RU2472506C1 - Method for preeclampsia prevention - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely obstetrics, and may be used for preventing preeclampsia. That is ensured by prescribing nicotinic acid tablets 50 mg 2 times a day for 30 days combined with intravenous introductions of actovegin 400 mg/day in 5% glucose 100 ml for the first 5 days in a pregnant woman up to 9 weeks of pregnancy.

EFFECT: invention provides prevention of eclampsia and severe preeclampsia ensured by metabolic and antioxidant action of the preparations used in the presented therapeutic scheme.

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Description

The invention relates to medicine, namely to obstetrics, can be used to prevent preeclampsia in the first trimester of pregnancy.

A known method for the prevention of preeclampsia, based on the appointment of small doses (75-120 mg) of aspirin daily. He in the high-risk group reduces the frequency of preeclampsia by 15% (Enkin M., Keirs M., Neilson D. et al. Guidelines for effective care for pregnancy and childbirth. Translation from English, edited by Mikhailova AV - St. Petersburg : Publishing house "Petropolis". - 2003. - P.125).

The disadvantages of the prototype: it is not effective in terms of the prevention of severe preeclampsia.

Effect: increasing the effectiveness of the prevention of the method.

This result is achieved by applying a complex of therapeutic effects: daily for 30 days, the administration of nicotinic acid tablets that improve blood flow and rheological properties of blood, and at the same time during the first 5 days of intravenous administration of the drug Actovegin, which has antihypoxic and metabolic effects.

The method is as follows: a pregnant woman in the first trimester (up to 9 weeks) is prescribed nicotinic acid tablets of 50 mg 2 times a day for 30 days and at the same time during the first 5 days, Actovegin is administered intravenously at 400 mg / day in 100 ml of 5% solution glucose. The treatment complex is selected so that each ingredient contributes to the preventive effect. So, nicotinic acid improves microcirculation, and actovegin has an antihypoxic and metabolic effect. For the prevention of preeclampsia, such a treatment complex has not been used before.

The positive effect of the proposed method is the complete disappearance of eclampsia and severe forms of preeclampsia. The value of the proposed method lies in the absence of side effects and complications, high efficiency. An important positive aspect of the use of this drug is the optimal ratio of price and quality.

Case Studies

Example 1. Pregnant M. 32 years old turned to the antenatal clinic about pregnancy for 5 weeks. She had a history of long periods of 13 years, one medical abortion, early surgical delivery at 28 weeks for severe preeclampsia. On examination, cyanosis of the vaginal mucosa; the cervix is clean, the discharge is milky, moderate. The uterus is slightly enlarged, softened. According to ultrasound, uterine pregnancy is 5 weeks. Clinical tests - without features, examined by a therapist - blood pressure 125/85 mm Hg, no diseases were detected, optometrist - segmental artery spasm in the fundus. Based on the clinical and laboratory examination, the diagnosis was made: Pregnancy 5 weeks. A burdened obstetric and gynecological history (medical abortion, severe preeclampsia in previous births). Scar on the uterus. Pregnant in the first trimester (from 6 weeks), preeclampsia was prevented: nicotinic acid tablets of 50 mg 2 times a day for 30 days and simultaneously during the first 5 days, intravenous administration of actovegin 400 mg / day in 100 ml of 5% glucose solution. Further on, the pregnancy proceeded without complications (the total weight gain during pregnancy was 16 kg, there was no edema, no increase in blood pressure and proteinuria, which did not allow the diagnosis of preeclampsia to be diagnosed), it ended with a cesarean section (indications are a scar on the uterus, a large fetus ) and the birth of a living, healthy full-term girl weighing 3 kg 700 g.

Example 2. Pregnant J. 27 years old was registered in the gestational age of 7-8 weeks. A history of autonomic dystonia syndrome of hypertonic type since 17 years, painful periods since 17 years, antenatal fetal death on the background of severe preeclampsia at 32 weeks. On examination, cyanosis of the vaginal mucosa, cervix is clean, milky, moderate discharge. The uterus is enlarged to 8 weeks of pregnancy, softened. According to ultrasound, uterine pregnancy is 8 weeks. Clinical analyzes - without features. Examined by a therapist, blood pressure 125/80 mm Hg, diagnosed with a syndrome of autonomic dystonia of the hypertonic type, optometrist - spasm of the arteries in the fundus. Based on the clinical and laboratory examination, the diagnosis was made: Pregnancy 8 weeks. SVD hypertonic type. Burdened obstetric history (antenatal fetal death on the background of severe preeclampsia). Pregnant in the first trimester (from 8 weeks), preeclampsia was prevented: nicotinic acid tablets of 50 mg 2 times a day for 30 days and simultaneously for the first 5 days, intravenous administration of actovegin 400 mg / day in 100 ml of 5% glucose solution. Subsequently, an increase in blood pressure was noted from 22-23 weeks of pregnancy (maximum - 150/95 mm Hg), 250 mg 3 times a day dopegine was prescribed until the end of pregnancy. There were no repeated increases in blood pressure, proteinuria was not detected in the urinalysis, the baby developed normally, during pregnancy he was diagnosed with pregnancy-induced hypertension without significant proteinuria, and no preeclampsia was diagnosed. The pregnancy ended in childbirth at 38-39 weeks of pregnancy, a lively, healthy full-term girl was born weighing 3 kg 300 g.

Example 3. Pregnant S. 36 years old was registered for pregnancy in the period of 6-7 weeks. In the anamnesis - long, plentiful, painful periods since 12 years; arterial hypertension of 1 degree, 1 stage from 30 years; chronic endometritis from 28 years old; treated chlamydia; two miscarriages at 9 and 6 weeks; antenatal fetal death in severe preeclampsia at 26 weeks. This pregnancy is planned, pregravid preparation was carried out - immunomodulatory therapy with polyoxidonium, three courses of hirudotherapy, and spa treatment. When viewed from the cyanosis of the vaginal mucosa, the cervix is clean, milky discharge is moderate. The uterus is enlarged to 9 weeks, softened, deflected posteriorly. According to ultrasound, uterine pregnancy is 7 weeks. Clinical analyzes - without features. Examined by a therapist - blood pressure 150/90 mm Hg, diagnosed with essential arterial hypertension, 1 degree, 1 stage, moderate risk; Optometrist - segmental spasm of arteries in the fundus. On the basis of clinical and laboratory examination, the diagnosis was made: Pregnancy 7 weeks, essential hypertension 1 degree, 1 stage, moderate risk, burdened obstetric and gynecological history (2 miscarriages in the early stages, severe preeclampsia in a previous pregnancy, antenatal fetal death). Chronic endometritis Pregnant in the first trimester (from 7 weeks), preeclampsia was prevented: nicotinic acid tablets of 50 mg 2 times a day for 30 days and simultaneously for the first 5 days, intravenous administration of actovegin 400 mg / day in 100 ml of 5% glucose solution. Given the history and levels of blood pressure, immediately prescribed dopegit 250 mg 2 times a day and duphaston 10 mg for up to 12 weeks, followed by gradual cancellation. Subsequently, an increase in blood pressure was noted in 24-25 weeks to 135/95 mm Hg. (which required an increase in the dose of dopegitis to 750 mg / day); increased blood pressure to 145/100 mm Hg, the appearance of edema without proteinuria, impaired blood flow in the uterine arteries at 35-36 weeks, which required treatment in a hospital (intravenous administration of magnesia, re-appointment of nicotinic acid 50 mg 2 times a the day before childbirth and intravenous administration of Actovegin at 400 mg / day for 5 days). During pregnancy, a woman was diagnosed with hypertension caused by pregnancy, no preeclampsia was diagnosed. Pregnancy ended in an operative birth (according to the sum of relative indications - age-old primogenous, burdened obstetric and gynecological history, chronic fetoplacental insufficiency) at 38-39 weeks and the birth of a live full-term boy weighing 3 kg 200 g.

Example 4. Pregnant P. 26 years old was registered for pregnancy at 6 weeks. A history of abundant, painful periods since 13 years, chronic endometritis for 10 years, frozen pregnancy at 22 weeks against a background of severe preeclampsia. The features of a family history were revealed - an early (at 45 years old) myocardial infarction in the father. On examination, cyanosis of the vaginal mucosa, the cervix is clean, the discharge is moderate, milky. The uterus is enlarged to 6 weeks of pregnancy, softened. According to ultrasound, uterine pregnancy is 6 weeks. Clinical analyzes - without features. Examined by a therapist - no pathology was detected at the time of examination, blood pressure 120/90 mm Hg; optometrist - fundus - without features. Based on the clinical and laboratory examination, the diagnosis was made: Pregnancy 6 weeks. Burdened obstetric history (missed pregnancy with severe preeclampsia). Hereditary thrombophilia is not excluded. Chronic endometritis Considering the anamnesis, hereditary thrombophilia screening is recommended, and preeclampsia was prevented in the first trimester: nicotinic acid tablets 50 mg 2 times a day for 30 days and simultaneously for the first 5 days, intravenous administration of actovegin 400 mg / day in 100 ml 5 % glucose solution. After 3 weeks, the examination revealed hereditary thrombophilia (heterozygous mutations of factors II, VII and tetrahydrofolate reductase), about which from 10-11 weeks (after receiving the results of the examination), 0.3 ml fraksiparin was prescribed until the end of pregnancy. Further, the pregnancy proceeded without complications (no diagnosis of preeclampsia was made), ended with induced birth at 39 weeks and the birth of a live full-term girl weighing 3 kg 50 g.

The proposed method for the prevention of preeclampsia was tested in 30 patients who sought medical attention from an obstetrician-gynecologist.

Claims (1)

A method for the prevention of preeclampsia by the appointment of disaggregants, characterized in that the pregnant woman is prescribed nicotinic acid tablets of 50 mg 2 times a day for 30 days and at the same time in the first 5 days, intravenous administration of actovegin 400 mg / day in 100 ml 5% glucose solution.