PERINATOLOGIYA AND PEDIATRIYA.2019.2(78):13-18; doi 10.15574/PP.2019.78.13

Davydova Iu. V., Limanskaya А. Yu., Ogorodnyk A. O., Butenko L. P.
SI Institute of Pediatrics, Obstetrics and Gynecology named after academician O. Lukyanova of the National Academy of Medical Sciences of Ukraine, Kyiv

Objective. To study effectiveness of prevention of severe preeclampsia development in planned pregnancy by correction of endothelial dysfunction with the use of L-arginine preconceptively and in the first trimester of pregnancy in women with severe preeclampsia in history.

Patients and methods. The effectiveness of endothelial dysfunction correction, the effect of it on prevention of preeclampsia and on reduction of the target organs damage, in particular, expressed hypertension (the use of two-component hypotensive therapy) was studied. Tivortin aspartate (produced by Yuria Pharm) was used preconceptively and in the period of early gestation in women with severe preeclampsia during the previous pregnancy. Women were divided into two groups: the first (I) — 9 women who gave birth in 28-32 weeks of the previous pregnancy; the second (II) — 18 women who gave birth in 32–34 weeks of the previous pregnancy. Given that the risk of re-preeclampsia in the first group of women is 50% and in the second one — 25%, the endothelial dysfunction correction by using L-arginine to prevent preeclampsia is absolutely justified. Women received preconception (for 3 months before present pregnancy) and in the early gestational period (up to 12 weeks), Tivortin asparate (produced by Yuria Pharm) orally 5 g (2.85 L-arginine) per day. The effectiveness of therapy was estimated by the number of endothelial cell precursors and obstetric effects of the pregnancy. The prevention of preeclampsia in the second and the third trimesters of pregnancy has been conducted in accordance with the requirements of the current clinical guidelines.

Results. The achievement of arterial hypertension control as a result of combination of basic hypotensive therapy with effective therapy using Tivortin asparate (produced by Yuria Pharm) contributes to reduction in obstetric complications incidence (iatrogenic preterm labor, placental excision). The reduction in the incidence of hypertensive complications is proved by the duration of gestation in period of more than 37 weeks in 77.7% of women in group I, and in 94.4% of women in group ІІ, as well as by decrease in the use antihypertensive drugs for control of hypertension in both groups. This demonstrates the effectiveness of hypertension control with one drug and helps to avoid polypharmacy. Proper correction of endothelial dysfunction with Tivortin asparate (produced by Yuria Pharm) promotes adequate increase in endothelial cell precursor cells, which in its turn optimizes endothelial function in women with pre-eclampsia and high risk of its recurrence; and today is a reliable marker for the effectiveness of correction.

Conclusions. Non-invasive nature of Tivortin asparate (orally), its ease of use, high efficacy in pregnant women, and high safety profile make it possible to recommend the indicated treatment regimen for endothelial dysfunction correction in women at high risk for preeclampsia.

Key words: pre-eclampsia, pregnancy, endothelial dysfunction, prophylaxis, L_arginine.

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Article received: Feb 08, 2018. Accepted for publication: May 27, 2019.