Preparations at placentary insufficiency of
According to medical statistics, placentary insufficiency develops approximately at 24% of future mothers. For treatment of this complication of pregnancy there is a number of special preparations.
the Placenta (a so-called afterbirth) is body by means of which there is a food, breath of a fruit and removal of the processed metabolism products, In this body two difficult systems of blood vessels meet. One of them (maternal) connects a placenta with uterus vessels, other (fruit) passes into the umbilical cord arteries going to a fruit. Between two systems of vessels the membrane (one layer of cages) which plays a barrier role between an organism of mother and child is located; thanks to this membrane blood of mother and a fruit does not mix up.the Placentary barrier is impenetrable
for many harmful substances, viruses, bacteria. At the same time oxygen and substances, necessary for life, without problems pass from mother`s blood to the child as well as the fulfilled products from a fruit organism easily get to mother`s blood then are allocated through her kidneys. The placentary barrier carries out immune function: passes protective proteins (antibodies) of mother to the child, providing his protection, and at the same time detains the cages of immune system of mother capable to cause reaction of rejection of a fruit, having distinguished in it alien object, Besides, in a placenta the hormones important for successful incubation of pregnancy, and the enzymes destroying harmful substances are produced.
What is placentary insufficiency?function of a placenta can be broken by
At adversely proceeding pregnancy. There is a so-called placentary insufficiency at which process of maturing of a placenta is broken, decreases matochno - placentary and plodovo - a placentary blood-groove, gas exchange and a metabolism in a placenta is limited, synthesis of its hormones decreases. All these changes define insufficient intake of oxygen and nutrients to a fruit, slow down its growth and development, aggravate the available pregnancy complications.the Syndrome of placentary insufficiency is realized by
at various level therefore several forms of this disease are defined:
- haemo dynamic, caused by violations in vessels matochno - platsentarno - a fruit blood-groove;
- platsentarno - the membrane, characterized by decline in the ability placentae to carrying of various substances and oxygen;
- the cellular, connected with violations of exchange processes in cages placentae. Distinguish primary and secondary placentary insufficiency.
Primary (early) placentary insufficiency develops till 16 weeks of pregnancy, arising when forming a placenta. More often uterus pathology is its reasons: uterus myoma (a benign tumor), uterus malformations (saddle, small, two-horned), the previous abortions, hormonal and genetic disorders. In some cases primary placentary insufficiency passes into secondary.
Secondary (late) placentary insufficiency, as a rule, arises against already created placenta after 16 weeks of pregnancy. In emergence of late placentary insufficiency infections, gestoza are of great importance (complications at which work of all bodies and systems of an organism of the pregnant woman is broken, most often they are shown by increase of arterial pressure, emergence of hypostases, protein in urine), pregnancy interruption threat, and also various diseases of mother (arterial hypertension, dysfunction of bark of adrenal glands, diabetes, a thyrotoxicosis, etc.) .Irrespective of the factors promoting development of placentary insufficiency it violations of blood circulation in matochno - a placentary complex, the placentae leading to violation of all functions are the cornerstone of
change of respiratory function of a placenta is demonstrated by fruit hypoxia symptoms - insufficient intake of oxygen to it. At the same time at the beginning of a disease the woman pays attention to the increased (chaotic) physical activity of a fruit, then - to its reduction. The chronic hypoxia of a fruit and violation of nutritious function of a placenta lead to a delay of its pre-natal development. Manifestation of a delay of pre-natal development of a fruit is reduction of the sizes of a stomach of the pregnant woman (a stomach circle, height of standing of a bottom of a uterus) in comparison with the indicators characteristic of this term of pregnancy. Violation of protective function of a placenta leads to pre-natal infection of a fruit under the influence of the pathogenic (pathogenic) microorganisms getting through a placenta. The fruit which development happens in the conditions of placentary insufficiency in much bigger degree is subject to risk of a travmatization at childbirth and incidence during the period newborn.Diagnostics
are applied by
To diagnostics of placentary insufficiency:
- Assessment of warm activity of a fruit. Besides simple listening an obstetric stethoscope, the most available and widespread method of an assessment of warm activity of a fruit is the kardiotakhografiya which is based on registration of changes of frequency of serdtsebiyeniye of a fruit depending on reductions of a uterus, action of external irritants or activity of the fruit in terms after 28 weeks of pregnancy.
- Ultrasonic research (ultrasonography). At the same time determine the sizes of a fruit and their compliance to pregnancy term, estimate localization and thickness of a placenta, compliance of degree of a maturity of a placenta to pregnancy term, volume of amniotic waters, an umbilical cord structure, possible pathological inclusions in structure of a placenta. Besides, study anatomical structure of a fruit for detection of anomalies of its development, respiratory and physical activity of a fruit. Dopplerometriya`s
- . It is BONDS option - researches at which blood-groove speed in vessels of a uterus, an umbilical cord and fruit is estimated. The method allows to estimate directly a blood-groove condition in each of vessels in the second half of pregnancy.
- Laboratory methods. They are based on determination of level of hormones of a placenta (estriol, a horionichesky gonadotrophin, a placentary lactogene), and also activities of enzymes (an oksitotsinaza and thermostable alkaline phosphatase) in blood of pregnant women in any term of pregnancy.
on the basis of complex inspection the conclusion not only about the fact of existence or lack of placentary insufficiency, but also about severity of such violation becomes. Tactics of conducting pregnancy at varying severity of placentary insufficiency different.
Prevention and treatment
, unfortunately, are not possible to relieve Now completely the pregnant woman of the arisen placentary insufficiency any medical influences. The applied means of therapy can promote only stabilization of the available pathological process and maintenance kompensatorno - adaptive mechanisms at the level allowing to provide continuation of pregnancy to the optimum term of a rodorazresheniye. Therefore it is very important to carry out prevention at the women having risk factors of development of placentary insufficiency.
the Leading place in prevention is taken by treatment of the main disease or complication at which emergence of placentary insufficiency is possible. An important condition is observance of the pregnant woman of the corresponding mode: good sufficient rest (the dream on the left side is more preferable), elimination of physical and emotional activities, stay in the fresh air 3 - 4 hours a day, the balanced balanced diet. Include polyvitamins, iron preparations, respiratory gymnastics for increase in delivery of oxygen through lungs, use of amino acids in a course of prevention, glucose, Galaskorbin, Orotat of potassium, ATP which are a direct power source for a set of biochemical and physiological processes.At initial signs of placentary insufficiency treatment in the conditions of a maternity welfare unit with carrying out repeated ultrasonic research with a dopplerometriya in 10 - 14 days after an initiation of treatment is possible
. At more expressed placentary insufficiency, especially in combination with other complications of pregnancy or the general diseases of mother, hospitalization in a hospital is obligatory. Duration of therapy has to make not less than 6 weeks (in a hospital, with continuation of therapy in the conditions of a maternity welfare unit). In case of detection of this pathology and carrying out the corresponding therapy in the second trimester for fixing of effect of the first course it is necessary to repeat treatment on terms 32 - 34 weeks of pregnancy.to
At deterioration in indicators against treatment, emergence of the signs of a decompensation of placentary insufficiency which are defined by sharp deterioration in a condition of a fruit and a possibility of his death showed the emergency rodorazresheniye by operation of Cesarean section irrespective of pregnancy term.
Special medicamentous therapy
Now for treatment of placentary insufficiency a large number of the medicamentous funds allocated for elimination of violations matochno - platsentarno - a fruit blood-groove and on increase of resistance of a fruit to oxygen starvation exists. Each of these preparations has the point of application, the mechanism of action.
the Preparations promoting relaxation of muscles of a uterus (tokolitika) - Partusisten, Ginipral, Magne - In 6 , Periodic increase of a tone of a uterus promotes violation of blood circulation in a placenta whereas small doses of tokolitik reduce resistance of vessels at the level of small arteries and lead to considerable strengthening matochno - a placentary blood-groove. At Ginipral and Partusisten`s application increase in heart rate at mother is possible (tachycardia), lowering of arterial pressure, a tremor of fingers of hands, a fever, nausea and concern. For prevention of tachycardia in parallel with preparations appoint Verapamil, Izoptin. Contraindications to Ginipral and Partusisten`s application is the thyrotoxicosis (the increased function of a thyroid gland), heart diseases, bronchial asthma.
Eufillin, but - a shpa possess vasodilating action, reduce the peripheral resistance of vessels. Trental (pentoks - an eagle owl), besides vasodilating effect, is capable to improve rheological properties (fluidity) of blood and circulation in small capillaries (microcirculation), Side effect of these preparations - heartburn, nausea, vomiting, a headache. Contraindication to application of a pentoksa - an eagle owl is the lowered arterial pressure (hypotonia), Eufillina - the increased function of a thyroid gland, a heart disease, epilepsy.
At placentary insufficiency chronic violation of fibrillation (strengthening of activity of platelets and plasma factors of coagulability) takes place. Therefore the preparations interfering formation of blood clots in vessels - antiagregant are applied to treatment (Aspirin, Kurantil). These preparations, besides improvement of a rheology of blood, have the expanding effect on small arteries, causing considerable strengthening of speed of a blood-groove. They do not cause expansion of all vessels and the relative falling of arterial pressure connected with it and at the same time raise a metabolism without simultaneous increase of consumption of oxygen. Kurantil it is possible to accept since the first trimester of pregnancy. Antiagreganta are contraindicated to women with stomach ulcer of a stomach and duodenum, at bleedings and recently postponed surgeries. Due to the risk of bleeding in labor these preparations cancel in 34 - 36 weeks of pregnancy.
Aktovegin increases resistance of a brain and fabrics of a fruit to a hypoxia, makes active a metabolism, increases glucose consumption, stimulates renewal of cells of a fruit. Besides, the preparation strengthens blood circulation in system mother - a placenta - a fruit, promotes the best shipping a fruit of the patrimonial act. Treatment by Aktovegin renders the expressed effect on a condition of a fruit. It is expressed in improvement of indicators of a blood-groove and improvement of growth of a fruit that allows to reduce the frequency of the compelled early rodorazresheniye. The preparation is received from blood of calfs, possesses a minimum of side effects, rather rare emergence of allergic reactions is noted. Contraindications to application of a preparation is heart failure, hypostasis of lungs. Women with habitual not incubation have pregnancies and serious diseases (diabetes, arterial hypertension, pathology of a thyroid gland, heart, liver) Aktovegin appoint for the purpose of prevention of placentary insufficiency courses for 2 - 3 weeks, 2 - 3 times for pregnancy.
Considering the major neutralizing function of a liver, and also its defining role in production of proteins and factors of fibrillation, in complex therapy of placentary insufficiency it is expedient to use gepatoprotektor - the preparations protecting a liver (Essentsi - Alya, Gepatil). They have the normalizing effect on an exchange of fats, proteins and for function of a liver. Preparations have a minimum of side effects, some patients note unpleasant feelings in a stomach and a liver. Hofitol represents the purified extract of leaves of an artichoke field. Except gepato - tire-tread property, Hofitol contains many macro - and minerals, including iron, manganese, phosphorus, vitamins A, In and S. Besides, the preparation has the expressed antioxidant properties. The hypoxia arising against placentary insufficiency leads to increase in quantity of free radicals who have the damaging effect on cages. Hofitol improves protection against free radicals that exerts positive impact on function of a placenta. Hofitol is contraindicated at biliously - a stone illness, sharp diseases of a liver, bile - and urinary tract.
Instenon - the combined preparation improving brain blood circulation, work of heart and a metabolism at a fruit in the conditions of a hypoxia. It is applied in a complex with other preparations to treatment of placentary insufficiency to avoid negative consequences of a hypoxia for nervous system of a fruit. During reception of a preparation it is necessary to avoid the use of coffee and tea as they weaken its action. The most frequent by-effect at its application is the headache. Instenon it is impossible to apply at a condition of strong excitement and spasms, manifestations of the increased brain pressure (its signs: long headache, vomiting, sight violation), epilepsy.
of the Indication for the choice of this or that preparation is defined by the doctor, proceeding from a form of placentary insufficiency. If the basic in an origin is blood circulation violation, then the preparations influencing vessels are appointed. If in a basis cellular violations - that the drugs influencing a fabric exchange. Often use combinations from several preparations.
in conclusion wants to be emphasized: placentary insufficiency - serious complication of pregnancy at which independent application and cancellation even of the most harmless drugs are inadmissible. This pathology demands fixed supervision of the doctor.