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Immunity against... pregnancies of

Diagnosis:“ The anti-phospholipidic syndrome“

the State about which the speech will go is one of the possible reasons of female infertility. But those who will hear from the doctor the diagnosis “an anti-phospholipidic syndrome“ should not despair: at the qualified medical care of the woman, having this disease, become happy mothers too.

At an anti-phospholipidic syndrome (AFS) at women with habitual not incubation of pregnancy, pre-natal death of a fruit or a delay of its development in blood are defined by the antibodies developed by the pregnant woman`s organism to own phospholipids - to special chemical structures of which walls and other parts of cages are constructed. These antibodies (AFA) become the reason of formation of blood clots when forming vessels of a placenta that can lead to a delay of pre-natal development of a fruit or its pre-natal death, an otsloyka of a placenta, development of complications of pregnancy. Also in blood of the women suffering from AFS reveal volchanochny anticoagulant (the substance defined in blood at system red a wolf cub 1 ).

Complications of AFS are the abortion and premature birth, gestoza (the pregnancy complication which are shown increase of arterial pressure, emergence of protein in urine, hypostases), plodovo - placentary insufficiency (at this state the fruit lacks oxygen).

At AFS the frequency of complications of pregnancy and childbirth makes 80%. Antifosolipidny antibodies to various elements of reproductive system are found in 3% of clinically healthy women, at pregnancy not incubation - in 7 - 14% of women, in the presence of two and more spontaneous abortions in the anamnesis - in every third patient.

of Manifestation of AFS

At primary AFS only specific changes in blood come to light.

secondary AFS complications of pregnancy or infertility are observed by

At at patients with autoimmune diseases, such as system red a wolf cub, autoimmune tireoidit (an inflammation of a thyroid gland), etc.

Primary and secondary AFS similar clinical manifestations have rheumatism: habitual not incubation of pregnancy, not developing pregnancies in the I-II trimesters, pre-natal death of a fruit, premature birth, severe forms of a gestoz, plodovo - placentary insufficiency, heavy complications of the postnatal period, thrombocytopenia (decrease in quantity of platelets). In all cases a harbinger of death of fetal egg is development of the DVS chronic form - a syndrome.

of Supervision is shown that without treatment the death of a fruit occurs at 90 - 95% of the women having AFA.

Among patients with habitual not incubation of pregnancy of AFS comes to light at 27 - 42%. Frequency of this state among all population is equal to 5%.

Preparation for pregnancy

is Especially important

preparation for pregnancy of the women who had not developing pregnancies, spontaneous abortions in the anamnesis (on terms of 7 - 9 weeks), early and late toxicoses, an otsloyka of a horion (placenta). In these cases examination on genital infections (methods of the immunofermental analysis - IFA, polimerazny chain reaction - PTsR), research of a hemostasis is conducted - indicators of the curtailing system of blood (gemostaziogramma), exclude availability of the volchanochny anticoagulant (VA), AFA, estimate system of immunity by means of special analyses.

Thus, preparation for pregnancy includes the following stages:

Most often in the presence of AFS the chronic viral or bacterial infection comes to light. Therefore the first stage of preparation for pregnancy is carrying out the antibacterial, antiviral and immunocorrecting therapy. Also other preparations are in parallel appointed.

Indicators of the system of a hemostasis (curtailing systems) at pregnant women with AFS significantly differ in

from indicators at women with the physiological course of pregnancy. Already in the I trimester of pregnancy the hyperfunction of platelets often steady against the carried-out therapy develops. In the II trimester such pathology can be aggravated and lead to hyper coagulation increase (fibrillation increase), to activation of an intra vascular tromboobrazovaniye. In blood signs of the developing DVS - a syndrome appear. These indicators reveal by means of blood test - a koagulogramma. In the III trimester of pregnancy of the phenomenon of hyper coagulation accrue and to hold them in the limits close to normal, it is possible only at active treatment under control of indicators of the curtailing system of blood. Similar researches are conducted at these patients also at the time of delivery and the postnatal period.

the Second stage of preparation begins

with repeated inspection after the carried-out treatment. It includes control of a hemostasis, the volchanochny anticoagulant (VA), AFA. At changes of a hemostasis antiagregant - the preparations preventing formation of blood clots (ASPIRIN, KURANTIL, TRENTAL, REOPOLIGLYuKIN, INFUKOL), anticoagulants (GEPARIN, FRAKSIPARIN, FRAGMIN) are applied.

(after inspection and treatment) carry out by

At approach of the planned pregnancy dynamic control of formation plodovo - a placentary complex, prevention of fetoplatsentarny insufficiency and correction of function of a placenta at its change (AKTOVEGIN, INSTENON).

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Tactics of conducting pregnancy

From the I trimester, the most important period for development of a fruit in the conditions of autoimmune pathology, each 2 - 3 weeks carry out control of a hemostasis. From early terms, it is possible in a cycle of the planned conception, appoint treatment hormones - the glucocorticoids possessing antiallergic, anti-inflammatory, antishock action. The combination of glucocorticoids (METIPRED, DEKSAMETAZON, PREDNIZOLON, etc.) with antiagregant and anticoagulants deprives of activity and brings out of AFA organism. Thanks to it hyper coagulation decreases, coagulability of blood is normalized.

All patients with AFS have a chronic viral infection (a virus of simple herpes, papillomavirus, a cytomegalovirus, Koksaki`s virus etc.) . Due to the features of a course of pregnancy, application of glucocorticoids even in the minimum doses activation of this infection is possible. Therefore during pregnancy carrying out 3 courses of preventive therapy which consists of intravenous administration of IMMUNOGLOBULIN in a dose of 25 ml (1,25 g) or OKTAGAMA of 50 ml (2,5 g) every other day, only three doses is recommended; candles with VIFERONOM are at the same time appointed. Small doses of immunoglobulin do not suppress production of immunoglobulins, and stimulate protective forces of an organism. Repeatedly introduction of immunoglobulin is carried out in 2 - 3 months and before childbirth. Introduction of immunoglobulin is necessary for the prevention of an exacerbation of a viral infection, for suppression of development autoantitet. At the same time in an organism of the pregnant woman protection (passive immunity) against a chronic infection is formed and circulating in blood autoantitet, and indirectly - and protection of a fruit against them.

At introduction of immunoglobulin, sometimes there are phenomena of catarrhal character (cold, etc.) . For prevention of these complications it is necessary to check the immune, interferon status with definition in blood of immunoglobulins of the class IgG, IgM, and IgA (antibodies of IgM and IgA are developed at the first hit of the infectious agent in an organism and at an aggravation of infectious process, IgG remain in an organism after the postponed infection). At the low IgA level it is dangerous to enter immunoglobulin from - for possible allergic reactions. For the purpose of prevention of similar complications to the woman before introduction of immunoglobulins enter antihistamines then appoint plentiful drink, tea, juice, and at the phenomena, similar catarrhal, - febrifuges. It is not necessary to inject these drugs on a hungry stomach - shortly before procedure the patient has to eat food.

there were in recent years researches in which in treatment of AFS infusional therapy is recognized as solutions of the hydroxyethylated starches (GEK) leading to improvement of microblood circulation on vessels one of the perspective directions. Clinical trials of solutions of hydroxyethylated starch II - go generations (INFUKOL - GEK) in many clinics of the Russian Federation showed their efficiency, safety.

Knows that thrombosis and ischemia of vessels of a placenta (emergence of sites where there is no blood circulation) at pregnant women with existence of AFS begins with early terms of pregnancy therefore treatment and prevention of placentary insufficiency are carried out from the I trimester of pregnancy under control of a hemostasis. From 6 - 8 weeks of pregnancy stage-by-stage purpose of antiagregant and anticoagulants against glucocorticoid therapy {KURANTIL, TEONIKOL, ASPIRIN, GEPARIN, FRAKSIPARIN) is used. At changes of a hemostasis (hyperfunction of platelets, etc.) and resistance to antiagregant in a complex with this therapy appoints course INFUKOLA every other day intravenously kapelno.

Pregnant women with AFS treat risk group on development of fetoplatsentarny insufficiency. They need careful control of a condition of blood circulation in a placenta, plodovo - a placentary blood-groove, possible when carrying out an ultrasonic dopplerometriya. This research is conducted in 2 - m and 3 - m pregnancy trimesters, since 16 weeks, with an interval of 4 - 6 weeks. It allows to diagnose in due time features of development of a placenta, its state, violation of a blood-groove in it, and also to estimate efficiency of the carried-out therapy that is important at detection of a hypotrophy of a fruit, placentary insufficiency.

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For prevention of pathology of a fruit to women with AFS from early terms of pregnancy appoint the therapy improving a metabolism. The preparations and vitamins normalizing okislitelno - recovery and exchange processes at the cellular level of an organism enter this complex (which cannot be replaced with reception of usual polyvitamins for pregnant women). During pregnancy it is recommended to apply 3 - 4 times a course of such therapy lasting 14 days (2 schemes for 7 days everyone). During reception of these preparations polyvitamins cancel, and between courses recommend to continue reception of polyvitamins.

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For the prevention of fetoplatsentarny insufficiency at women with AFS also recommends in the II trimester of pregnancy, from 16 - 18 weeks reception of AKTOVEGINA inside in the form of tablets or intravenously kapelno. At emergence of signs plodovo - placentary insufficiency appoint such preparations as TROKSEVAZIN, ESSENTsIALE, LIMONTAR, KOGITUM. At suspicion of development (hypotrophy) conduct a course of special therapy (IPFEZOL and other preparations) of lag of a fruit.

Tactics of maintaining pregnant women with AFS stated in this article is approved by

in practice and showed high efficiency: at 90 - 95% of women pregnancy comes to the end in due time and safely provided that patients carry out all necessary researches and appointments.

of Newborns at women with AFS is surveyed only at the complicated current of the early neonatal period (in maternity hospital). In this case conduct research of the immune status, and also a hormonal assessment of a condition of the child.

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