RU2473339C1 - Method of prevention or treatment of intrauterine growth retardation syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to obstetrics and gynecology and can be used for prevention and treatment of intrauterine growth retardation syndrome. For this purpose medications are administered to pregnant women of risk group in terms of pregnancy, determined in accordance with the critical period of fetus development. At term of pregnancy, equal to 14-18 weeks, administered is natural micronised progesterone in dose 200 mg intravaginally 2 times per day in 30-day course, complex of polyunsaturated fatty acids of family omega-3 in 30-day course, dry water extract of fresh artichoke leaves in dose 2 tablets 3 times per day in 14-day course, levocarnitin in dose 8 drops 3 times per day in 30-day course, instenon 5.0 ml on 5% dextrose in dose 500 ml intravenously 10 injections every second day per course, deproteinised hemoderivate from calf blood with low-molecular peptides and derivates of nucleic acids 5.0 ml on 5% dextrose in dose 500 ml intravenously every second day 10 injections per course, combined polyvitamin complex with micro- and macro-elements and potassium iodide in dose 200 mg per day daily until fetus birth. After that, at pregnancy term 20-24 weeks and 30-34 weeks, respectively, administered is complex of polyunsaturated fatty acids of family omega-3 in 30-day course, levocarnitin in dose 8-10 drops 3 times per day in 14-day course, calcium nadroparin in dose 0.3 ml subcutaneously in 30-day course, dry water extract of fresh artichoke leaves in dose 2 tablets 3 times per day in 14-day course, instenon on 5% dextrose in dose 500 ml intravenously 10 injections every second day per course, deproteinised hemoderivate from calf blood with low-molecular peptides and derivates of nucleic acids 5.0 ml on 5% dextrose in dose 500 ml intravenously 10 injections every second day per course.

EFFECT: method ensures considerable reduction of number of obstetric complications in pregnancy and labour, prevents perinatal loss, increases quality of individual health of born babies.

2 ex, 1 tbl

Description

The invention relates to medicine and can be used in obstetrics to reduce the number of fetuses with intrauterine growth retardation and improve perinatal outcomes.

Against the background of a decrease in the quality of health of pregnant women, the reproduction rates of the population are deteriorating, unfavorable risk factors accumulate in the pregnant population due to negative trends in the health status of women of childbearing age. These risk factors include: gynecological diseases: chronic endometritis, pelvic inflammatory diseases, adenomyosis and a history of infertility); burdened obstetric history (increased reproductive activity, habitual miscarriage, antenatal fetal death, history of birth of small children, gestosis, threatened termination, multiple pregnancy, placenta previa, placental insufficiency in previous pregnancies); extragenital pathology: (hypertension, diabetes mellitus, lung disease, gastrointestinal tract, cardiovascular disease); carriage of opportunistic pathogens (often sick in childhood, suffering from chronic tonsillitis, sinusitis, pyelonephritis, dysbiosis); as well as social and domestic disorder: (low level of education, single-parent family, psychoemotional stress, age over 30, industry harmfulness, insufficient protein intake in food, hard physical labor, bad habits (smoking, alcohol). Therefore, it is necessary for women at risk medical prenatal prevention of intrauterine growth retardation.

Intrauterine growth retardation is a condition in which there is a slowdown or cessation of fetal growth and the actual fetal growth is less than normal and latent growth corresponding to gestational age. The syndrome of intrauterine growth retardation (FET) is a consequence of chronic placental insufficiency (FPF) - a pathological condition that manifests itself in a decrease in the relationship between the mother and the fetus. In this case, the transport, trophic, endocrine, metabolic and other important functions of the placenta are violated (G. M. Savelyeva, M. V. Fedorova and others. Placental insufficiency. - M .: Medicine, 1991. S. 5-8). Two main types of SZRP are distinguished: symmetric (10-30% of occurrence) and asymmetric (70-90% of cases) (Elliott K. Main. Pregnancy and high-risk labor, edited by F. Arias. - M .: Medicine, 1989, p. 269). The reasons for the symmetric form of SZRP include genetic factors, intrauterine infection, radiation, bad habits, drug therapy, and are considered to be associated with under-laying (underdevelopment) of the fetal cellular elements, their number. The reasons for the asymmetric form of SZRP include hypertension and vegetovascular dystonia, chronic pyelonephritis, anemia, late gestosis, multiple pregnancy, premature detachment and placenta previa, placental abnormalities, that is, which leads to hypotrophy of cellular elements. Lampe L., Gaal J. (Intensive birth block, 1978, p.21) identified two main forms of chronic placental insufficiency: 1 - violation of nutritional function (trophic insufficiency), in which the absorption and assimilation of nutrients is disturbed, as well as the synthesis of their own products metabolism of the fetus; 2 - respiratory failure, consisting in the violation of the transport of oxygen and carbon dioxide. These two forms can exist independently or combine. However, SZRP is more characteristic of trophic insufficiency. In the pathogenesis of chronic FSF, several links are distinguished, the impact on which underlies the modern complex therapy of SZRP: impaired blood outflow from the placenta due to tissue edema and slowed blood flow; insufficient blood flow into the intervillous space as a result of peripheral spasm, vascular thrombosis, hypovolemia; disorders of the rheological and coagulation properties of the blood of the mother and fetus; metabolic disorders, mainly protein, and all types of metabolism (G. M. Saveliev, M. Fedorov and others. Placental insufficiency. - M .: Medicine, 1991. S. 70-82). Delayed fetal development is a subsequent risk factor for diseases of the central nervous and cardiovascular systems and metabolic diseases. Factors leading to deficiency of body weight at birth are able to permanently change the body structure, disrupt metabolic stability, reduce the level of adaptive capabilities of the body, realized through the activity of the endocrine, immune, nervous and cardiovascular systems.

Currently, much attention is paid to the problem of reducing the number of fetuses with developmental delay and improving perinatal outcomes.

A known method of treating SZRP according to the scheme developed by G. M. Savelieva et al. (1991), described in the monograph by M.V. Medvedev and E.V. Yudina ("Delay in fetal development", p.161-162), including: treatment of the main pathology of pregnancy; oxygen therapy (60% with an oxygen-air mixture), the introduction of drugs that affect energy metabolism (folic, glutamic acid, halascorbin, ferroplex, cocarboxylase); vasoactive and tocolytic drugs (trental, partusisten, isadrine - per os or iv drip, depending on the severity of the SZRP; reopoliglyukin to improve the rheological properties of blood; freshly frozen plasma with a low protein content in the blood of pregnant women. There is a known method for the treatment of SZRP with actovegin ( GL Gromyko. Actovegin. Experience in obstetric practice. St. Petersburg, 1997, pp. 23-43. These methods are usually not effective enough, since they do not affect all parts of the pathogenesis of the disease, while fetoplacental lack of chnost - a pathophysiological phenomenon that consists of a set of trophic disorders, metabolic and endocrine functions of the placenta.

There is a method of treating or preventing fetal growth retardation or discordance using calcium dobesilate (patent application No. 9811482, A61K 31/10, A61K 33/06, A61P 43/00). However, the use of the method is limited by contraindications to calcium dobsilate: hypersensitivity, peptic ulcer of the stomach and duodenum (in the acute stage), bleeding from the gastrointestinal tract, kidney and liver diseases, hemorrhage (while taking anticoagulants), pregnancy (especially the first trimester), children up to 13 years old.

There is a method of treating fetal growth retardation syndrome in women whose pregnancy was complicated by gestosis by correcting hemodynamic disturbances in the mother-placenta-fetus system, characterized in that continuous-flow plasmapheresis is performed twice in the second half of pregnancy with a plasma exfusion volume of 400-600 ml ( Application for invention No. 2002116942 IPC ⁷ A61K 35/16, A61P 43/00). However, fetal growth retardation syndrome can develop without gestosis in a woman's earlier pregnancy.

A known method for the prevention of fetoplacental insufficiency, which consists in the appointment of pharmacological preparations during pregnancy, respectively determined by the critical period of fetal development and depending on the period in which the pregnant woman entered the dispensary registration for pregnancy. The following drugs are prescribed: vitamin therapy, drugs that improve the rheological properties of blood and vasodilators, essential amino acids and oxygenation of the body, depending on the duration of pregnancy (Aksenov A.N., Bodyagina V.I., Vanina L.V. and others. Physiological and pathological pregnancy, fetoplacental system // Handbook of Obstetrics and Gynecology / edited by G. M. Savelyeva. - 2nd ed., revised and additional - M., 1996. - S.5-116.). A disadvantage of the known integrated method is that it has insufficient effectiveness, due to the fact that the prescribed drugs do not affect all parts of the pathogenesis, as a result of which a rather high percentage of obstetric complications remains.

A known method for the prevention of placental insufficiency in pregnant women at high risk, including the appointment of vitamin therapy, drugs that improve the rheological properties of blood, vasodilators, essential amino acids, oxygenation of the body depending on the gestational age and pharmaceutical composition containing succinic acid, extracts of badan and motherwort and glucose, for 3 weeks, 0.5 g 3 times a day, then for 3 weeks, 0.5 g per day, thus alternating courses of administration before the birth of the fetus (Pat nt RU №2282439, IPC A61K 31/19, A61K 31/194, A61K 36/185, A61K 36/533, A61P 5/00, A23L 1/30). The known method improves the respiratory function of the placenta, reduces the risk of fetal hypoxia, but does not improve the trophic function of the placenta, a violation of which leads to SZRP.

There is a method of treating intrauterine growth retardation syndrome by prescribing drug therapy, including drugs that improve the uteroplacental blood flow (trental, chimes - administered with a 5% glucose solution), antispasmodics (no-spa, papaverine, aminophylline), as well as food supplements for based on blue-green algae Spirulina Platensis in therapeutic dosages of 3-4 g per day (recommendations of the State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, 1997; certificate N72-CGS-2376 from 05.22.97) for 2 weeks and until adequate fetal growth dynamics is obtained and with ultrasound, and subsequently taking maintenance doses of 1.5-2 g per day before delivery (patent RU No. 2160602, IPC ⁷ A61K 35/80) (prototype). The method allows to reduce perinatal losses by prenatal stimulation of the metabolism of the fetoplacental system in complex therapy with PSA. However, the manufacturer of food supplements Spirulina Platensis indicates side effects when taking dietary supplements and, therefore, the need for a test introduction because of the possibility of developing anaphylactic reactions and the need to control indicators of water-electrolyte balance. Among other possible side effects are urticaria, a feeling of flushing, fever, fever.

The objective of the invention is to increase the effectiveness of the prevention or treatment of intrauterine growth retardation syndrome in pregnant women at risk by prenatal stimulation of the metabolism of the fetoplacental system in the treatment of SZRP.

The technical result is the improvement of trophic, endocrine and metabolic functions of the placenta in the system "mother-placenta-fetus".

This is achieved by the fact that for the prevention or treatment of intrauterine growth retardation syndrome, including the administration of medications to pregnant women at risk during pregnancy, determined respectively by the critical period of fetal development and depending on the period in which the pregnant woman entered the dispensary for pregnancy, with gestational age 14-18 weeks prescribed natural progesterone micronized 200 mg intravaginally 2 times a day for 30 days, a complex of polyunsaturated fatty acids 30-day omega-3 family slot, dry water extract of fresh artichoke leaves 2 tablets 3 times a day for 14 days, levocarnitine 8 drops 3 times a day for 30 days, instenon 5% dextrose 500 ml intravenously with 10 injections through day, deproteinized calf blood hemoderivative with low molecular weight peptides and nucleic acid derivatives of 5.0 ml for 5% dextrose intravenously with a course of 10 injections every other day, a complex multivitamin complex with micro and macrocells for 30 days and potassium iodide 200 mg per day about before the birth of the fetus, then at a gestational age of 20-24 weeks and 30-34 weeks, respectively, a complex of polyunsaturated fatty acids of the omega-3 family is prescribed for 30 days, dry water extract of fresh artichoke leaves 2 tablets 3 times a day for 14 days, instenon for 5% dextrose 500 ml intravenously with a course of 10 injections every other day, deproteinized hemoderivative from calf blood with low molecular weight peptides and nucleic acid derivatives 5.0 ml for 5% dextrose intravenously with a course of 10 injections every other day, 8-10 drops of levocarnitine 3 times a day Shade course of 30 days, nadroparin calcium 0.3 ml subcutaneously course of 30 days.

The method is as follows: pregnant women at high risk are prescribed medications during pregnancy, respectively determined by the critical period of fetal development and depending on the period in which the pregnant woman has been registered for pregnancy: 14-18 weeks of pregnancy; 20-24 weeks of pregnancy; 30-34 weeks of gestation. According to the claimed method, with a gestational age of 14-18 weeks pregnant, assigned to the risk group, is prescribed:

- natural progesterone micronized 200 mg intravaginally 2 times a day for 30 days; progesterone - a progestational agent, has a selective effect on the endometrium, promotes the formation of a normal secretory endometrium in women, reduces the excitability and contractility of the muscles of the uterus and tubes;

- a complex of polyunsaturated fatty acids of the omega-3 family with a course of 30 days; when taking the complex, the cardiovascular system improves, blood pressure normalizes, vision improves, cholesterol and free radicals are eliminated from the body, inflammatory processes are removed, mental processes are improved, immunity is strengthened, in addition, numerous studies have shown that sufficient consumption of omega- 3 pregnant women have a beneficial effect on the development of the child;

- dry water extract of fresh leaves of artichoke 2 tablets 3 times a day for 14 days; the aforementioned drug increases the outflow of bile, reduces intrahepatic cholestasis, restores liver cells, has a mild diuretic effect, reduces the content of nitrogenous substances in the blood, and exhibits antioxidant activity.

- Levocarnitine, 8 drops 3 times a day for 30 days;

- a natural substance, related to B vitamins, participates in the metabolism as a carrier of long chain fatty acids (palmitic and others) from the cytoplasm to mitochondria, where these acids undergo a β-oxidation process with the formation of adenosine triphosphoric acid and acetyl-CoA, increases secretion and the enzymatic activity of gastric and intestinal juices, improves digestion, increases resistance to physical stress, inhibits the formation of keto acids and anaerobic glycolysis, reduces the degree of lactic acidosis, promotes economical consumption of glycogen and increases its reserves in the liver and muscles, has anabolic and lipolytic effects;

- instenon - on 5% dextrose 500 ml intravenously over a course of 10 days every other day 10 injections - a combined drug with a neuroprotective effect based on the mutual potentiation of the effects of its constituent components - etophylline, ethamivan and hexobendin (combining nootropic, vascular and neurotonic components), for activation of the limbic-hypothalamic-reticular complex and improvement of blood circulation in the functional system mother-placenta-fetus - deproteinized hemoderivative from calf blood with low molecular weight peptides ids and derivatives of nucleic acids, 5.0 ml 5% dextrose intravenous course of 10 days in a 10 day injections;

- a combined multivitamin complex with micro and macro elements, the effect of which is due to the effects of its constituent components, before the birth of the fetus;

- potassium iodide 200 mg per day daily until the birth of the fetus, to make up for iodine deficiency in the body to normalize thyroid function, which is especially important for pregnant women living in the endemic area (after consultation with the endocrinologist).

Further, taking into account that up to 28 weeks, up to 90% of fetal growth ends, with a gestational age of 20-24 weeks, the pregnant woman assigned to the risk group is prescribed: a complex of polyunsaturated fatty acids of the omega-3 family for 30 days, a dry aqueous extract of fresh artichoke leaves 2 tablets 3 times a day for 14 days, instenon for 5% dextrose 500 ml intravenously for 10 days every other day 10 injections deproteinized calf hemoderivative with low molecular weight peptides and nucleic acid derivatives 5.0 ml for 5% dextrose intravenously with 10 days a day, levocarnitine 8-10 drops 3 times a day for 14 days, calcium nadroparin 0.3 ml subcutaneously for 30 days.

With a gestational age of 30-34 weeks, the above course of medications is re-prescribed.

Example 1

Pregnant Ia S.S., 26 years old, re-pregnant, primiparous (history of medical abortion, spontaneous abortion), somatically burdened with anemia of the 1-2 degree, there are signs of genital infantilism, mycoplasmosis was treated before pregnancy. It is put on dispensary registration for pregnancy for a period of 8-9 weeks. Pregnancy: At 14 weeks, she suffered acute pyelonephritis with t = 38 ° C, antibacterial therapy with cephalosporins, symptomatic treatment. At 16 weeks - treatment in a hospital at the place of residence for a threatened miscarriage. At 24 weeks, an ultrasound scan: signs of placental insufficiency, a first-degree respiratory system with asymmetric type, oligohydramnios. She was hospitalized, received therapeutic complex therapy according to the claimed method: a complex of polyunsaturated fatty acids of the omega-3 family with a course of 30 days, a dry aqueous extract of fresh artichoke leaves 2 tablets 3 times a day for 14 days, instenon for 5% dextrose 500 ml intravenously for 10 days every other day 10 injections, deproteinized hemoderivative from calf blood with low molecular weight peptides and nucleic acid derivatives 5.0 ml for 5% dextrose intravenously for 10 days every other day, levocarnitine 8-10 drops 3 times a day for 14 days s, nadroparin calcium 0.3 ml subcutaneously course of 30 days. After the treatment was completed for a period of 27-28 weeks during the ultrasound examination, there were no signs of fetal growth retardation syndrome. Re-hospitalized at 32 weeks of pregnancy to receive a treatment and prophylactic course according to the claimed method, because placental insufficiency was present. At 38 weeks, she was hospitalized for preparation for childbirth: according to ultrasound, there was no SZRP, the placenta was of 3 maturity, but since the diagnosis of SZRP during pregnancy was made at certain dates, in order to prevent complications of the birth and complications of the fetus during childbirth and early neonatal period. A spontaneous urgent delivery without features occurred. The period of adaptation in the child passed without features, was discharged on the 5th day in satisfactory condition under the supervision of the district pediatrician.

Example 2

Pregnant P-va O.V., 27 years old, multiparous, the first birth ended in the birth of a child with signs of SZRP; when registering for a period of 6-7 weeks, it is assigned to the risk group by the risk factor for the formation of SZRP. She had a history of medical abortion, chronic salpingo-oophoritis, treated with chlamydia, and was in the dispensary as a child for chronic bronchitis; she was examined for sexually transmitted infections (STIs) - no infections were detected. The pregnant woman was prescribed a treatment and prophylactic complex according to the claimed method, which was carried out at 14-18 weeks, 20-24 weeks, 30-34 weeks. Ultrasound screening was performed three times, there were no signs of placental insufficiency and SZRP. Was admitted to the obstetric department of the Municipal Health Institution “City Clinical Hospital No. 1” with a diagnosis of Pregnancy 38 weeks. 1st stage of labor 2 .. Delivery through the natural birth canal, amniotomy was performed, for 6 hours and 50 minutes a girl m = 3280 g, 51 cm tall, independently delivered, with an Apgar score of 8/9 points. The adaptation period was uneventful, she was discharged home for 5 days under the supervision of a local pediatrician.

The claimed method was applied in 100 pregnant high-risk groups for the development of SZRP. The course of pregnancy, childbirth, and perinatal outcomes were studied in 200 high-risk women for the development of FET with full-term pregnancy. The main group consisted of 100 patients in whom the claimed method for the prevention or treatment of intrauterine growth retardation syndrome was applied. The comparison group included 100 pregnant women, allocated to the risk group, who refused his proposed method for the prevention of SZRP. For a more accurate assessment of the effectiveness of the claimed method, couples of pregnant women were selected in the main group and the comparison group by age, parity, and the presence of extragenital pathology. Pregnant women were examined according to a single assessment, which involves the study of general somatic status, obstetric and gynecological history, and features of the course of pregnancy. Women of the main group and the comparison group were comparable in almost all indicators with slight differences.

At the first appearance, vitamin therapy was recommended for women in both groups, after consultation with an endocrinologist - potassium iodide 200 mg per day. Women in the comparison group, the pregnant women refused the proposed preventive treatment of ZVRP and placental insufficiency.

An analysis of the course of pregnancy revealed that pregnancy complications were observed in the main group in 32, and in the comparison group in 82 (82%). According to laboratory studies, reflected in the outpatient chart, 52 women (52%) of the main group showed signs of urogenital infection, in the comparison group - 46 (46%). In both groups, at a gestational age of 14-16 weeks, antibacterial treatment was carried out with a semisynthetic antibiotic from the subclass of azalide at a dose of 0.5 g once daily for 6 days in conjunction with interferon alpha-2bB + taurine rectally.

Pregnancy was aggravated by early toxicosis in 17 (17%) in the main group and 54 (54%) in the comparison group; the threat of interruption in 12 (12%) in the main group and 51 (51%) in the comparison group; placental insufficiency in 10 (10%) in the main group, 45 (45%) in the comparison group; preeclampsia in 17 (17%) in the main group, 55 (55%) in the comparison group, and it should be noted that manifestations of preeclampsia in the main group were slightly expressed, in the comparison group there were episodes of increased blood pressure up to 160 mm Hg

An ultrasound of the uterus was performed. Ultrasound for short periods of time paid attention to the low implantation of the fetal egg; fuzzy visualization of the embryo; the presence of chorionic detachment sites; abnormal yolk sac, which may be irregular in shape, displaced to the periphery or calcified; mismatch of the diameter of the fetal egg to the gestational period, preservation of the pulsating nature of the blood flow according to dopplerometry.

Ultrasound for a period of 20-24 weeks in the main group in 86% of cases did not reveal deviations in the state of the uteroplacental complex, signs of placentitis were found in 9% (antibiotics were prescribed antibiotic therapy for these pregnant women from the azalide subclass at a dose of 0.5 g 1 once a day orally for 6 days).

Ultrasound for a period of 20-24 weeks in the comparison group: pregnancy in 42% of women at 20-24 weeks was accompanied by chronic functional placental insufficiency, with signs of placentitis in 17%, and in 35%, an increase in the level of chorionic gonadotropin was noted. Pregnant women were hospitalized in the obstetric department, received treatment: deproteinized calf hemoderivative 5.0 ml intravenously, dipyridamole 25 mg 3 times a day orally, thiamine pyrophosphate 100 mg intravenously, antibacterial therapy.

In both groups, the biophysical profile of the fetus was evaluated. Ultrasonography drew attention to the presence of SZRP, respiratory movements, fetal motor activity, fetal muscle tone, the amount of amniotic fluid (polyhydramnios, oligohydramnios), placental maturity, umbilical cord diameter and hyperdevelopment. Dopplerometry revealed violations of the utero-placental and fetal-placental blood flow (increased vascular resistance indices in the uterine-fetal blood flow, the absence of the diastolic component of the blood flow or its retrograde direction). In both groups, once every 5 days, the results of dopplerometry and antenatal cardiotocography of CTG were evaluated starting from 32 weeks, and before delivery of CTG with functional tests (non-stress test, functional tests: maternal breath-holding test, cold test, step test, oxygen test , sound stimulation test).

Ultrasound at 32-34 weeks of gestation in the main group in 88% of women identified 1 degree of placental maturity, the estimated fetal weight was 2470 g ± 120 g; In 8 pregnant women (8%), ZVRP, asymmetric form, 1 degree was detected. Blood flow disorders and CTG changes were not detected.

When ultrasound was performed at 32-34 weeks of gestation in the comparison group in 53% of pregnant women, the degree of maturity of the placenta corresponded to 2-3 degrees, the estimated weight of the fetus was 2120 g ± 142. The diagnosis of SZRP 1 tbsp. asymmetric form ”was exposed to 19 pregnant women (19%),“ SZRP 2 tbsp. asymmetric form ”- 6 pregnant women (6%), violation of the utero-placental blood flow with preserved fetal-placental blood flow (1 A tbsp.) was found in 15 pregnant women with ZVRP 1 tbsp. and in 2 pregnant women with a symmetric form of ZVRP, violations of fetal-placental blood flow (PPK) with preserved uteroplacental blood flow (MIC) (1 B st.) in 1 pregnant woman with grade 2 ZVRP (he underwent dopplerometry (without fetometry) through day and daily (CTG); violation of the IPC and PPC, not reaching critical values (2 tbsp.), in 1 pregnant woman with ZVRP of a symmetrical shape (she was prescribed an examination: dopplerometry, CTG daily)

When CTG fetus paid attention, first of all, to the presence of a monotonic type in the cardiotachogram, a decrease in the variability of the basal rhythm, the number of accelerations, their amplitude and duration, the appearance of decelerations.

The pregnant women from the comparison group were hospitalized for treatment: deproteinized calf hemoderivative with low molecular weight peptides and nucleic acid derivatives 5.0 ml intravenously, dipyridamole 25 mg 3 times a day orally, thiamine pyrophosphate 100 mg intravenously, calcium nadroparin 0.3 ml subcutaneously. The choice of the optimal time and method of delivery depended on the adaptive reserve capabilities of the fetus and was based on an assessment of the severity of placental insufficiency, fetal hypoxia and the form of the syndrome of fetal growth retardation.

Indications for planned caesarean section from the fetus were: a decrease in the variability of the basal rhythm, the number of accelerations, their amplitude and duration; hemodynamic disturbances of fetal-placental blood flow of the II degree in the presence of bilateral changes; fetal growth retardation syndrome in combination with gestosis, pregnancy prolongation, which was diagnosed in 12 pregnant comparison groups; in these women, the pregnancy ended with cesarean section in a planned manner.

In the main group, 2 pregnancies according to combined indications ended in a planned procedure with cesarean section in a planned manner: the first case is an elderly primiparous, pelvic presentation of a male fetus; the second case is gestosis, fetal development retardation syndrome 1 tbsp., a long history of infertility. 25 pregnant women underwent programmed childbirth, in which a progesterone inhibitor 200 mg orally and dinoprostone 0.5 mg intracervical were used to prepare the cervix for childbirth.

Pregnancy outcomes and features of the course of childbirth in women of the main group and the comparison group are shown in the table.

Table Pregnancy outcomes and features of the course of childbirth in women of study groups,% Main group (n-100) Comparison Group (n-100) Early delivery - 5 Planned Caesarean section 2 four Emergency Cesarean Section one 12 Spontaneous urgent delivery 97 79 SZRP 8 31 Anomalies of labor 2 12 Hypotonic bleeding 2 9 Uterine Subinvolution 8 26 Postpartum endometritis - 8 Anemia 38 51

The body weight at birth in children of women of the main group in 90% of cases exceeded 3100 g, all children were born without signs of intrauterine growth retardation.

In the comparison group, 31% of the babies were born with a body weight of less than 3000 g and signs of intrauterine growth retardation, they underwent a morphological determination of gestational age, weight growth index, laboratory tests, and specialist consultations.

A comparative analysis of the condition of the newborns revealed that the newborns in the main group of fetal hypoxia did not have a severe degree, and in the newborns in the comparison group this indicator was 13%, 90 children (90%) were born in satisfactory condition (Apgar score 8-10 points); in a state of mild hypoxia - 8 (8%); moderate severity - 3 (3%); severe - 0. In 20 newborns (20%) in the main group the following was noted: hyper-excitability syndrome, 3 (3%) cephalohematoma, 7 (7%) hyperbilirubinemia.

In the comparison group, the number of children born in a state of hypoxia was significantly greater: mild - 10 (10%); moderate severity - 9 (9%); severe - 12 (12%). 50 (50%) newborns in the comparison group had hyper excitability syndrome; cephalohematoma - in 9 (9%) newborns; 10 newborns (10%) had intraventricular hemorrhages (IVH), 4 (4%) newborns had a collarbone fracture, 12 (12%) newborns had polycythemic syndrome, 20 (20%) newborns had hyperbilirubinemia, and 5 (5 %) of newborns - meconium aspiration, in 6 (6%) newborns - hemorrhagic syndrome.

Thus, the identification of pregnant women at risk of giving birth to full-term babies with intrauterine growth retardation syndrome, timely treatment and prophylactic measures according to the claimed method significantly reduces the number of obstetric complications during pregnancy and childbirth, prevents perinatal losses, improves the quality of individual health of children born.

Claims (1)

A method for the prevention or treatment of intrauterine growth retardation syndrome, including prescribing medications to pregnant women at risk during pregnancy, defined respectively by the critical period of fetal development, characterized in that when the gestational age is 14-18 weeks, natural micronized progesterone 200 mg intravaginally 2 times a day course of 30 days, a complex of polyunsaturated fatty acids of the omega-3 family, a course of 30 days, dry water extract of fresh leaves of artichoke 2 tablets 3 r aza per day for 14 days, levocarnitine 8 drops 3 times a day for 30 days, instenon 5.0 ml for 5% dextrose 500 ml intravenously 10 injections after 1 day for a course, deproteinized hemoderivative from calf blood with low molecular weight peptides and nucleic derivatives acids 5.0 ml for 5% dextrose 500 ml intravenously every other day 10 injections per course, a complex multivitamin complex with micro and macro elements and potassium iodide 200 mg per day daily until the birth of the fetus, then with a gestational age of 20-24 weeks and 30 -34 weeks, respectively, are prescribed a complex of polyunsaturated fatty acids of the omega-3 family with a course of 30 days, levocarnitine 8-10 drops 3 times a day with a course of 14 days, calcium nadroparin 0.3 ml subcutaneously with a course of 30 days, dry water extract of fresh artichoke leaves 2 tablets 3 times a a day course of 14 days, instenon on 5% dextrose 500 ml intravenously 10 injections after 1 day per course, deproteinized hemoderivative from calf blood with low molecular weight peptides and nucleic acid derivatives 5.0 ml for 5% dextrose 500 ml intravenously 10 injections after 1 day on course.