Medicine for pregnant
Application of medicines by pregnant women in each separate case demands carefully thought over and careful approach. Some of medicines can negatively influence the course of pregnancy, development of a fruit, up to formation at it congenital defects, to cause complications in a fruit and the newborn. Assume that about 1% of all congenital anomalies cause medicines.to
Therefore the choice of necessary medicine for future mother irrespective of, it is released according to the recipe of the doctor or it is authorized to non-prescription dispensing, the doctor and only the doctor can carry out. The close attention after the “talidomidovy“ epidemic which struck pregnant women in 60 - x was paid years to this obligatory principle. At that time in many countries the preparation Talidomid as the safe calming and sleeping medicine for pregnant women was widely used. It caused heavy uglinesses, generally anomalies of development of extremities, more than in 10 000 children.
the Trouble with application of Talidomid raised before pharmacologists of the whole world a question of need of careful studying of effect of the medicine on health of the pregnant woman and a fruit. Classification of categories of risk for a fruit in connection with use of medicines was created. Allocate an embriotoksichnost, a teratogennost and a fetotoksichnost. These concepts define on what term of pregnancy this or that preparation causes fruit malformations.
is Assumed that about 1% of all congenital anomalies cause medicines.
understand toxic influence of a medicine in the first 2 - 3 weeks of pregnancy from the moment of emergence of an embryo As an embriotoksichnost. It belongs to the preparations which are weak acids ( Phenobarbital, sulfanylamide preparations, acetilsalicylic acid ). Embriotoksichnost a number of hormones, diuretic ( furosemide, a hydrochlorothiazide, diakarb ), some antineoplastic means possess.
of Teratotoksichnost arises in case of impact of some medicines on a fruit with 3 - y on 8 - 10 - yu weeks of pregnancy. Here above-stated Talidomid , preparations of sex hormones, some antiepileptic means belongs (fenitoin, valproyevy acid), etc.
of Fetotoksichnost results from impact on a mature fruit. Use of medicines during this period of life of the pregnant woman is usually connected with diseases of future mother, with fruit pathology, with need of interruption of pregnancy.
are allocated Now by the next critical periods in embryo lives in which it is most sensitive to the damaging effect of drugs:
- from the moment of conception to 11 - go day after it when under the influence of adverse factors including drugs, the germ either perishes, or remains viable. The similar phenomenon is caused by the fact that at this stage of a cage of a germ are not differentiated yet;
- with 11 - go day to 3 - y weeks when at a fruit laying of bodies begins. The type of defect depends on pregnancy term. After the end of formation of any body or system in their development violations are not noted. So, formation of malformations of a nervous tube (for example, lack of a brain - an anentsefaliya) under the influence of teratogen happens to 22 - 28 - go day after fertilization (until closing of a nervous tube);
- between 4 - y and 9 - y for weeks when danger of a growth inhibition of a fruit remains, but teratogenny action practically is not shown any more;
- fetal period: with 9 - y weeks till the child`s birth. During this period of growth structural defects, as a rule, do not arise, but violation of postnatal functions and various behavioural anomalies is possible.
As medicines influence a fruit?
Ability of the medicine taken by mother to pass through a placenta in many respects depends on their physicist - chemical properties. Through cellular membranes best of all there pass fat-soluble drugs and it is much worse - water-soluble. Physicians began to consider that the lack of some vitamins, minerals (in particular, gland) can slow down pre-natal development of a fruit and promote the subsequent suppression of physical and intellectual development of the child. At the same time their introduction in excess quantity can also bring irreparable troubles - to be the cause of congenital uglinesses.
through a placenta small molecules Well get and it is much worse - medicines with a molecular weight more than 1000 pieces. The natural anticurtailing preparation Heparin has a big molecule and therefore does not pass through a placenta while anticoagulants of indirect action ( neodibenzopyrone, pelentan, varfarin ) which are effective only at introduction to an organism and do not influence coagulability when mixing with blood out of an organism, can get into an organism of a fruit and lower coagulability of blood.
If medicine well gets through a placenta, then it is capable to collect in fabrics of a fruit and to exert adverse impact on a fruit, causing in the subsequent heavy complications in the child. Application by the woman during 3 - 5 - monthly pregnancy of an antibiotic of the Streptomycin possessing a wide range of antimicrobic activity can cause deafness in the child for a long time. Antibiotics from group of a tetratsiklin ( metacycline, tetratsiklin, rondomitsin , etc.) negatively influence process of a kosteobrazovaniye; anticonvulsive means ( difenin, a hexamidine ) can have adverse effect on functional activity of the central nervous system of the child; sulfanylamide preparations ( etazol, sulfadimezin, sulfalene, biseptol , etc.) red blood cages of a fruit can influence toxic erythrocytes; many hypnotic drugs ( phenobarbital ) suppress the respiratory center.At the same time should recognize
that pregnant women quite often have chronic diseases of internals. Some of them have aggravations and complications of chronic diseases, there are new diseases which can constitute health hazard and even for life of the woman and a fruit. Cancellation of drugs in these situations is criminal. For this reason the doctor tries to apply preparations, the safest to a fruit and at the same time effective to treatment of diseases of the pregnant woman.
At catarrhal states are quite often used by medicines from vegetable raw materials. The calming effect renders decoction from the crushed flowers and fruits of a hawthorn, and in the people long since the small pillows filled with herbs for a dream - for example, with hop and a camomile enjoyed popularity.
What is considered by the doctor, appointing the pregnant woman`s medicine?
the Danger arising at use of medicines depends on a number of factors: from need of careful selection of a preparation and its dose for each individual case, from a way of receipt of drugs to the pregnant woman`s organism.
On what completeness and speed of receipt of drugs in a blood-groove depends?by
during pregnancy slows down absorption of drugs from - for deteriorations in blood circulation of a mucous membrane of a stomach, decrease in physical activity zheludochno - an intestinal path, reduction in most cases of the volume of secretion and contents of intestines. Delay of physical activity of a stomach reduces the speed of receipt of drugs in small intestines in which there is an absorption of the majority of medicines. Time of influence of acidity of gastric juice for drugs therefore a number of means already in a stomach of the pregnant woman collapses increases. Decrease in motive activity of intestines complicates “hashing“ of contents of intestines and reduces the area of contact of a surface of intestines with intestines contents, including the accepted medicines. All this reduces a possibility of full absorption of medicines and speed of their accumulation in medical concentration in blood. This problem becomes especially important at single application of drugs, for example anesthetics or even hypnotic drugs.
the Important factor of impact of drugs on an organism of the pregnant woman is the method of application of drugs.
At a rassasyvaniye under language of medicine are not affected by digestive and microbic enzymes and therefore begin to influence an organism 2 - 3 times faster, than at intake. Therefore if it is necessary to reach faster action of a preparation, medicine is given under language.should consider
At application of drugs in the form of candles through a rectum that in a rectum there are no digestive enzymes and further medicine comes to a blood-groove passing a liver, that is it in it does not collapse and comes to an organism in an active state. On the other hand, at pregnancy occurs the mechanical pressure of a uterus upon veins of a basin and the lower hollow vein. It complicates full outflow of blood from a rectum and owing to this fact reduces full receipt of medicine in a blood-groove.
When using drugs in the form of ointments, creams - both with the medical purpose, and with cosmetic - the operating biologically active agents can collect and be late in hypodermic cellulose of the pregnant woman from - for increases in thickness of a fatty layer by 3 - 4 kg. It leads not only to the expressed local action, but also to gradual receipt of drugs in the general blood-groove, i.e. they gradually show also the general action on an organism in general. It is necessary to be especially careful when drawing on skin of pregnant strong substances, in particular hormones of bark of adrenal glands, antibiotics, etc. Even at insignificant excess of concentration of a preparation in blood undesirable (toxic) influence of medicine can be shown.
Pricks allow drugs to come to an organism (an intramuscular or intravenous way of introduction) quickly. At this way there is an opportunity to enter an exact dose of active ingredient, and it, in most cases, several times is less, than at drug intake inside. However, if this preparation in the used quantity after an injection shows side undesirable effect, then is extremely difficult to reduce its influence. It is also impossible to forget that some women (is more often at full) at intramuscular introduction of drugs in the place of an injection can have an inflammatory process. At intravenous administration of medicine even if it was carried out absolutely correctly, there can sometimes be a damage of a vascular wall.
Therefore to the doctor appointing this or that preparation to the pregnant woman, at the choice of drugs, the recommended dose, ways of introduction and duration of reception should consider various factors. It is pregnancy term (development of a fruit and in this regard - estimated sensitivity to medicinal influences), existence of diseases of bodies through which drugs are allocated (kidneys, intestines), age of the pregnant woman (the woman is more senior, the danger of emergence of complications from the medicine which came to an organism is more).
Around the world, applying drugs to pregnant women, widely use the following categories of risk developed by the American administration on control of drugs and foodstuff - FDA (Food and Drug Administration):
- A - medicine which was taken by a large number of pregnant women and women of childbearing age without any proofs of their influence on the frequency of development of congenital anomalies or the damaging action on a fruit. ( Paracetamol, klotrimazol - locally, penicillin , antatsidny means - almayeel, maaloks etc.)
- B - medicine which was taken by the limited number of pregnant women and women of childbearing age without any proofs of their influence on the frequency of congenital anomalies or the damaging action on a fruit. At the same time in researches on animals increase in frequency of damages of a fruit is not revealed or such results are received, but the proved dependence of the received results with application of a preparation is not revealed. ( Heparin, diclofenac, ibuprofen, azitromitsin, acyclovir, metronidazole etc.)
- C - drugs which in researches on animals showed teratogenny or embriotoksichesky action. There are suspicions that they can render on a fruit or newborns the reversible damaging influence (caused by pharmacological properties) not causing development of congenital anomalies. Controlled researches in public were not conducted. ( Aspirin, dexamethasone, dyufaston, diuretic preparations etc.)
- D - the drugs causing or suspected that they can cause congenital anomalies or irreversible damages of a fruit. It is necessary to correlate risk for a fruit to potential advantage of use of medicine. ( Hypnotic drugs - barbiturates, doxycycline, tetratsiklin etc.)
- X - drugs with high risk of development of congenital anomalies or permanent damages of a fruit as there are proofs of their teratogenny or embriotoksichesky action both on animals, and on the person. They should not be applied during pregnancy.
Thus, prescription of medicines to future mother was and remains a complex problem. The doctor considers a way of introduction, the used preparation dose, counts whether “the advantage exceeds risk“. Therefore at prescription of medicines amateur performance of the pregnant woman and her relatives is inadmissible.also the timely care about health of future mother and future father is Very important
. It is necessary to the people of both sexes planning the child`s birth carefully treats reception of a number of strong drugs and contact with toxic substances on production (lead) and houses (alcohol, drugs, etc. is especially dangerous) which can become the reason of diseases of the woman during pregnancy and the birth of the sick child.