RU2281774C1 - Method for prophylaxis of pregnancy gestosis - Google Patents

Abstract

FIELD: medicine, obstetrics and perinatology.

SUBSTANCE: invention relates to a method for prophylaxis of the pregnancy gestosis. Method involves administration of aspiring beginning from the second trimester of pregnancy and additional administration of the preparation "Omeganol" in the dose 2 capsules, 3 times per a day for 1 month. Then 2 months later the course of administration of the preparation "Omeganol" is repeated. Method provides improving circulation in the system mother-placenta-fetus and anticoagulant and fibrinolytic effects that results to decreasing hypercoagulation that accompanies gestosis in pregnancy.

EFFECT: improved method of prophylaxis of gestosis.

3 tbl, 2 ex

Description

The invention relates to medicine, namely to obstetrics and perinatology, and can be used to prevent gestosis of the second half of pregnancy in maternity wards and pregnancy pathology departments of maternity hospitals.

According to various authors, the frequency of gestosis varies from 1.5% to 23.2% of cases. Gestosis is characterized by a deep disorder of all types of metabolism, changes in the activity of the cardiovascular and nervous system, impaired functions of the placenta, kidneys and other vital organs, which entails an increase in maternal and perinatal mortality [2].

Currently, a large number of pharmacological preparations aimed at correcting these disorders have been proposed, however, intensive drug therapy is not indifferent to a pregnant woman, fetus, and newborn. In modern conditions, the only way to reduce the incidence of gestosis and prevent the development of severe forms is the early diagnosis and prevention of this pregnancy complication [3].

There is a method for the prevention of late gestosis of pregnancy (RF patent No. 2129863, A 61 K 31/00, 33/26, 38/24, BI No. 13, 1999) consisting in the introduction of microfollin in a dose of 0.0125-0.0250 mg / day for 8-14 days from 21-24 weeks of pregnancy with symptomatic therapy with aminophylline, methionine, vitamins, iron-containing drugs.

However, this method has several disadvantages:

1) does not have a positive effect on the parameters of central hemodynamics and indicators of the hemostatic system;

2) microfollin, being a synthetic hormone, increases hypercoagulation;

3) aminophylline increases hyperhomocysteinemia, which exacerbates endotheliosis;

4) iron preparations during pregnancy cause hemosiderosis in the placenta, which exacerbates placental insufficiency;

5) low efficiency;

Closest to the proposed method is a method for the prevention of gestosis by administering small doses of acetylsalicylic acid - 60 mg per day, starting from the second trimester of pregnancy (Russian Journal of the Obstetrician-Gynecologist, No. 3 (5), 2001).

Small doses of aspirin inhibit prostoglandinsynthetase, disrupt the synthesis of A2 thrombocane, prostacyclin, inhibit the release and reduce platelet adhesion.

However, this method according to research does not affect the decrease in the frequency of gestational hypertension, proteinuria and intrauterine growth retardation. [four]

The problem solved by the invention is to increase the effectiveness of prevention of gestosis, reducing the number of complications in the mother and fetus.

The problem is solved due to the fact that the drug “Omeganol” is additionally prescribed in a prophylactic dose of 2 capsules 3 times a day with a second course in 2 months.

Preparations that contain fish oil, obtained from fish liver, carcasses of marine fish, contain a huge amount of toxins that accumulate there, which makes them limited for use during pregnancy. In contrast, the Omeganol preparation contains fish oil, obtained only from tissue subcutaneous fat from fish of a strictly defined age, size and habitat, which is why it is refined pure, harmless and therefore can be optimally used throughout pregnancy. Also, the composition of the drug includes allicin, which acts as a biostimulant, olive and palm oils are powerful antioxidants.

The omega-3, omega-6 polyunsaturated fatty acids (PUFAs) contained in Omeganol are included in the phospholipids of the cell membranes of the whole body, contribute to their structural and mechanical rearrangement, changes in the activity of membrane-bound enzymes and the synthesis of biologically active substances, and normalization of the prostocycline / thromboxane, changes of which occupy one of the key positions in the genesis of gestosis, delayed intrauterine development of the fetus (SVRP) and associated placental insufficiency (PN). Noteworthy is their favorable effect on blood viscosity, fluidity of cell membranes and development of the fetal brain, and also have a regulatory effect on fetal body weight [1].

The method is as follows.

Along with taking aspirin from 15-16 weeks of gestation, Omeganol is prescribed - 2 capsules (0.9 g) 3 times a day (2.7 g / day) for 1 month for women who have had a history of obstetric complications (severe gestosis, perinatal losses, etc.), with a second course after 2 months, similarly to primiparous women from the high-risk group. Under observation were 50 women with a pregnancy of 15 to 36 weeks with a burdened obstetric history, who were at high risk for developing gestosis. There were 28 nulliparous, nulliparous - 22. The age of patients ranged from 20 to 36 years, averaging 24 ± 0.5 years.

The first group (main) consisted of 30 women who had been given prophylaxis with aspirin at a dose of 60 mg per day, and additionally with the preparation "Omeganol" 2.7 g per day, starting from 15-16 weeks of pregnancy.

The second group (control) consisted of 20 women, the prevention of which was carried out by the usual medication method - aspirin at a dose of 60 mg per day.

In the presence of extragenital pathology, appropriate treatment was prescribed.

All studies in pregnant women were performed before and 1 month after the start of treatment.

When studying the hemostatic system, the following parameters were investigated: activated partial thromboplastin time (APTT) according to Larrien in the modification of Z.S. Barkagan, recalcification time (ABP), prothrombin index (PTI) according to Quick, thrombin time (TB) according to Biggs, platelet aggregation from ADP according to Born with gravimetric registration, antithrombin 3 according to Abildgaard et al.

In order to determine the effect of this prophylaxis method on the state of blood circulation in the mother - placenta - fetus system, dopplerographic studies of blood flow in the umbilical and uterine arteries were performed using only a qualitative assessment of blood flow velocity curves with the calculation of the so-called "coal-independent" indices: systole diastolic ratio and resistance index. Echographic and Dopplerometric studies were performed using sophisticated scanning instruments: the Aloka-1700 apparatus (Japan) and the SIM 5000plus apparatus (Italy), which had a Doppler unit and sensors with a frequency of 3.5 and 5 MHz.

The content of total protein, protein fractions, creatinine, total bilirubin, urea in the blood of pregnant women, as well as hematocrit, were determined by conventional methods.

All data obtained were processed by methods of variation statistics with the calculation of the Student criterion and the nonparametric χ-square criterion. Differences were rated as significant at p <0.05

Table 1
Comparative dynamics of utero-placental and fetal-placental blood flow in women at high risk for the development of gestosis. Indicators Before treatment (control group) After treatment (control group) Before treatment (main group) After treatment (main group) DLS in the umbilical artery 5.78 ± 0.62 3.81 ± 0.31 6.82 ± 0.42 3.21 ± 0.24 ** IR in umbilical artery 0.91 ± 0.02 0.72 ± 0.04 0.87 ± 0.4 0.69 ± 0.21 DLS in the uterine artery. 3.01 ± 0.08 2.01 ± 0.17 * 3.14 ± 0.06 1.91 ± 0.15 *** IR in the uterine artery. 0.83 ± 0.04 0.54 ± 0.03 0.78 ± 0.061 0.51 ± 0.01 The degree of reliability of the difference of the compared values in groups 1 and 2 * p <0.05 ** - p <0.01 *** - p <0.001

As can be seen from table 1, after the prophylactic course of treatment with the additional drug "Omeganol", in pregnant women with a high risk of developing gestosis, the level of peripheral vascular resistance in the uteroplacental (p <0.001) and fetal-placental (p <0.01) blood flow was significantly lower than in pregnant women treated in the traditional way. Therefore, the use of this method for the prevention of gestosis of pregnancy helps to improve blood circulation in the mother-placenta-fetus system, thereby reducing the number of perinatal complications.

Table 2.
Comparative dynamics of indicators of the hemostatic system Indicators Control Group (n = 20) Main group 2 (n = 30) Before treatment After treatment Before treatment After treatment 1. APTT, sec. 26.06 ± 0.7 33.12 ± 0.65 * 27.12 ± 0.41 36.41 ± 0.6 ** 2. ABP, sec. 54.19 ± 1.26 61.62 ± 1.41 * 51.07 ± 1.32 66.51 ± 1.12 ** 3. PTI,% 105.36 ± 1.75 101.43 ± 1.37 * 107.05 ± 1.62 99.38 ± 1.74 * 4. Fibrinogen, g / l 5.59 ± 0.14 4.75 ± 0.52 * 5.66 ± 0.11 4.22 ± 0.12 * 5. The degree of aggregation. Thrombus. With ADP,% 55.33 ± 1.37 51.39 ± 1.21 * 56.88 ± 1.89 48.42 ± 1.47 * 6. Antithrombin III,% 0.154 ± 0.02 0.168 ± 0.031 0.159 ± 0.91 0.172 ± 0.041 * 7. TV, sec. 13.87 ± 0.094 14.12 ± 0.096 * 13.92 ± 0.047 14.39 ± 0.096 *** The degree of reliability of the difference of the compared values in the studied groups * p <0.05 ** - p <0.01 *** - p <0.001

The data obtained (table 2) prove a positive effect on the hemostatic system in women included in the high-risk group for the development of gestosis, in particular, on a decrease in the activity of factors of the internal (p <0.01) and external (p <0.05) blood coagulation pathways . Against the background of taking the drug in pregnant women of both groups, the amount of the main blood coagulation substrate, fibrinogen, significantly decreased (p <0.05), and in pregnant women of the main group this decrease occurred in a short period of time. The action of the known method (prototype) does not show the effect on the activity of the procoagulant link of the hemostatic system, on the other hand, when using this method, the anticoagulant and fibrinolytic properties of the latter were confirmed. This led to a decrease in the hypercoagulation characteristic of chronic DIC - a syndrome accompanying gestosis and manifested by polythromboses in the microcirculation system. This is confirmed by the dynamics of thrombin time (TB), which characterizes the final stages of thrombin formation, with a greater degree of significantly increasing in the main group compared with the control group (p <0.05).

Table 3.
Analysis of the course and outcomes of pregnancy in women with a high risk of developing gestosis when the Omeganol preparation is included in the prevention complex Indicators Control Group (n = 20) The main group (n = 30) Number of cases % Number of cases % Hypoxia of the fetus. 7 35 2 6.6 Intrauterine growth retardation. 3 fifteen one 3 Cesarean section:
- planned
- emergency
5
3
2
25
40
60
6
5
one
twenty
83.3
16 Gestosis 12 60 four 13.3 Gestational age at the time of birth, (weeks) 37.8 ± 0.18 38.6 ± 0.18 *** The degree of reliability of the difference of the compared values in the studied groups

* p <0.05 ** - p <0.01 *** - p <0.001

Compared to women in the control group, fetal hypoxia (p <0.05) was found in women of the main group compared with women in the control group, and intrauterine growth retardation was detected 5.0 times less often (p <0.01). In the group of women treated with the proposed method, 1.25 times lower frequency of cesarean section.

Thus, the positive effect of the drug, included in the course of prophylaxis of gestosis, on the hemostatic system, hormonal background, metabolic processes and adaptation indicators in the body of a pregnant woman contributed to the optimization of the gestational process and a favorable outcome of pregnancy. Therefore, the use of the drug "Omeganol" for the prevention of gestosis with a high risk of its development is pathogenetically substantiated.

Example 1

Pregnant V., 34 years old, was registered for pregnancy from 21 weeks in the antenatal clinic (medical history 2148). Diagnosis upon registration: Pregnancy 21-22 weeks, burdened obstetric history (severe preeclampsia in history). Chronic fetoplacental insufficiency with hemodynamic disorders of the 1st degree, compensated form. Chronic pyelonephritis, remission stage. From the anamnesis it was established: in childhood I had chickenpox. Somatic diseases: chronic pyelonephritis since 1991

Menses from 14 years old, did not settle immediately, 5 days, after 28 days, regular, painless, moderate. M - 04/30/04. Sexual life since 18 years. The husband is healthy, from bad habits - notes smoking. This pregnancy is the second. During the first pregnancy, she underwent severe gestosis, and therefore was delivered ahead of schedule at 36 weeks of pregnancy, the child - a girl weighing 2450 g, was transferred to the second stage of rehabilitation.

Estimated date of second birth 06.02.05.

Objectively: the condition is satisfactory, the skin and visible mucous membranes are clean, obyanoy coloring. In the lungs, vesicular breathing, no wheezing. Heart sounds are clear, rhythmic, Ps-80в ', blood pressure - 120/80, 130/80 mm Hg. On palpation, the abdomen is soft, painless, there are no symptoms of peritoneal irritation. The symptom of striking is negative on both sides. No swelling. Physiological administration is normal. In a bimanual study: the external genitalia are formed correctly, the perineum is without features, the vagina is capacious. The cervix is formed, the vaginal part is 3.0 cm, the external pharynx is closed. The uterus is enlarged up to 20 weeks of pregnancy, in normotone, painless. Appendages are not determined, the pelvis is capacious, without exostoses and deformities. The discharge is normal.

At the initial examination, the following analyzes were obtained:

- OAK: Hb - 116 g / l, Er - 3.2 · 10 ¹² , Le - 5.3 · 10 ⁹ (e - 3%, pb - 11%, sya - 66%, l - 18%, m - 2%), Ht - 42%, relative to St. - 5'20-5'52.

- Fractional composition of blood serum: total protein - 60 g / l, protein fractions - 55.2 - 17.2 -20.7 - 6.9, creatinine - 58 mmol / l, uric acid - 3.2 mmol / l, bilirubin - 7.5 mmol / l, potassium - 2.9.

- Hemostasiogram: platelets - 198 · 10 ⁹ , fibrinogen - 5.2 g / l, IPT - 96%, PTV - 21 '', recalcification time - 58 '', APTT - 31 ''.

- OAM: specific weight - 1008, B - traces, Le - single, Er - 0-2.

- Ultrasound of the fetus: there is one living fetus in the uterus, it is located longitudinally, the head is due, SB. (+), BPR - 52 mm, LZR - 65 mm, DB - 32 mm, coolant - 170 mm. A placenta along the front wall, 28 mm thick, plain, amniotic fluid sufficient. According to biometric indicators, the fetus corresponded to 22-23 weeks of pregnancy.

- Dopplerometry: in the uterine arteries: SDO - 6.82, IR - 0.7, in the artery of the umbilical cord SDO - 3.14, IR - 0.69. Conclusion: Hemodynamic disorders of 1a degree.

- Ophthalmologist examination: hypertensive retinal angiopathy of the first degree is determined on the fundus.

- Neurologist examination: There is no acute neurological symptomatology.

Given the data of an objective examination and laboratory tests (the phenomena of hypercoagulation, pathological weight gain, hemodynamic disorders of the 1st degree by dopplerometry), a diagnosis of pretoxicosis was made. In addition to aspirin at a dose of 60 mg per day, the drug "Omeganol" 0.45 is also included in the course of prevention - 2 capsules 3 times a day.

When viewed after 1 month.

The abdomen is increased in volume due to the pregnant uterus. VDM - 27 cm. On palpation, the abdomen is soft, painless, there are no symptoms of peritoneal irritation. The uterus is in a normal tone, painless. The heart tones of the fetus are clear, rhythmic 140 '. The symptom of striking is negative on both sides. There are no visible edema. Physiological administration is normal. In a bimanual study: the external genitalia are formed correctly, the perineum is without features, the vagina is capacious. The cervix is formed, the vaginal part is 3.0 cm, the external pharynx is closed. The uterus is enlarged up to 27 weeks of pregnancy, in normotone, painless. Appendages are not determined, the pelvis is capacious, without exostoses and deformities. The discharge is normal.

Repeated examination:

- OAK: Hb - 120 g / l, Er - 3.8 · 10 ¹² , Le - 6.0 · 10 ⁹ (e - 1%, pb - 6%, sya - 55%, l - 33%, m - 1%), Ht - 34%, relative to St. - 4'40-6'0.

- Fractional composition of blood serum: total protein - 65 g / l, creatinine - 58 mmol / l, uric acid - 3.3 mmol / l, bilirubin - 8.0 mmol / l, potassium - 3.0.

- Hemostasiogram: platelets - 200 · 10 ⁹ , fibrinogen - 3.0 g / l, IPT - 94%, PTV - 17 '', recalcification time - 58 '', APTT - 31 ''.

- OAM: beats. weight - 1018. B - negative, Le - single, Er - 0-2.

- Daily protein loss - 44 mg / l

- Ultrasound of the fetus: there is one living fetus in the uterus, it is located longitudinally, the head is due, SB (+). The placenta along the front wall, 3.1 cm thick, maturity degree "2", amniotic fluid sufficient. According to biometric indicators, the fetus corresponded to 27-28 weeks of pregnancy.

- Dopplerometry: in the uterine arteries: SDO - 1.91, IR - 0.58, in the umbilical artery: SDO - 3.21, IR - 0.52. Conclusion: no violations.

- Eye examination: there are no changes in the fundus.

- Neurologist examination: No acute neurological symptoms were found.

Further, the pregnant woman was under the supervision of a doctor of the antenatal clinic. There were no complications. It was delivered in 38 weeks by means of urgent delivery in the front view of the occipital previa, with a boy m = 3 kg, height - 53 cm, without asphyxiation, with an Apgar score of 8-9 B.

Example 2

Pregnant A., 16 years old, was registered for pregnancy from 13-14 weeks in the antenatal clinic (medical history 2212). Diagnosis of registration: Pregnancy 13-14 weeks, young pre-pregnant. Pregnant anemia of 1 degree. Chronic pyelonephritis.

From the anamnesis it was established: in childhood, she had rubella, appendectomy.

Somatic diseases: chronic pyelonephritis since 1999.

Menses from 12 years old, did not settle immediately, for 3-4 days, after 21 days, regular, painful, moderate. M - 05/06/04. Sexual life since 15 years. Not married, no bad habits. Estimated date of birth 02.13.05.

Objectively: the condition is satisfactory, the skin and visible mucous membranes are clean, normal in color. In the lungs, vesicular breathing, no wheezing. Heart sounds are clear, rhythmic, Ps - 80 V ', blood pressure - 110/70, 100/70 mm Hg. On palpation, the abdomen is soft, painless, there are no symptoms of peritoneal irritation. The symptom of striking is negative on both sides. No swelling. Physiological administration is normal. In a bimanual study: the external genitalia are formed correctly, the perineum is without features, the vagina is capacious. The cervix is formed, the vaginal part is 3.0 cm, the external pharynx is closed. The uterus is enlarged to 13-14 weeks of pregnancy, painless. Appendages are not determined, the pelvis is capacious, without exostoses and deformities. The discharge is normal.

At the initial examination, the following analyzes were obtained:

- OAK: Hb - 106 g / l, Er - 3.1 · 10 ¹² , Le - 7.3 · 10 ⁹ (e - 3%, pb - 11%, sya - 66%, l - 18%, m - 2%), Ht - 32%, relative to St. - 4'20-4'52.

- Fractional composition of blood serum: total protein - 60 g / l, protein fractions - 55.2 - 17.2 - 20.7 - 6.9, creatinine - 55 mmol / l, uric acid - 3.5 mmol / l, bilirubin - 8.0 mmol / l, potassium - 2.4.

- Hemostasiogram: platelets - 202 · 10 ⁹ , fibrinogen - 3.2 g / l, IPT - 98%, PTV - 18 '', recalcification time - 52 '', APTT - 31 ''.

- OAM: beats. weight - 1008, B - no, Le - single, Er - 0-2.

- Ultrasound of the fetus: there is one living fetus in the uterus, it is located longitudinally, the head is due, SB. (+), With a heart rate of 157 rpm. KTR - 81 mm, corresponds to 14 weeks, the collar space is 1.6 mm. Chorion is localized on the back wall. The anatomy of the fetus is not changed.

Conclusion: Pregnancy 14 weeks.

- Eye examination: No changes in the fundus

- Neurologist examination: There is no acute neurological symptomatology.

- Inspection of the therapist: Chronic pyelonephritis, stage of remission. Pregnant anemia of 1 degree.

Further, the pregnant woman was regularly monitored by a female doctor.

Since the pregnant woman was from a high-risk group for the development of gestosis, from 15-16 weeks for prophylactic purposes it was prescribed: aspirin 60 mg per day, Omeganol 2.7 g per day.

Re-examination after 1 month.

Objectively: The abdomen is increased in volume due to the pregnant uterus. VDM - 27 cm. On palpation, the abdomen is soft, painless, there are no symptoms of peritoneal irritation. The uterus is in a normal tone, painless. The heart tones of the fetus are clear, rhythmic 140 '. The symptom of striking is negative on both sides. There are no visible edema. Physiological administration is normal. In a bimanual study: the external genitalia are formed correctly, the perineum is without features, the vagina is capacious. The cervix is formed, the vaginal part is 3.0 cm, the external pharynx is closed. The uterus is enlarged to 27 weeks of pregnancy, painless. Appendages are not determined, the pelvis is capacious, without exostoses and deformities. The discharge is normal.

- OAK: Hb - 120 g / l, Er - 3.8 · 10 ¹² , Le - 6.0 · 10 ⁹ (e - 1%, pb - 6%, sya - 55%, l - 33%, m - 1%), Ht - 34%, relative to St. - 4'40-6'0.

- Fractional composition of blood serum: total protein - 65 g / l, creatinine - 58 mmol / l, uric acid - 3.3 mmol / l, bilirubin - 8.0 mmol / l, potassium - 3.0.

- Hemostasiogram: platelets - 210 · 10 ⁹ , fibrinogen - 3.0 g / l, IPT - 94%, PTV - 14 '', recalcification time - 56 '', APTT - 32 ''.

- OAM: beats. weight - 1018; B - negative, Le - single, Er - 0-2.

- Ultrasound of the fetus: there is one living fetus in the uterus, it is located longitudinally, the head is due, SB. (+). BPR - 54 mm, LZR - 72 mm, DB - 42 mm, coolant - 181 mm. The placenta along the front wall, 2.7 cm thick, maturity degree "2", amniotic fluid sufficient. According to biometric indicators, the fetus corresponded to 21-22 weeks of pregnancy.

- Dopplerometry: in the uterine arteries: SDO - 1.92, IR - 0.55, in the umbilical artery: SDO - 3.25, IR - 0.61. Conclusion: Hemodynamic disorders were not detected.

- Eye examination: there are no changes in the fundus.

- Neurologist examination: No acute neurological symptoms were found.

After 2 months at a period of 31-32 weeks, the pregnant woman was again prescribed prophylaxis of gestosis with aspirin at a dose of 60 mg per day, Omeganol at a dose of 2.7 g per day.

Screening before appointment:

Objectively: The condition is satisfactory, the skin and visible mucous membranes are clean, normal in color. In the lungs, vesicular breathing, no wheezing. Heart sounds are clear rhythmic, pulse - 86 per minute, blood pressure - 120/80, 125/80 mm RT. Art. The abdomen is enlarged due to the pregnant uterus. VDM - 30 cm. On palpation, the abdomen is soft, painless, there are no symptoms of peritoneal irritation. The uterus is in a normal tone, painless. Fetal heart tones are clear, rhythmic 144 per min. The symptom of striking is negative on both sides. No swelling. Physiological administration is normal. In a bimanual study: the external genitalia are developed correctly, the perineum is without features, the vagina is narrow. The cervix is up to 3.5 cm long, the external pharynx is closed. The uterus is enlarged up to 32 weeks of pregnancy, painless. Appendages are not determined. The pelvis is capacious, without exostoses and deformities.

The discharge is normal.

The following analyzes were obtained:

- OAK: Hb - 106 g / l, Er - 3.14 · 10 ¹² , Le - 5.3 · 10 ⁹ (e - 3%, pb - 11%, sya - 66%, l - 18%, m - 2%), Ht - 36%, relative to St. - 4'20-4'52.

- Fractional composition of blood serum: total protein - 56 g / l, protein fractions - 55.2 - 17.2 - 20.7 - 6.9, creatinine - 55 mmol / l, uric acid - 1.4 mmol / l, bilirubin - 8.0 mmol / l, potassium - 2.4.

- Hemostasiogram: platelets - 202 · 10 ⁹ , fibrinogen - 4.7 g / l, IPT - 9%, DTV - 13.33 '', recalcification time - 57 ', APTT - 31''.

- OAM: beats. weight - 1008, B - 0.033 g / l, Le - single, Er - 0-2.

- Ultrasound of the fetus: there is one living fetus in the uterus, it is located longitudinally, there is a head, SB (+), BPR - 74 mm, LPR - 97 mm, DB - 62 mm, coolant - 76 mm. The placenta along the front wall, 3.1 cm thick, maturity degree "2", amniotic fluid sufficient. According to biometric indicators, the fetus corresponded to 31 weeks of pregnancy.

- Dopplerometry: in the uterine arteries: SDO - 3.14, IR - 0.68, in the umbilical artery: SDO - 6.62, IR - 0.84. Conclusion: violation of the uteroplacental blood flow 1B degree.

- Eye examination: No changes in the fundus

- Neurologist examination: There is no acute neurological symptomatology.

- Examination of the therapist: Chronic pyelonephritis, stage of remission.

Pregnant anemia of 1 degree.

Repeated examination after 1 month:

- OAK: Hb - 116 g / l, Er - 3.2 · 10 ¹² , Le - 6 · 10 ⁹ (e - 3%, pb - 11%, sya - 66%, l - 18%, m - 2%), Ht - 36%, v. - 4'20-4'52.

- Fractional composition of blood serum: total protein - 66 g / l, protein fractions - 55.2 - 17.2 - 20.7 - 6.9, creatinine - 66 mmol / l, uric acid - 1.8 mmol / l, bilirubin - 8.0 mmol / l, potassium - 2.4.

- Hemostasiogram: platelets - 264 · 10 ⁹ , fibrinogen - 3.7 g / l, IPT - 98%, PTV - 17.44``, recalcification time - 68 ', APTT - 42''.

- OAM: beats. weight - 1008, B - no, Le - single, Er - 0-2.

- Dopplerometry: in the uterine arteries: SDO - 1.91, IR - 0.44, in the umbilical artery: SDO - 3.24, IR - 0.68. Conclusion: violation of the uteroplacental blood flow is not detected.

- Eye examination: No changes in the fundus

- Neurologist examination: There is no acute neurological symptomatology.

- Inspection of the therapist: Chronic pyelonephritis, stage of remission. Pregnant anemia of 1 degree.

Further, the pregnant woman was regularly observed in the antenatal clinic, the pregnancy proceeded without complications, was delivered at 39 weeks of pregnancy by means of urgent delivery in the rear view of the occipital presentation by the girl m - 3120 g, height - 51 cm, without asphyxia with an Apgar score of 8-86.

Thus, the additional prescription of the drug "Omeganol" for pregnant women with a high risk of developing gestosis prevents the development of gestosis, normalizes hemostasiological parameters, improves the rheological properties of blood, and reduces the frequency of perinatal lesions of the fetus.

The advantages of the proposed method are:

1) availability and minimum cost;

2) non-invasiveness of use;

3) lack of side effects;

4 a positive effect on the procoagulant part of the pregnant hemostasis system, in particular, a significant reduction in fibrinogen;

6) a decrease in the frequency of gestosis;

7) a decrease in the frequency of perinatal lesions of the fetus (decrease in the development of fetal hypoxia of the fetus, intrauterine growth retardation).

Information sources

1. Vikhlyaeva E.M. Drug prevention of complications of the gestational process. Therapeutic Archive. 1999, No. 10, p. 49-53.

2. Kustarov V.N. and other gestosis. - S.Pb .: Hippocrates, 2003.

3. Strizhakov A.N. et al. A differentiated approach to the prevention of gestosis and placental insufficiency in pregnant high-risk groups. Obstetrics and gynecology. 2003. No. 3, p. 14-17.

4. Strizhakov A.N. et al. Prevention of gestosis and placental insufficiency in modern obstetrics. Russian Bulletin of the Obstetrician-Gynecologist. 2001, No. 3 (5), p. 32-37.

Claims (1)

A method for the prevention of gestosis of pregnancy, including taking aspirin from the second trimester of pregnancy, characterized in that it additionally introduces "Omeganol" 2 capsules 3 times a day for 1 month, after 2 months the course is repeated.