RU2240129C2 - Method for treating pregnant women at fetoplacental insufficiency - Google Patents

Abstract

FIELD: medicine, obstetrics.

SUBSTANCE: the present innovation takes into account female metabolic status while treating. The method deals with introducing metabolic complex consisting of vitamin E, folic acid and epithalamin. The latter should be introduced per 10 mg intravenously by drops daily for 5 d. One should perform 1-2 courses of therapy. The method enables to increase the quality of therapy due to the impact upon female metabolic status by taking into account the type of acetylation, that is the growth of acetylation in slow acetylators predisposed to severe forms of fetoplacental insufficiency.

EFFECT: higher efficiency of therapy.

3 ex, 2 tbl

Description

The invention relates to obstetrics, in particular to the treatment of renal failure (fetoplacental insufficiency), taking into account the metabolic status of a woman. There are medical methods for the treatment of AFN (Arzhanova OA, Kosheleva NG, Gromyko GL, etc. Placental insufficiency: diagnosis and treatment. - St. Petersburg, 2001). However, a drawback of existing drug therapy methods for FPI is the simultaneous administration of a large number of drugs without taking into account their effect on the rate of metabolic processes and the initial metabolic status of a woman. At the same time, the appointment of a large number of drugs, often of unidirectional action, can disrupt individual physiological gestational homeostasis and is unsafe for the mother and the fetus. The closest analogue prototype is the treatment with Actovegin for violations of fetal-placental blood flow and metabolism of the mother and fetus (Gromyko GL Actovegin. Experience in obstetric practice. - St. Petersburg, 1997.). But the disadvantage of this method of treatment of FPI is the possibility of allergic reactions and the unidirectional effect of actovegin as part of complex therapy to increase the rate of acetylation reactions, which is not advisable.

The task is to improve the quality of treatment for pregnant women with FSF by using a non-specific peptide bioregulator - epithalamin as a monotherapy, taking into account the initial metabolic status of a woman. The problem is solved as follows. In pregnant women with PDF, the acetylation phenotype is determined by the Wallenberg-Gribennik method, and epitalamine is prescribed epithalamine in courses of 5 mg 10 mg intravenously every day for 1-2 courses to normalize the disturbed mechanisms in the mother-placenta-fetus system. Of the components of basic therapy, a reduced metabolic complex is retained, including vitamin E and folic acid. In the treatment with epithalamin, its positive effect on the condition of the fetus was noted according to cardiotocography and Doppler measurements (Table 1).

Epithalamin, in contrast to traditional therapy, has a subtle regulatory effect on metabolic status. Under the influence of epithalamin, there is a statistically significant increase in the rate of acetylation reactions only in slow acetylators predisposed to severe forms of renal failure. Acceleration of acetylation reactions in fast and intermediate acetylators with epithalamin is not appropriate, unlike traditional therapy (Table 2).

Acceleration of acetylation reactions with a quick and intermediate type of acetylation is impractical. This is due to the fact that the intermediate phenotype of acetylation is the most favorable, and the acceleration of reactions in fast acetylators can lead to an aggravation of the pathology of the fetoplacental complex, because the fast phenotype is pathogenetically associated with the hemodynamic form of FSF.

Example 1

Shpak I.A. 28 years old was admitted to the maternity ward of the Perinatal Center with a diagnosis of pregnancy 35-36 weeks. RSA. Long-term combined OCG-gestosis. VSD hypertonic type. FPN. SZRP II degree, symmetrical shape. Chronic fetal hypoxia.

Of the gynecological diseases in the history - cervical erosion, primary infertility.

This pregnancy was complicated by threatening preterm birth in the period of 30 weeks, acute respiratory viral infections in the first half of pregnancy, long-term OCG-gestosis, and renal failure.

The study of the status of the fetoplacental complex in the hospital revealed: ultrasound - SZRP II degree, symmetrical shape, early maturation of the placenta; by dopplerometry - a violation of the uteroplacental blood flow I degree A; CTG - fetal hypoxia. The amount of active isoniazid in the urine during the study of the acetylation phenotype by the Wallenberg-Gribennik method before the course of epithalamine therapy was 19%, which allowed the woman to be classified as slow acetylator.

Vitamin E and folic acid were treated. At the same time, 10 mg epithalamine was additionally administered intravenously daily for 5 days. Against the background of the therapy, there was a positive dynamics in the state of the fetus according to cardiotocography (an increase in the variability of the basal rhythm, the number and amplitude of acceleration, the appearance of a reactive non-stress test) and dopplerometry (a decrease in the resistance index of the uterine arteries), which allowed prolonging the pregnancy to a period of 38 weeks.

Determination of the acetylation phenotype after a course of therapy revealed a phenotype shift towards the intermediate.

At 38 weeks - induced childbirth, no complications in childbirth were observed. She gave birth to a live full-term male fetus weighing 2450 g, length 55 cm, with an Apgar score of 8-9 points.

Histological examination of the placenta revealed placental hypoplasia, dissociated maturation of the villi, moderate involutive-dystrophic changes, pronounced compensatory reactions (small syncytial nodes, syncytiocapillary membranes, vascularization of the villi). Infectious changes in the placenta were not detected.

The early neonatal period was uneventful. According to neurosonography - dilatation of the lateral ventricles of a mild degree. The child was discharged on the 7th day after childbirth in a satisfactory condition with a diagnosis of ZVUR II degree hypotrophic type, cerebral ischemia I degree.

Example 2

Glushkova I.A. 34 years old was admitted to the maternity ward of the Perinatal Center with a diagnosis of Pregnancy 34-35 weeks. OASA. Scar on the uterus after cesarean section. Combined OP gestosis. ICD. Chr. pyelonephritis, remission. FPN. SZRP I degree, asymmetric form. Polyhydramnios. Chronic fetal hypoxia.

A history of Cesarean section surgery for a clinical narrow pelvis. The postoperative period was complicated by endometritis. This pregnancy was complicated by the threat of termination of pregnancy in the period of 7 and 22 weeks, anemia, OP-gestosis, FPI.

During the examination in the hospital according to the ultrasound data, the first-degree FWRS, polyhydramnios were revealed; according to CTG - fetal hypoxia; according to Dopplerometry, no violations of the uteroplacental-fetal blood flow were detected. When studying the polymorphic acetylation system, it was found that a woman is a fast acetylator.

Vitamin E and folic acid were treated. At the same time, 10 mg epithalamine was additionally administered intravenously daily for 5 days. The course of therapy did not cause a statistically significant change in the rate of acetylation. During therapy, an improvement in the fetus was noted according to cardiotocography and normalization of the amount of amniotic fluid. This allowed the pregnancy to be prolonged to a period of 38-39 weeks. Given the presence of clinical signs of scar inferiority, the woman was delivered by Caesarean section as planned. A live full-term male fetus was born, weighing 2750 g, 52 cm long, with an Apgar score of 7-8 points.

A histological examination of the placenta revealed pronounced involutive-dystrophic changes, pronounced compensatory reactions (small syncytial nodes and vascularization of the villi), and chronic placentitis.

The course of the early neonatal period was complicated by the development of conjugation jaundice. According to neurosonography - signs of immaturity, intrauterine hypoxia. Discharged on the 10th day with a diagnosis of ZVUR of the I degree by hypotrophic type, cerebral ischemia of the I degree of hypoxic origin.

Example 3

Bessolitsina I.V. 34 years old was admitted to the maternity ward of the Perinatal Center with a diagnosis of Pregnancy 36 weeks. OAA FPN. SZRP I degree, asymmetric form.

Somatic and gynecological history is not burdened. This pregnancy was complicated by the threat of termination, SARS, FPI.

In the hospital, a complete examination of the status of the fetoplacental complex was performed. At the same time, it was revealed: by ultrasound - SZRP I degree, asymmetric form; CTG-fetal hypoxia; according to Dopplerometry, there were no violations of the utero-placental-fetal blood flow. A study of the polymorphic acetylation system revealed that the woman belongs to intermediate acetylators.

Vitamin E and folic acid were treated. At the same time, 10 mg epithalamine was additionally administered intravenously daily for 5 days. Under the influence of therapy, changes in the rate of acetylation reactions were not observed.

Against the background of the therapy, the fetus improved (according to cardiotocography, an increase in the variability of the basal rhythm, fetal heart rate, the number and amplitude of acceleration was noted). This allowed the pregnancy to be prolonged to a period of 38-39 weeks.

At 38 weeks induced labor. No complications of labor were observed. She gave birth to a live full-term female fetus weighing 2700 g, length 50 cm, with an Apgar score of 8-9 points.

Histological examination of the placenta revealed moderate involutive-dystrophic and compensatory reactions.

The early neonatal period was uneventful. Neurosonography revealed no pathology. The child was discharged on the 7th day after the birth with a diagnosis of ZVUR I degree according to the hypotrophic type.

Epithalamin treatment does not require special preparation and equipment and can be carried out in any maternity ward and on an outpatient basis.

Claims (1)

A method of treating pregnant women with fetoplacental insufficiency using a metabolic complex including vitamin E and folic acid, characterized in that it further includes epithalamine, which is administered in a dose of 10 mg intravenously daily for 5 days, 1-2 courses of treatment are carried out.