Резюме
Неєлова О.В. Методологія оцінювання адекватності впливу венотонічних засобів при дисфункції плаценти.
У статті висвітлені актуальні питання практичного акушерства – методологічні аспекти ведення, лікування пацієнток з недіференцированою дисплазією сполучної тканини. Встановлений, що включення препарату детралекс в схеми лікування дисфункції плаценти в данного контингенту пацієнток покращує перинатальні результати як для плоду, так і для матері.
Ключові слова: недіференцирована дисплазія сполучної тканини, дисфункція плаценти, лікування, детралекс.
Резюме
Неелова О.В. Методология оценивания адекватности влияния венотонических средств при дисфункции плаценты.
В статье освещены актуальные вопросы практического акушерства – методологические аспекты ведения, лечения пациенток с недифференцированной дисплазией соединительной ткани. Установленно, что включение препарата детралекс в схемы лечения дисфункции плаценты у данного контингента пациенток улучшает перинатальные исходы как для плода, так и для матери.
Ключевые слова: недифференцированная дисплазия соединительной ткани, дисфункция плаценты, лечение, детралекс.
Summary
Neelova O.V. Methodology of evaluation of adequacy of phlebotropic drug`s influence at dysfunction of placenta.
In the article the pressing questions of practical obstetrics are lighted up are methodological aspects of conduct, treatments of patients with undifferentiated connective tissue dysplasia. Set, that plugging of preparation of detraleх in treatment of dysfunction of placenta at this contingent of patients improves perynatal ends both for a fetusand for a mother.
Key words: undifferentiated connective tissue dysplasia, dysfunction of placenta, treatment, detraleх.

Рецензент: д.мед.н., проф. В.В. Сімрок

УДК 618.3+618.5+618.7]-06-036-084:616.018.2

Харківська медична академія післядипломної освіти

Харьковская медицинская академия последипломного образования

Kharkov medical academy of Postgraduate Education

oksana.neelova78@gmail.com

The pressing question of modern practical obstetrics is working of therapeutic measures for women with undifferentiated connective tissue dysplasia (UCTD) and disfunction of placenta. From data of different authors prevalence of UCTD hesitates from 20% to 80% and more frequent meets for women - 53%. Technology of raising of diagnosis and qualification of phenotypic displasia of UCTD is difficult, however from data of literature popular is application to that end of ball scale of Smol'novoi T.Yu. [4,7]. It «Detraleks» (Serv'e, France) vegetable phlebotropic with two fractions of bioflavonoids – diosmin and gesperetin. Among his advantages high bioavailability, absence of embriotoxic effects.

Research purpose – to work out methodology of evaluation of therapeutic influence of venotonic facilities at placenta disfunction for pregnant from UCTD.

Materials and methods. For gaining end under a supervision it was taken 170 pregnant with fenotipom of UCTD from by feto-eutherianss by violations (group of comparison) and 54 practically healthy pregnant of woman (control). For implementation of research tasks the pregnant groups of comparison are up-diffused on three sub-groups. To the first sub-group 24 patients are attributed with the diagnosed placenta disfunction and with the delay of prenathal retardation (ZVR), however for diverse reasons executed a prophylaxis of placenta disfunction was. To the second sub-group a 71 patient is included, in which the correction of placenta disfunction is executed after standard methods. The third sub-group was made by 75 patients in which treatment was conducted identically to the second sub-group and was complemented the venotonichnim mean of «Detraleks». Treatment and dynamic supervision of pregnant of both groups is executed after their informed consent. Preparation of «Detraleks» was appointed perorally in the average daily dose of 2,0g, beginning from 12 week of pregnancy; duration of treatment made eight weeks with an interruption for a week after the fourth week of reception of remedy.  Ultrasonic research (BRIDLES) of pregnant with the dopplerometric estimation of the state of hemodynamics in FPK is executed with the use licensed and metrology permanent equipment of «Sonoace-8000» (“Medison“, Korea).

Research results. It is set during research, that in the third sub-group, by comparison to the second, frequency of relapse of threat of abortion goes down in 1,9 times, in 2,6 times - premature, in 2,8 times - swift and rapid births, and also frequency of favourable perinathal results is increased (r<0,05). Certain differences, probably, conditioned the protektiv action of venotonic mean in relation to maturing of pregnancy and state of FPK. Among the studied dopplerometric descriptions a maximal dynamics the indexes of systol-diastolic correlation (S/D) were subject in uterine and umbilical cord arteries for the patients of the third sub-group. Yes, in the second sub-group of S/D in uterine arteries was 2,70±0,02, by comparison to 3,10±0,06 in the third sub-group and from 3,20±0,08 in control; S/D in the artery of umbilical cord in the second sub-group was 3,20±0,06 by comparison to 2,80±0,06 in the third sub-group and from 2,70±0,06 in control (p2-3 <0,05). This fact can be explained the improvement of venous outflow and appropriate decline of diastolic of constituent in vessels feto-placenta to the complex on a background application of venotonic mean. As by the most informing index of resistance of vessels in to the feto-placenta complex there is S/D in an umbilical cord, normalization of this index testifies to wide possibilities of preparation of detraleks in relation to the improvement of mikrocirkulation in a placenta.

Birth of child in an asphyxia took place only in the second sub-group (2,8%), where frequency of kardiorespiratations violations in five times exceeded an index in the third sub-group (7,0% and 1,3%). General frequency of the tranzit consisting of new-born the second sub-group was for certain higher (49,3% against 24,0%). The use of «Detraleks» from UCTD resulted pregnant in the positive dynamics of indexes of maternity traumatism of new-born: at general frequency of maternity traumas in the first sub-group in a 8,2% percent of this pathology in 3 sub-groups purchased a decline to 2,7%, and in the second sub-group is growth to 9,9%, that even is higher than index in the first sub-group - 7,9% (r<0,05).

At the analysis of morbidity on gypoxic-ischemic the defeat of cns (GIU CNS) is set positive influence of «Detraleks» on this index: frequency in the second sub-group 19,6%, and in 3 - 8,0% (r<0,05).

Reliable differences of mass, length of child, estimation, after a scale Apgar, the masses of placentas in sub-groups it is not set by us (r>0,05).

Relatively high indexes of violations of early neonatal'noy adaptation, maternity traumatism and GIU CNS, at the use for pregnant from UCTD of dezagregantiv and reologichnikh preparations, probably, is the certificates of potention of mechanisms NSTD-dependent vascular pathology. It grounds to deem it wise expansion of clinical protocols for pregnant from UCTD due to including of facilities of angioprotektornoy action, in particular with venotonichnim influence.

Conclusion. The analysis of the got results and modern thematic researches grounds to define the unique pathological complex «associated from UCTD of placenta violations», which grounds expedience and necessity them purposeful prophylaxis by application of angioprotektornoy therapy. At presence of placenta disfunction for pregnant with UCTD-fenotype of application of system venotonic and angioprotektive (for example, «Detraleks») in a greater measure, by comparison to the traditional conduct of such patients, improves a hemodynamics at the level of vascular river-bed of small pelvis, functional state of foetus and placentas, and also adaptation potential new-born.

Литература

1. Богачёв В.Ю. Консервативное лечение хронической венозной недостаточности нижних конечностей с точки зрения доказательной медицины / В.Ю. Богачёв // Соnsilium medicum. - 2005. - Т. 7, № 5. - С. 43-45.
2. Грищенко О.В. Значение венозного звена гемодинамики в обеспечении  функции фето-плацентарной системы / О.В. Грищенко, И.В. Лахно, А.Э. Ткачев // Мат. IV съезд акушеров-гинекологов России: тез. докл. – М., 2008. - С. 60-61.
3. Грищенко О.В. Состояние фето-плацентарного комплекса у беременных с хронической венозной недостаточностью: предварительные результаты / О.В. Грищенко, И.В. Лахно, А.Э. Ткачев // Репр. здоровье женщины. - 2008. - № 3, ч. ІІ. - С. 138-141.
4. Гурбанова С.Р. Роль недифференцированной дисплазии соединительной ткани в патогенезе истмико-цервикальной недостаточности / С.Р. Гурбанова // Мат. IV съезд акушеров-гинекологов России: тез. докл. – М., 2008. - С. 63-64.
5. Камаева А.Р. Особенности течения беременности и родов у женщин с клиническими маркерами дисплазии соединительной ткани /Мат. IV съезд акушеров-гинекологов России: Тез. докл.- Москва:2008- С. 105-106.
6. Оценка эффективности диосмина при лечении нарушений плодово-плацентарного кровотока / М.Д. Хачатурова, О.К. Федорович, Е.С. Лебеденко [и соавт.] // Мат. IV съезд акуш.-гинек. России: тез. докл. – М., 2008 .- С. 272.
7. Патент України на корисну модель №22873 11А МПК А61К31/00. Спосіб лікування фетоплацентарної недостатності у вагітних із сполучнотканинною дисплазією / Назаренко Л.Г., Неєлова О.В., Ромадіна О.В., Грабар В.В. - № 200613992; заявл. 28.12.2006; опубл. 25.04.2007, Бюл. №5.
8. Патент України на корисну модель №24018 IIА МПК А61В8/00. Спосіб діагностики фетоплацентарної недостатності та затримки розвитку внутрішньоутробного плоду у жінок-носіїв фенотипу сполучнотканинної дисплазії / Неєлова О.В. - № U200702157. - заявл. 28.02.2007; опубл.11.06.2007, Бюл. № 8.