• Methodology of preventing major obstetrical syndromes
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Methodology of preventing major obstetrical syndromes

HEALTH OF WOMAN. 2018.6(132):25–33

Tezikov Yu. V., Lipatov I. S., Frolova N. A., Kutuzova O. A., Prikhod’ko A. V.
Samara State Medical University, Samara, Russian Federation
Questions of gynecology, obstetrics and perinatology, 2016, v. 15, № 2, p. 20-30
DOI 10.20953 / 1726-1678-2016-2-20-30

The objective. Development of a method for prevention of pathological pregnancy syndrome from the positions of single genesis determined by morphofunctional disorders in the fetoplacental system, with assessment of the effectiveness by methodological standards of evidence-based medicine.

Patients and methods. A prospective study was conducted among 435 women with a high risk for decompensation of placental insufficiency. Depending on the method of prevention of gestational complications, 4 groups were formed: group 1 comprised 145 pregnant women, who received dydrogesterone from the 6th to 20th wk of gestation, and from the 21st week – the angio-protector diosmin; group 2 – 118 women, who received a course of preventive treatment with low doses of acetylsalicylic acid; group 3 – 102 women, who received a preventive course of monotherapy with a magnesium preparation; group 4 – 70 pregnant women, who refused prophylaxis. The control group consisted of 30 healthy pregnant women. The dynamic examination included detection of markers of endothelial-haemostasiological dysfunction, vascular-thrombotic link, apoptosis, inflammatory response, decidualization, angiogenesis, placental energy supply, modulation of the immune response, general reactive potential of the body, concentrations of magnesium and carbonic acid, also placental histology and stereometry was performed. For objectification of the effectiveness of the developed method we used standards of evidence-based medicine.

Results. The method of prevention of major obstetric syndromes by consecutive administration of the progestagen dydrogesterone from early terms of gestation with subsequent, in the во 2nd half of gestation, substitution with the angio-protector diosmin has shown its high efficacy (NNT 1.4 (95% CI 1.1–1.7); OR 5.3 (95% CI 4.7–5.8), manifested by a decrease of preeclampsia by 93%, PI with IUGR and/or chronic fetal hypoxia – by 95%, preterm labour – by 86%, and by the absence of placental abruption, of severe forms of PE and PI. A higher clinical effectiveness of the proposed method of preventing pathological pregnancy syndrome, as compared with the use of low doses of acetylsalicylic acid and magnesium preparation can be explained by a marked normalizing effect of dydrogesterone and diosmin on immune and biochemical homeostasis, processes of apoptosis and angiogenesis, activation of endothelial-haemostasiological system, compensatory-adaptive responses in the placenta.

Conclusion. The method of choice for prevention of pathological pregnancy syndrome in a high risk for decompensation of the embryo(feto)placental system is the use of the progestagen dydrogesterone and the angio-protector diosmin according to the developed method. The study has shown the potential of a targeted choice of a preventive method depending on individual specificities of pregnant women.

Key words: angiogenesis, apoptosis, acetylsalicylic acid, dydrogesterone, diosmin, magnesium preparation, prevention of major obstetrical syndromes, endothelial dysfunction.

REFERENCES

1. Strizhakov AN. Lipatov IS. Tezikov YuV. 2014. Platsentarnaya nedostatochnost: Patogenez. Prognozirovaniye. Diagnostika. Profilaktika. Akusherskaya taktika. Samara. OFORT. 

2. Kravchenko YuL. Lipatov IS. Danilova NN. Toporova IB. Tezikov YuV. Krylova OL. 2006. Aspekty profilaktiki sotsialnykh i ekologicheskikh faktorov riska perinatalnoy smertnosti v usloviyakh gorodskoy klinicheskoy bolnitsy krupnogo promyshlennogo goroda. Chelovek i Vselennaya. 56(3):119–32. 

3. Lipatov IS. Tezikov YuV. Bykov AV. Nasikhullina RN. Ergunova GA. Potapova IA i dr. 2006. Apoptoz i ego rol v formirovanii fetoplatsentarnoy nedostatochnosti. Vestnik Samarskogo gosudarstvennogo universiteta 44(4-4):220–6.

4. Potapova IA, Purygin PP, Belousova ZP, Selezneva ES, Lipatov IS, Tezikov YV. 2001. Syntesis and biological activity of aliphatic and aromatic sulfonical acid azolides. Pharmaceutical Chemistry Journal. 35(11):588–90.

5. Tezikov YuV. Lipatov IS. 2011. Rezultaty primeneniya karbogenoterapii dlya profilaktiki platsentarnoy nedostatochnosti. Rossiyskiy vestnik akushera-ginekologa 11(5):71–7.

6. Strizhakov AN. Lipatov IS. Tezikov YuV. 2012. Kompleksnaya otsenka stepeni tyazhesti khronicheskoy platsentarnoy nedostatochnosti. Akusherstvo i ginekologiya 3:20–5.

7. Savelyeva GM. Panina OB. Kurtser MA. Gnetetskaya VA. Bugerenko EYu. Konovalova OV. 2010. Prenatalnyy period: fiziologiya i patologiya. Rossiyskiy vestnik akushera-ginekologa 10(2):61–5.

8. Strizhakov AN. Tezikov YuV. Lipatov IS. Sharypova MA. Anpilogova IV. Azizov KU i dr. 2014. Standartizatsiya diagnostiki i klinicheskaya klassifikatsiya khronicheskoy platsentarnoy nedostatochnosti. Voprosy ginekologii. akusherstva i perinatologii 13(3):5–12.

9. Sidorova IS. Nikitina NA. 2014. Prediktivnyy. preventivnyy podkhod k vedeniyu beremennykh gruppy riska razvitiya preeklampsii. Rossiyskiy vestnik akushera-ginekologa 14(5):44–9.

10. Brosens I, Pijnenborg R, Vercruysse L, Romero R. 2011. The «Great Obstetrical Syndromes» are associated with disorders of deep placentation. Am J Obstet Gynec. 204(3):193-201.

11. Lipatov IS. 1993. Klinicheskaya otsenka immunnykh proyavleniy povrezhdeniya sosudistoy stenki pri fiziologicheskoy i oslozhnennoy gestozom beremennosti. Avtoref. diss. kand. med. nauk. Samara. 

12. Strizhakov AN. Tezikov YuV. Lipatov IS. Agarkova IA. Ivanova IV. 2011. Klinicheskoye znacheniye indutsirovannogo trofoblastom apoptoza immunokompetentnykh kletok pri oslozhnennom techenii beremennosti. Voprosy ginekologii. akusherstva i perinatologii 10(6):26–31.

13. Lipatov IS. Tezikov YuV. 2011. Prognozirovaniye platsentarnoy nedostatochnosti na osnove markerov endotelialnoy disfunktsii. detsidualizatsii. apoptoza i kletochnoy proliferatsii. Saratovskiy nauchno-meditsinskiy zhurnal 7(1):52–9.

14. Lipatov IS. Tezikov YuV. Esartiya MA. 2008. Prognozirovaniye i korrektsiya narusheniy laktatsionnoy funktsii s ispolzovaniyem vidimogo infrakrasnogo polyarizovannogo sveta na etape laktogeneza. Rossiyskiy vestnik akushera-ginekologa 8(2):30–6.

15. Lipatov IS. 1996. Patogenez. diagnostika i profilaktika sosudistykh narusheniy na rannem etape formirovaniya patologicheskoy beremennosti. Avtoref. diss. dokt. med. nauk. M. 

16. Melnikov VA. Kupayev IA. Lipatov IS. 1992. Protivososudistyye antitela u zhenshchin s fiziologicheskoy i oslozhnennoy gestozom beremennostyu. Akusherstvo i ginekologiya 3-7:19–21.

17. Tezikov YuV. 2013. Patogeneticheskoye obosnovaniye prognozirovaniya. ranney diagnostiki i profilaktiki tyazhelykh form platsentarnoy nedostatochnosti. Avtoref. diss. dokt. med. nauk. Samara. 

18. Tezikov YuV. Lipatov IS. Melnikov VA. Salov VV. Mineyeva EL. Anpilogova IV i dr. 2009. Prognosticheskaya znachimost metodov diagnostiki platsentarnoy nedostatochnosti i sostoyaniya ploda. Uralskiy meditsinskiy zhurnal 3:33–40.

19. Sukhikh GT. Krasnyy AM. Kan NE. Mayorova TD. Tyutyunnik VL. Khovkhayeva PA i dr. 2015. Apoptoz i ekspressiya fermentov antioksidantnoy zashchity v platsente pri preeklampsii. Akusherstvo i ginekologiya 3:11–5.

20. Tezikov YuV. Lipatov IS. 2011. Prediktornyye indeksy tyazhelykh form khronicheskoy platsentarnoy nedostatochnosti. Meditsinskiy almanakh 6:60–3. 

21. Tezikov YuV. Lipatov IS. Esartiya MA. Salov VV. 2010. Stanovleniye laktatsii u zhenshchin s platsentarnoy nedostatochnostyu i novyye podkhody k lecheniyu gipogalaktii. Uralskiy meditsinskiy zhurnal 3:42–8.

22. Tezikov YuV. Melnikov VA. Lipatov IS. 2010. Novyye podkhody k vedeniyu beremennykh zhenshchin s platsentarnoy nedostatochnostyu. Vestnik Volgogradskogo gosudarstvennogo meditsinskogo universiteta 2:64–7.

23. Strizhakov AN. Davydov AI. Ignatko IV. Belotserkovtseva LD. Sichinava LG. Timokhina TF. 2012. Vysokotekhnologichnyye metody issledovaniya sostoyaniya materi i ploda: obespecheniye zdorovia budushchego pokoleniya. Voprosy ginekologii. akusherstva i perinatologii 11(4):6–12.

24. Tezikov YuV. Lipatov IS. Santalova GV. Valeyeva GR. Dremlyuga NM. Kozlova IV. 2009. Prikladnyye aspekty immunologicheskoy tolerantnosti v sisteme «mat–plod». Uralskiy meditsinskiy zhurnal 64(10):121–8.

25. Raghupathy R, Al Mutawa E, Makhseed M, Al-Azemi M, Azizieh F. 2007, Jul. Redirection of cytokine production by lymphocytes from women with pre-term delivery by dydrogesterone. Am J Reprod Immunol. 58(1):31–8.

26. Tezikov YuV. Lipatov IS. Agarkova IA. 2011. Faktory riska dekompensatsii platsentarnoy nedostatochnosti. Kazanskiy meditsinskiy zhurnal XCII(3):372–6.

27. Lipatov IS. Kupayev IA. Babkin SM. Yakimova NA. Sposob diagnostiki sosudistykh narusheniy u beremennykh na rannem etape razvitiya patologicheskogo techeniya gestatsii: patent RF na izobreteniye №2061960. prioritet ot 01.03.1994. Byul. Izobreteniya. 16:259. 

28. Lipatov IS. Tezikov YuV. Santalova GV. Ovchinnikova MA. 2014. Profilaktika retsidivov gerpeticheskoy infektsii u beremennykh i vnutriutrobnogo infitsirovaniya ploda virusom prostogo gerpesa. Rossiyskiy vestnik akushera-ginekologa 14(4):63–8.

29. Kotelnikov GP. Shpigel AS. 2012. Dokazatelnaya meditsina. Nauchno-obosnovannaya meditsinskaya praktika. M. GEOTAR-Media:210–22.