internal” (p <0.01) and “external” (p <0, 05) blood coagulation pathways. In addition, during treatment in group 1 pregnant women, the amount of the main blood coagulation substrate, fibrinogen, significantly decreased (p <0.05).

 Conventional metabolic therapy did not affect the activity of the procoagulant link in the hemostatic system. In this regard, we concluded that the anticoagulant and fibrinolytic properties of Na-Ca alginate.

 During therapy with Na-Ca alginate in group 1 pregnant women, a decrease in plasma concentrations of soluble fibrin-monomer complexes (RFMCs) (p <0.001) and degradation products of fibrin and fibrinogen (PDFF) (p <0.01) was established, which indicated a decrease in intravascular thrombosis in the uteroplacental circle of blood circulation. In women of group 2, a decrease in the level of RFMC occurred with a lower degree of reliability (p <0.05), and PDF was not significant.

 The decrease in polythrombosis in the placenta microcirculation system is due to the anticoagulant and fibrinolytic effects of Na-Ca alginate. This is confirmed by the dynamics of thrombin time, which characterizes the final stages of thrombin formation and increases with a greater degree of reliability in group 1 (p <0.001), compared with group 2 (p <0.05).

 Reception of Na-Ca alginate contributed to a decrease (p <0.001) in the content of endogenous intoxication markers - medium weight molecules (MSM) - in the blood of pregnant women at risk of developing placental insufficiency, which is due to the detoxification effect of alginic acid salts (Table 5).

 In order to assess the effect of prophylactic therapy using Na-Ca alginate on the state of blood circulation in the mother-placenta-fetus system, pregnant women of the comparison groups on the eve of the second course of preventive therapy (at 21-23 weeks) and 7-10 days after its completion, a Dopplerometric study uterine-placental and fetal-placental blood flow, with the calculation of systolic-diastolic ratio (SDO) in the umbilical arteries and uterine arteries (Table 6).

 After the first course of preventive therapy in pregnant women who took Na-Ca alginate, the level of peripheral vascular resistance in the uteroplacental and fetal-placental blood flow was lower than in pregnant women who did not receive Na-Ca alginate.

 A repeated course of prophylactic therapy with the inclusion of Na-Ca alginate in pregnant women of group 1 reduced peripheral vascular resistance in the microvascular network of the fetal part of the placenta (p <0.001) and uterine arteries (p <0.01), and these indicators were lower than the corresponding values in women group 2 (p <0.05). Therefore, the use of Na-Ca alginate improves blood circulation in the mother-placenta-fetus system.

A morphological study of the placenta found that women who received Na-Ca alginate as part of prophylactic therapy had a greater weight and surface area of the placenta (480.46 ± 14.2 g and 297.2 ± 12.3 cm ^2, respectively) than in puerperas who received conventional metabolic therapy (434.37 ± 12.8 g (p <0.05) and 263.28 ± 10.8 cm ² (p <0.05), respectively), which indicated an improvement in compensatory-adaptive placenta reactions while taking Na-Ca alginate.

 Pathological immaturity of the villus tree was less frequent (p <0.001) in the placentas of women of group 1 than in the placentas of patients of the 2nd group (16.67% (8 people) and 59.57% (28 people), respectively). In the placenta of pregnant women of group 1, the variant of intermediate differentiated villi predominated; in 20.83% (10 people) of cases, there was a relative immaturity of the placenta villi mainly according to the type of deficiency of terminal specialized villi. In placentas of women of group 2, a variant of intermediate immature villi was more often observed, in 7 placentas a variant of chaotic sclerotic villi was diagnosed, in 2 women a variant of mesenchymal villi was noted, in 4 women - a variant of placental embryonic villi; relative immaturity of the villous chorion occurred in 29.78% (14 people) of cases and was presented in most cases as a variant of dissociated development of villi.

 Involuntarily dystrophic changes in the placenta (maternal fibrinoid deposits, calcifications, pseudo-infarcts) were less frequently observed (p <0.01) in the placentas of group 1 patients than in placentas of women in group 2 (35.4% (17 people) and 65.96 % (31 people), respectively). Circulatory disorders in the placenta (intervascular hemorrhage, villi collapse, intervillous thrombosis, heart attacks) were less common (p <0.001) in women who received Na-Ca alginate as part of prophylactic therapy than in women who received traditional metabolic therapy (14.58% (7 people) and 44.68% (21 people), respectively). Inflammatory lesions of the afterbirth (chorioamnionitis, deciduitis, villusitis, funiculitis, placentitis) were less frequently diagnosed (p <0.001) in women of group 1, compared with puerperas of group 2 (16.67% (8 people) and 55.32% (26 people), respectively).

 Compensatory-adaptive reactions in placentas at the cellular and tissue levels (an increase in the number of syncytial kidneys and the number of specialized terminal villi with a sufficient number of syncytiocapillary membranes, villi angiomatosis) occurred more often (p <0.001) in the placentas of patients taking Na-Ca alginate in the prophylactic complex therapy, compared with placentas of women who received a metabolic complex without Na-Ca alginate (81.25% (39 people) and 25.53% (12 people), respectively).

 2. Assessment of the effect of metabolic therapy with the use of Na-Ca alginate on the course and outcome of pregnancy, neonatal adaptation of the offspring.

 In the group of pregnant women who received Na-Ca alginate as part of prophylactic therapy, the course of pregnancy was more favorable, with fewer complications of the gestational period than in the comparison group (Table 7).

 Pregnant women of group 1 compared with women of group 2 were 3.6 times less likely to have low water, lower was the frequency of the threat of termination of pregnancy (p <0.01), 1.4 times less common was hypochromic anemia, and 1.5 times less were symptoms preeclampsia. The use of Na-Ca alginate helped to reduce the frequency of perinatal injuries: the frequency of fetal hypoxia of the fetus in group 1 decreased by 3 times (p <0.05), and the fetal growth retardation syndrome was diagnosed 2.9 times less (p <0.05).

 Analysis of pregnancy outcomes in the compared groups of women showed that the average gestational period was longer (p <0.05) in women who received Na-Ca alginate compared with patients who did not take enterosorbent as part of metabolic therapy.

 In group 1, the total frequency of caesarean section was 1.5 times lower; the need for emergency surgical delivery arose 2.4 times less often. Complications of labor were less frequently observed in women who received Na-Ca alginate: pathological labor - 1.8 times, the frequency of prenatal amniotic fluid outflow - 2.5 times (p <0.05), bleeding in the subsequent and early postpartum period - in 3.4 times (p <0.05), fast and rapid childbirth - 2.3 times, anomalies of labor - 1.3 times less.

 Thus, the normalizing effect of Na-Ca alginate on microelement homeostasis, immune status, hemostatic system, and metabolic processes in pregnant women contributed to the optimization of the gestational process and a favorable pregnancy outcome.

 The favorable course and outcome of pregnancy affected the state of health and the adaptive abilities of newborns (Table 8).

 The Apgar score in the first minute of life and the body weight of the newborns were higher (p <0.01 and p <0.05, respectively) in the group of women who received Na-Ca alginate in the preventive therapy complex. The period of neonatal adaptation of newborns whose mothers received Na-Ca alginate was milder: earlier umbilical cord dropping was observed (p <0.01), weight loss in the early neonatal period in 82.14% (23 people) was not more than 10-12% of the original and was significantly less (p <0.001) than in newborns in the comparison group, the lower the weight deficit upon discharge from the maternity hospital (p <0.01).

 Respiratory disorder syndrome, indicating morphofunctional immaturity, developed in 3 premature infants of group 2, in children of group 1 it did not occur. The incidence of newborns was higher in group 2 (p <0.01).

 The most common manifestation of antenatal hypoxia was a hemoliquorodynamics disorder (a violation of cerebral and spinal circulation), which was significantly more often diagnosed in newborns whose mothers did not receive Na-Ca alginate in the preventive therapy complex (p <0.01).

 Congenital malformations of the fetus (curvature of the nasal septum, torticollis, clubfoot, hip dysplasia, facial asymmetry, narrowness of the lacrimal canals) were more common in children of group 2 compared to newborns of group 1 (p <0.05). Birth injury to the fetus (mainly spinal circulation failure) in group 2 was observed 2.6 times more often than in group 1.

 Example 1. Pregnant By-I, 19 years old, (individual card of pregnant N 8, puerperas - N 1567) was registered in the antenatal clinic with a gestational age of 10-11 weeks. When registering for pregnancy, no complaints were made.

 From the anamnesis it is known that menstrual function in a woman from 11 years old was established immediately. Menses 7-8 days after 30 days, mild, painful. The last menstruation - 02.11.96. Sexual life from 15 years old, not married. Real pregnancy is the first.

 Profession - 3rd year student of engineering college. The environmental background of the place of residence is unfavorable. Of extragenital diseases, chronic tonsillitis is noted. Thus, on the basis of anamnesis, a woman is at risk of developing placental insufficiency.

 In the period of 11-12 weeks, the pregnant woman complained of pain in the lower abdomen of inconstant, pulling nature, with which the woman turned to the local gynecologist.

A pregnant woman underwent a clinical and laboratory examination, including determination of the content of toxic and essential metals in blood serum (Cu-24.08 μmol / L, Zn-34.88 μmol / L, Mn-1.73 μmol / L, Li-0.43 μmol / L, Pb-1.14 μmol / L, Cd-0.27 μmol / L), immune status (lymphocytes-1.6 • 10 ⁹ / L, total T-lymphocytes-61%, B-lymphocytes-14 %, T-helpers-39%, T-suppressors-23%, IRI-1.69, IgA-1.1 g / l, IgM-0.58 g / l, IgG-7 g / l, CEC-81 cu), study of the hemostatic system (ABP-51 sec, APTV-35 sec, PTI-107%, fibrinogen-3.25 g / l, platelets-250 • 10 ³ / l, GAT-8 sec, aggregation with VIA-13 sec, TV-12 sec, ATIII-89%, XII-a dependent fibri nolysis - 3 min, RFMK-8 • 10 ^-2 / l, PDFF-4 • 10 ^-2 / l), determination of the enzymatic activity of blood leukocytes (SchF-108 conventional units, KF-103 conventional units, MP- 178 conventional units) and the level of endogenous intoxication of the body (MSM-0.29 conventional units), ultrasound of the fetus and placenta (placenta along the front wall on the right, the thickness corresponds to the gestational norm, "0" degree of maturity, a sufficient amount of water, frequency fetal heart rate 154 beats. in min), determination of karyopichesia index (11%).

 As a result of the examination, it was found that a pregnant woman has a violation of microelement homeostasis (excess concentration of copper, lead, cadmium, manganese and zinc deficiency relative to gestational norms), the presence of a chronic form of disseminated intravascular coagulation (DIC), insufficiency of immunosuppression and high levels of CEC in the blood, a high level of endogenous intoxication of the body. According to the results of clinical and laboratory examination, the patient was diagnosed with Pregnancy 11-12 weeks. The threat of premature termination of pregnancy.

Against the background of prophylactic treatment (2 courses of 21 days after 28 days), including tincture of motherwort, α-tocopherol acetate, pyridoxalphosphate and Na-Ca alginate, the clinical signs of PPB disappeared and a clinical and laboratory test was performed again during pregnancy 22-23 weeks pregnant examination: determination of metal content in blood serum (Cu-15.58 μmol / L, Zn-39.01 μmol / L, Mn-1.18 μmol / L, Li-0.43 μmol / L, Pb-0.16 μmol / L, Cd-0.027 μmol / L), immune status (lymphocytes-1.7 • 10 ⁹ / L, total T-lymphocytes-58%, B-lymphocytes-16%, T-helpers-27%, T- suppressors-31%, IR I-0.87, IgA-0.52 g / l, IgM-1.4 g / l, IgG-9 g / l, CEC-35 c.u.), study of the hemostatic system (ABP-74 sec, APTT -41 sec, PTI-94%, fibrinogen-2.5 g / l, platelets-243 • 10 ³ / l, GAT-10 sec, aggregation with UIA-14 sec, TV-14 sec, ATIII-105%, XII -a dependent fibrinolysis-5 min, RFMK-0, PDFF-0), determination of the enzymatic activity of blood leukocytes (ЩФ-96 conditional units, KF-82 conditional units, MP-194 conditional units) and the level of endogenous organism intoxication (MSM-0.16 conventional units), Dopplerometric determination of DLS in umbilical cord arteries (3.12) and uterine arteries (1.78), determination of karyopiknotic index (5%).

 Consequently, preventive therapy with the inclusion of Na-Ca alginate helped normalize the microelement homeostasis of the pregnant woman's body (decrease the toxic lead and cadmium content, decrease the copper concentration to the physiological level, increase the zinc content), improve microcirculation and normalize blood circulation in the mother-placenta-fetus system, and restore immunological tolerance, a decrease in the intensity of catabolic processes, a decrease in the concentration of CEC and MSM.

 Correction of violations of the adaptation of the mother-placenta-fetus system contributed to the favorable course of pregnancy. The gestational period ended with the birth of a live full-term girl weighing 3720 g, with a growth of 50 cm, with an Apgar score of 8-9 points, without signs of hypoxia and malnutrition.

 Example 2. Pregnant AK, 28 years old (individual pregnant card N 61), when registering for pregnancy (at 7-8 weeks), there were no complaints.

 From the anamnesis it is known that menstrual function in a woman from 13 years old was established immediately. Menses 5 days after 30 days, profuse, painful. Last menstruation - 09/23/96. Sexual life from 20 years old, married. Real pregnancy is the first. Gynecological diseases: primary infertility of endocrine etiology within 3 years, treatment of 17-OPK for 6 months.

 Occupational hazards - work with a personal computer, emotional stress. The environmental background of the place of residence is unfavorable. Of extragenital diseases, chronic tonsillitis, chronic cholecystitis. Thus, based on the history, the woman is at risk of developing placental insufficiency.

 The course of this pregnancy at 10-11 weeks was complicated by candidal colpitis, acute respiratory viral infections, the threat of abortion. The clinical manifestation of premature termination of pregnancy was a single spotting from the genital tract, pain in the lower abdomen. At 14-16 weeks, there was a relapse of the threat of abortion (pain in the lower abdomen). In both cases, treatment for premature termination of pregnancy was performed on an outpatient basis.

Given the recurrent nature of the threat of premature termination of pregnancy, a woman underwent a clinical and laboratory examination at 22-23 weeks, including determination of the content of toxic and essential metals in blood serum (Cu-20.77 mmol / L, Zn-41.3 mmol / L, Mn-1.098 μmol / L, Li-0.43 μmol / L, Pb-1.29 μmol / L, Cd-0.27 μmol / L), the study of the immune status (lymphocytes-3.47 • 10 ⁹ / l, T-lymphocytes-62%, B-lymphocytes-29%, T-helpers-34%, T-suppressors-27%, IRI-1.25, IgA-1.2 g / l, IgM-0.89 g / l, IgG-5.5 g / l, CEC-31 c.u.), hemostatic system (ABP-62 sec, APTV-40 sec, PTI-100%, fibrinogen-4.75 g / l, platelets-260 • 10 ³ / l, GAT-9 sec, aggregation with UIA-14 sec, TV-14 sec, ATIII-97%, XII-a dependent fibrinolysis-4 min, RFMK-9 • 10 ^{- 2} / l, PDFF-4 • 10 ^-2 / l), determination of the enzymatic activity of peripheral blood leukocytes (ЩФ-116 conditional units, KF-112 conditional units, MP-169 conditional units) and the level of endogenous intoxication organism (MSM-0.24 conventional units), ultrasound of the fetus and placenta (placenta along the front wall on the right, thickness 24 mm, "0" degree of maturity, enough water, fetal heart rate of 150 beats. in minutes) with Dopplerometric determination of LMS in the arteries of the umbilical cord (3.69) and the uterus (2.48); determination of karyopichesia index (10%).

 As a result of the survey, it was found that a pregnant woman has: a violation of microelement homeostasis (excess concentration of copper, lead, cadmium and relative lithium deficiency relative to gestational norms), the presence of a chronic form of DIC, a lack of immunosuppression and an increased content of CEC in the blood, a high level endogenous intoxication of the body, circulatory disorders in the mother-placenta-fetus system of the II degree.

After the treatment (2 courses of 21 days after 21 days), which includes, in addition to Na-Ca alginate, motherwort tincture, thiamine pyrophosphate, α-tocopherol acetate, potassium orotate, a clinical laboratory examination was again prescribed for a pregnant woman in the period 32-33 weeks. The following was carried out: determination of the content of toxic and essential metals in blood serum (Cu-19.2 μmol / L, Zn-44.06 μmol / L, Mn-0.92 μmol / L, Li-0.86 μmol / L, Pb -0, Cd-0,044 mmol / l), the study of the immune status (lymphocytes-3.1 • 10 ⁹ / l, total T-lymphocytes-56%, B-lymphocytes-26%, T-helpers-29%, T- suppressors-30%, IRI-0.96, IgA-1.7 g / l, IgM-0.8 g / l, IgG-10 g / l, CEC-17 c.u.) and hemostatic system (ABP- 72 sec, APTV-49 sec, PTI-82%, fibrinogen-3.25 g / l, platelets-250 • 10 ³ / l, GAT-12 sec, aggregation with UIA-17 sec, TV-14 sec, ATIII- 99%, XII-a dependent fibrinolysis-4 min, RFMK-4.5 • 10 ^-2 / l, PDFF-2 • 10 ^-2 / l), enzyme determination the apparent activity of peripheral blood leukocytes (ЩФ-106 conventional units, KF-94 conventional units, MP-196 conventional units) and the level of endogenous intoxication of the body (MSM-0.13 conventional units), calculation of the karyopiknotic index (4%), Dopplerometric determination of DLS in the umbilical artery (2.83) and uterine arteries (1.87).

 Therefore, the therapy of placental insufficiency with the inclusion of Na-Ca alginate helped normalize the microelement homeostasis of the pregnant woman's body (decrease the lead and cadmium levels, decrease the copper concentration to the physiological level, increase the level of zinc and lithium in the blood serum), improve microcirculation and eliminate hemodynamic disturbances in the mother system -placenta-fetus, enhancing the suppressor dominant and increasing the content of IgG, lowering the concentration in the patient's blood of the CEC and MSM.

 Normalization of adaptation processes in the mother-placenta-fetus system contributed to the further uncomplicated course and outcome of pregnancy. The gestational period ended with the birth of a live full-term girl weighing 3000 g and growing 48 cm, with an Apgar score of 8–9 points, with no signs of hypoxia and malnutrition.

 Thus, the appointment of Na-Ca alginate to pregnant women at risk of developing placental insufficiency allows normalizing the adaptation processes in the mother-placenta-fetus system, and contributes to the birth of more viable children. The data obtained allow us to recommend the use of Na-Ca alginate in prophylactic complexes for the prevention and correction of placental insufficiency of any etiology.

Claims (1)

 A method for the prevention and treatment of placental insufficiency in pregnant women, including drug correction, characterized in that they additionally introduce sodium or calcium alginate 2 g of pure substance per day in the form of an aqueous solution or gel at the same time in the morning on an empty stomach 30 to 40 minutes before meals for 21 days , in two courses, the first - up to 12-14 weeks of pregnancy, the second - 4-6 weeks after the end of the first.

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