RU2610061C1 - Method of treating placental insufficiency in pregnant women suffering from vaginal dysbiosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to maieutics, and can be used for treating placental insufficiency in pregnant women suffering from vaginal dysbiosis. For this purpose it is combined with complex drug-induced and laser therapy. During 6 days daily pregnant vaginal sanitation with 0.01 % miramystine for 5 minutes. Tablets of fluomizine are introduced at bedtime. Optimum dose of laser exposure is selected based on parameters of ultrasonic examination, doplerography examination and cardiotocography of foetus. In disturbed uterine-placental perfusion of 1a degree, delay of intrauterine growth retardation on 1 week, sum of Fisher indicators of 7 points daily percutaneous exposure on median cubital vein at wave length of 905 nm, frequency 1000 Hz, radiation power 50 W, for 2 minutes, therapeutic course is 5 procedures. In disturbed uterine-placental perfusion 1b degree, gestational delay of 2 weeks and sum of Fisher indicators of 6-7 points daily percutaneous exposure on ulnar vein with laser device at wave length of 905 nm, frequency 1,000 Hz, radiation power 50 W, for 5 minutes, daily therapeutic course is 7 procedures. In disturbed uterine-placental perfusion of 2 degree, delay of intrauterine growth retardation of 3 weeks, evaluation by Fischer of 6 points daily percutaneous exposure on anterior abdominal wall within projection of placenta wavelength 905 nm, frequency 1,000 Hz, power 65 W, for 6 minutes. Daily therapeutic course is 10 procedures.

EFFECT: method provides higher clinical effectiveness, reduced length of treatment, reduced drug load on body of pregnant woman.

1 cl, 3 tbl, 3 ex

Description

The invention relates to medicine, namely to the obstetrics section, and for the treatment of placental insufficiency. The known method of complex treatment of patients with fetoplacental insufficiency was carried out against a background of traditional as well as modern laser therapy under the control of ultrasound, Doppler studies, cardiotocography of the fetus (Demidov VN "The value of automated antenatal cardiotocography in reducing perinatal mortality" // V .N. Demidov, I.K. Sigizbaeva, O.Yu. Ogai // III International Congress on Reproductive Medicine: Materials of the Congregation - M., 2009. P. 36-37; Voskresensky, S.L. Fetal Condition Assessment. Cardiotocography. oplerometriya Biophysical profile // Textbook M., 2004. -., pp. 304).

The disadvantage of this method is the lack of correlation of the proposed treatment regimen for placental insufficiency, depending on the individual combination of etiological factors and pathogenetic mechanisms of the development of this complication.

In recent years, various methods of treating placental insufficiency have been developed and continue to improve, but the problem is far from being resolved.

There is a method of treating fetoplacental insufficiency with dysbiotic disorders of the vagina with a biologically active supplement (BAA) containing Spirulina platensis, which leads to the restoration of disorders in the mother-placenta-fetus system, the intensification of oxygenation processes in the mother's body, the intensification of trophic processes in the fetus, and the improvement of its functional condition. This method of treatment helps to prolong the gestational age of the fetus with the threat of premature birth, increase the weight and growth rates of newborns. The indicated properties of Spirulina platensis suggest that the inclusion of this biologically active supplement in the complex of treatment of pregnant women with dysbiotic disorders of the vagina will increase the adaptive capacity of the fetus. Take 1 capsule 3 times daily before meals.

The disadvantage of this method is the increased sensitivity of the components of the drug, diseases of the gastrointestinal tract, diarrhea, headache, dizziness. (Kurkin V.A., Radzinsky V.E., Zakharova K.A. “Modern aspects of the chemical classification of biologically active compounds of medicinal plants // Pharmacy, 2002 - No. 2. - P. 8-16; Radzinsky V.E." Medicinal plants and biologically active additives in obstetrics and gynecology // Edited by V.E. Radzinsky, 2009, p. 215.).

Also known is a method of treating placental insufficiency using laser and drug therapy, where a laser unit generated pulsed low-intensity laser radiation with a wavelength of 780 nm, an average pulse power of 2.5 mW, and a pulse repetition rate of 50 to 100 Hz. Irradiation was performed on the projection area of the umbilical cord loops on the anterior abdominal wall of a pregnant woman, lasting 4-5 minutes. (Tulupova MS “The condition of fetuses, newborns born to mothers with fetoplacental insufficiency and depending on the method of delivery.” - Dis. Candidate of Medical Sciences; Moscow, 2002, p. 25.)

However, the disadvantage of this method is the need to know the exact location of the projection of the umbilical cord loops on the abdominal wall, which is impossible without preliminary ultrasound, the absence of pathogenetic condition when prescribing laser therapy, and there is no differentiated approach when prescribing LLLT (low-intensity laser radiation).

Closest to the claimed invention is a method of treating placental insufficiency, including both drug and laser therapy. Use a contact-stable technique. The wavelength is 0.89 μm, the pulse mode, the pulse repetition rate of 80 Hz. When intrauterine growth retardation of the fetus by 1 week, violation of utero-placental blood flow of 1a degree, fetal index 1.1-1.5, percutaneous exposure to the ulnar vein area is carried out daily using a contact-stable technique with a power of 55 W, lasting 4 minutes, course 5 treatments; with intrauterine growth retardation of the fetus by 2 weeks, violation of the uteroplacental blood flow of the 16th degree, a fetal condition index of 1.5-2, percutaneous exposure to the ulnar vein area is performed. Power 60 W, duration 5 minutes, course of 7 procedures. With intrauterine growth retardation of 3 weeks, violation of the uteroplacental blood flow of 2 degrees, a fetal index of more than 2, percutaneous exposure of the anterior abdominal wall to the area of the projection of the placenta is performed. Power 65 W, duration 6 minutes, daily course of 10 procedures. (Patent No. 2456031. A method for the treatment of placental insufficiency. Nayfonova AN, Tsallagova LV, Lazarev VV)

The disadvantage of this method is its lack of effectiveness in the treatment of pregnant women with placental insufficiency.

Also currently unknown in the literature are methods for the simultaneous treatment of pregnant women with fetoplacental insufficiency and bacterial vaginosis.

The purpose of the invention: the creation of an effective method for the treatment of placental insufficiency in pregnant women with vaginal dysbiosis. This goal is achieved by laser irradiation, with the help of which the percutaneous effect on the elbow vein was performed daily for pregnant women. Also, in parallel, vaginal sanitation was performed with miramistin 0.01% solution for 5 minutes, and then the introduction of 1 tablet of Fluomizin overnight for 6 days.

The optimal dose of laser irradiation was selected based on the parameters of ultrasound, Doppler study and cardiotocography of the fetus. In case of violation of utero-placental blood flow of 1a degree, intrauterine growth retardation by 1 week, Fisher score of 7 points, percutaneous exposure of the ulnar vein was performed daily at a wavelength of 905 nm, a frequency of 1000 Hz, a radiation power of 50 W, duration 2 minutes, a course of 5 procedures.

In case of violation of the utero-placental blood flow 16, intrauterine growth retardation of 2 weeks and the total Fisher score of 6-7 points, percutaneous irradiation was performed daily on the ulnar vein with a laser device with a wavelength of 905 nm, a frequency of 1000 Hz, a radiation power of 50 W, duration 5 minutes, a daily course of 7 procedures.

In case of violation of utero-placental blood flow of the 2nd degree, intrauterine growth retardation by 3 weeks, the fetus was assessed according to Fisher 6 points daily percutaneous irradiation on the anterior abdominal wall on the area of the projection of the placenta. Wavelength 905 nm, frequency 1000 Hz, power 65 W, duration 6 minutes, daily course of 10 procedures.

In order to correct vaginal dysbiosis, pregnant women underwent vaginal sanitation with Miramistin 0.01% solution for 5 minutes, followed by Fluomizin tablets overnight for 6 days.

The proposed method for the treatment of pregnant women with placental insufficiency on the background of vaginal dysbiosis was used in 110 women aged 18-42 years, of which 60 patients were the main and 50 control groups. In the first main group, the traditional treatment of placental insufficiency was supplemented by the use of laser therapy using a laser apparatus. Patients in the control group received standard therapy for fetoplacental disorders. Both groups at the second stage of treatment received “Atzilact” 1 suppository vaginally at night, for 7 days. A comprehensive study of the effectiveness of various methods of treating fetoplacental insufficiency in pregnant women with bacterial vaginosis is shown in Table. one.

Thus, the obtained data on the indicators of the biophysical profile of the fetus indicate that the best results were achieved in pregnant women of the main group who received laser therapy.

A Dopplerometric study of the feto-placental complex revealed a significant decrease in the systolodiastolic ratio (LDS), pulsation index (PI) and resistance index (IR) in the uterine arteries and umbilical arteries, which indicated an improvement in utero-placental and fetal-placental blood flow (table. 2 and 3).

Brief examples are provided as an illustration.

Example 1

Pregnant E., 28 years old

Complaints of pulling pains in the lower abdomen, increased motor activity of the fetus. Excessive vaginal discharge, itching, which appeared about two weeks ago.

Anamnesis: menstruation from 16 years, 4-5 days, after 28-30 days, regular, moderate, painless.

Sexual life since 23 years.

The first pregnancy ended in premature birth in the period of 30 weeks, the death of the fetus.

Real pregnancy II, the birth is coming first.

This pregnancy proceeded in the first half against the backdrop of the threat of interruption, about which she was hospitalized for 10-11 weeks.

Objectively: medium build, moderate nutrition. The general condition is satisfactory, AD-100/70 mm Hg, ps 79 beats. in minutes The abdomen is ovoid, enlarged due to pregnancy. The uterus is excitable by palpation. The position of the fetus is longitudinal; there is a head above the entrance to the small pelvis. The fetal heartbeat is somewhat muffled, rhythmic 140 beats. in minutes The waters are intact. No swelling. Physiological settings are normal. The height of the standing of the bottom of the uterus is 32. The circumference of the abdomen is 102 cm.

Gynecological status: NGOs are developed correctly, hyperemic; female type hair.

In the mirrors: the cervix is cyanotic. The external pharynx is closed. The discharge is white, plentiful.

Examined: March 17, 2015. Microscopic examination of the vaginal contents (the presence of key cells, white blood cells up to 10 units in the field of view), bacteriological examination (yeast-like fungi, gardnerella), dopplerometry (violation of the uterine-placental and fetal-placental blood flow 2nd A degrees), cardiotocographic examination (intrauterine growth retardation of the fetus by 2 weeks, according to Fisher 6-7 points).

Diagnosis: Pregnancy 33 weeks. Head presentation. The threat of premature birth. Fetoplacental insufficiency II Art. ZVUR fetus. OAA (antenatal fetal death). Scar on the uterus.

Prescribed treatment:

- A diet rich in protein and vitamins;

- glucose solution 40% - 10.0 with a solution of ascorbic acid 5% - 5.0 iv daily No. 10-15;

- Acylact suppositories, 1 at night, vaginally for 7 days

- Essential 5.0 iv for 10 days;

- trental 5.0 glucose 5% -400.0 intravenous drip daily or every other day No. 5;

- cocarboxylase 100 mg iv in a jet;

- Actovegin 5.0 to 200.0 - 10% iv glucose solution drip No. 5;

- piracetam 10.0 w / w, No. 10.

Drug therapy, including: correction of a fetoplacental disorder, vaginal sanitation with a Miramistin solution of 0.01% was carried out in parallel for 5 minutes, and then 1 tablet of Fluomizin was administered overnight for a course of 6 days.

In combination with percutaneous laser irradiation on the anterior abdominal wall to the area of the projection of the placenta, with a power of 65 W, lasting 6 minutes, a daily course of 10 procedures.

The treatment was carried out under the daily control of blood pressure and CTG of the fetus, as well as dopplerometry.

The control:

There are no complaints. The condition is satisfactory. The uterus is in good shape. The fetal heartbeat is clear rhythmic, 140 beats. in minutes

On day 10, microscopy of the vaginal contents of leukocytes was performed - 0.

Bacteriological examination of single yeast cells, flora - sticks.

After 2 weeks, control dopplerometry was performed: impaired fetal-placental blood flow of 16 degrees.

And CTG: signs of impaired fetal status (7-8 Fischer points).

Example 2

Pregnant M., 20 years old

Complaints: pulling pains in the lower abdomen, increased tone of the uterus, discomfort in the vagina.

Anamnesis: menstruation from 14 years, 3 days, after 28 days, regular, moderate, painless. Sexual life since 17 years.

Gynecological status: colpitis.

First pregnancy, upcoming births.

At the age of three, she was operated on for injuring abdominal organs.

Objectively: General condition is satisfactory, skin and visible mucous membranes are clean. HELL 100/70 mm Hg, pulse - 78 beats. in minutes The abdomen is longitudinal in shape, enlarged due to pregnancy. The height of the standing of the bottom of the uterus is 36 cm. The uterus is in normal tone. The fetal heartbeat is somewhat muffled, rhythmic 140 beats. in minutes The waters are intact. No swelling. Stool and diuresis are normal. The mammary glands are soft, painless on palpation.

In the mirrors: The external genitalia are developed correctly, the cervix and the walls of the vagina are hyperemic, the discharge from the vagina is white. Aminotest is positive

Examined: Microscopic examination of the vaginal contents (presence of key cells, leukocytes of 15 units in the field of view), bacteriological examination (yeast-like fungi, gardnerella, ureaplasma), dopplerometry (violation of the uteroplacental and fetal-placental blood flow of the 1st degree), cardiotocographic research (intrauterine growth retardation of the fetus by 1 week, according to Fisher 7-8 points).

Diagnosis: Pregnancy 35 weeks. Head presentation. The threat of premature birth. Placental impairment of blood flow, compensated form. Signs of fetal hypoxia. Premature maturation of the placenta. ZVUR fetus II Art. Gestational pyelonephritis, remission.

Prescribed treatment:

- A diet rich in protein and vitamins;

- glucose solution 40% - 10.0 with a solution of ascorbic acid 5% - 5.0 iv daily No. 10-15;

- Essential 5.0 iv for 10 days;

- trental 5.0 glucose 5% -400.0 intravenous drip daily or every other day No. 5;

- cocarboxylase 100 mg iv in a jet;

- Actovegin 5.0 to 200.0 - 10% iv glucose solution drip No. 5;

- Acylact suppositories, 1 at night, vaginally for 7 days

- laser irradiation of blood to the region of the ulnar vein with a course of 5 procedures for 2 minutes (radiation power of 50 W, wavelength 905 nm, frequency 1000 Hz).

Example 3

Pregnant Z., 23 years old

Complaints: increased uterine tone, increased fetal activity.

Anamnesis: menstruation from 13 years, 3-4 days, after 28 days, regular, moderate, painless. Sexual life since 20 years.

Gynecological status: pregnancy 3, childbirth 3. Isthmic-cervical insufficiency. Surgical correction of the cervix.

The first pregnancy (2011) ended in 24 weeks with placental abruption. Premature birth. Second pregnancy (2012) Preterm birth at 28 weeks. The fetus (1650), died on the 13th day.

A pregnant woman in a period of 8-9 weeks was hospitalized with a diagnosis of “threatened abortion”. In the period of 15-16 weeks, surgical correction of the cervix was performed.

Of somatic diseases, SARS, chicken pox.

Objectively: the general condition is satisfactory, the skin and visible mucous membranes are clean, blood pressure 120/70 mm Hg, pulse - 82 beats. in minutes The mammary glands are soft, painless on palpation.

The abdomen is longitudinal in shape, enlarged due to pregnancy. The height of the standing of the bottom of the uterus is 38 cm. The uterus is in normal tone. The fetal heartbeat is somewhat muffled, rhythmic 140 beats. in minutes The waters are intact. No swelling. Stool and diuresis are normal.

In the mirrors: The external genitalia are developed correctly, the cervix is cylindrical in shape, pale pink in color. The walls of the vagina without features. The discharge is milky, plentiful, with a "fishy smell." Aminotest is positive.

Examined: Microscopic examination of the vaginal contents (presence of key cells, 24 leukocytes in the field of view), bacteriological examination (yeast-like fungi, gardnerella), dopplerometry (impaired utero-placental and fetal-placental blood flow, 1st degree), cardiotocographic examination ( intrauterine growth retardation of the fetus by 2 weeks, according to Fisher 7 points).

Diagnosis: Pregnancy 35-36 weeks. Head presentation. The threat of premature birth. Fetoplacental insufficiency, compensated form. Signs of fetal hypoxia. Isthmic-cervical insufficiency. Surgical correction of the cervix. Anemia complicated by pregnancy. Varicose disease.

Prescribed treatment:

- A diet rich in protein and vitamins;

- glucose solution 40% - 10.0 with a solution of ascorbic acid 5% - 5.0 iv daily No. 10-15;

- Essential 5.0 iv for 10 days;

- trental 5.0 glucose 5% -400.0 intravenous drip daily or every other day No. 5;

- cocarboxylase 100 mg iv in a jet;

- Actovegin 5.0 to 200.0 - 10% iv glucose solution drip No. 5;

- piracetam 10.0 w / w, No. 10;

- Maltofer 1 tablet with meals;

- Acylact suppositories, 1 at night, vaginally for 7 days

- laser irradiation of blood to the region of the ulnar vein with a course of 5 procedures for 2 minutes (radiation power of 50 W, wavelength 905 nm, frequency 1000 Hz).

03/28/2015, the pregnancy ended in an urgent delivery. A fruit was born weighing 3600 kg, height 52 cm, Apgar score 8-8 points.

Medical and social effectiveness

This method of complex therapy of placental insufficiency with the use of laser therapy leads to a more effective treatment of this pathology in pregnant women, as well as to reduce bed days (7 days). In addition, an important factor is the reduction of the drug load on the pregnant woman.

Claims (1)

A method for the treatment of placental insufficiency in pregnant women with vaginal dysbiosis, including the simultaneous use of complex drug and laser therapy, characterized in that for 6 days, pregnant women undergo vaginal sanitation with a 0.01% Miramistin solution for 5 minutes, followed by the introduction of Fluomizin tablets at night and the optimal dose of laser irradiation is selected based on the indicators of ultrasound, Doppler ultrasound and cardiotocography of the fetus: intra-placental blood flow of 1a degree, intrauterine growth retardation by 1 week, Fisher score of 7 points daily percutaneous irradiation is performed on the ulnar vein region with a wavelength of 905 nm, a frequency of 1000 Hz, a radiation power of 50 W, a duration of 2 minutes, a course of 5 procedures ; in case of violation of the utero-placental blood flow 16, intrauterine growth retardation of 2 weeks and the total Fisher score of 6-7 points, percutaneous irradiation is performed daily on the ulnar vein with a laser device with a wavelength of 905 nm, a frequency of 1000 Hz, a radiation power of 50 W, lasting 5 minutes , a daily course of 7 procedures; in case of violation of utero-placental blood flow of 2 degrees, intrauterine growth retardation by 3 weeks, fetal assessment according to Fisher 6 points, percutaneous irradiation is performed daily on the anterior abdominal wall to the area of the projection of the placenta with a wavelength of 905 nm, 1000 Hz, power 65 W, duration 6 minutes, a daily course of 10 procedures.