HEALTH OF WOMAN. 2019.10(146): 55–61; doi 10.15574/HW.2019.146.55
Syusyuka V. G., Kolokot N. G., Belenichev I. F.
Zaporizhzhya State Medical University

The objective: estimate efficiency of complex, neuroprotective therapy of pregnant women with fetus growth inhibition and its influence on obstetric and perinatal consequences of delivery.
Materials and methods. Complex examination of 95 pregnant women in term 28–34 weeks of gestation were examined. The first group (the main group) includes 32 pregnant women with fetus growth inhibition (FGI). FGI was diagnosed according to data of ultrasonic examination. Pregnant women of this group had prescribed therapy with piracetam and thiotriazolinum (1000 mg and 250 mg consequently in 100 ml of 0.9% saline solution per day, intravenously by drop infusion) in complex with L-arginine hydrochloride (4.2%, 100 ml of solution per day intravenously by drop infusion) during 10 days and further L-arginine aspartate (5 ml, 6 times per day) during 14 days. In complex therapy pregnant women also get Flebodia (diosmin 600 mg per day) during 30 days. The second group (the comparison group) is presented by 33 pregnant women with FGI whose pregnancy follow-up and assistance in labour is provided by valid orders of Ministry of Healthcare of Ukraine. The third group (the control group) comprises 30 pregnant women without FGI.
Average age of pregnant women in the first group made 25.9±1.6 years in the second group – 27.7±1.8 years and 25.8±1.0 years in the control group. According to results of anthropometric measurements of pregnant women there was not determined statistically significant difference between examined groups (p>0.05). The severe somatic diseases were exclusion criterion. Variational and statistic processing of results was made using STATISTICA 13 – license standard application program packages for multidimensional statistical analysis.
Results. By means of analysis of peculiarities of gestation course in the examined groups there was found that rate of miscarriage in the second group made 39.4% and it was significantly higher than values of the first group (21.8%) and the third group (16.7%). General rate of anemia of pregnant women was also the highest in the second group and made 42.4% and in the first and third groups anemia occurred almost with the same rate (31/3% and 33.3%, correspondingly). Hypertensive disorders during pregnancy and labour were diagnosed only in pregnant women of the first group (6.3%) and the second group (9.1%). In the first group premature labour rate index made 3.1% and it was 6 times lower than the same index in the second group (21.2%). Fetus distress rate in the second group (18.2%) is almost 2 times higher than the same index in the first group (9.4%) and in the third group it made 3.3%. General rate of abdominal delivery was the highest in the second group and made 45.5% and in the first group – 15.6% and 6.7% in the third group. In the second group the rate of cesarean operations under urgent indications is 4 times higher than the same index in the first group (29.5% and 6.8% correspondingly).
State of newborns in the examined groups was analyzed under Apgar score. Both at the first and fifth minutes the general index under the certain score was statistically and significantly lower in the second group comparing to indices of the first and thirds groups. By means of characterizing perinatal complications there was found that considerable percentage of neonatal encephalopathy and neonatal jaundice in the second group made 33.3% and 36.4% correspondingly. In the first group their rate made 9.4% and 3.1% correspondingly. In structure of perinatal pathology prematurity had occurred in 21.2% of newborns of the second group that is 6 times higher than the same index of the first group (3.1%). Mentioned complications in the third group were not found. Based on anthropometric measurements of newborns there was revealed that average index of their weight in the second group made 2162.2±105.4 g and was statistically and significantly (р<0.05) lower than the same index in the first group (2785.2±100.2 g) and the third group (2914.3±180.2 g).
Conclusions. 1. Results of performed research indicate that obstetric and perinatal consequences of delivery of pregnant women with fetus growth inhibition are characterized by high rate of complications but their rate considerably prevails in the group of women who hadn’t proposed complex neuroprotective therapy. Thus in group of pregnant women with fetus growth inhibition who had proposed therapy there was found the decrease of rate of complications in labour (premature labour and fetus distress) having direct influence on rate of operative delivery under urgent indications.
2. Positive effect of proposed complex neuroprotective therapy for women with fetus growth inhibition was demonstrated by statistically significant (р<0.05) prevalence of both indices under Apgar score with correspondingly adaptation processes and results of anthropometric measurements of newborns and their body mass indices. Perinatal consequences of delivery are characterized by lower level of neonatal encephalopathy rate.
Key words: pregnancy, fetus growth inhibition, obstetric and perinatal complications, neuroprotective therapy.

REFERENCES

1. Artyimuk NV, Trishkin AG, Bikmetova ES. 2012. Perinatalnyie ishodyi i otdalennyie posledstviya pri zaderzhke rosta ploda. Zhurnal akusherstva i zhenskih bolezney LXI; 6: 68–75.

2. Bibik VV. 2001. Osobennosti patogeneticheskoy farmakoterapii ugrozyi preryivaniya beremennosti u vozrastnyih pervorodyaschih. Zbirnyk naukovykh prats «Aktualni problemy akusherstva i ginekologii, klinichnoi imunologii ta medychnoi genetyky». Kyiv-Lugansk 5: 9–15.

3. Bysaha NIu. 2019. Suchasni pidkhody do rozrodzhennia zhinok iz zatrymkoiu vnutrishnoutrobnoho rostu ploda na tli preeklampsii. Zdorove zhenshchyny 1 (137): 92–95.

4. Lahno IV, Korovay SV, Dudko VL, Neelova OV. 2009. Vyibor metoda lecheniya hronicheskoy venoznoy nedostatochnosti vo vremya beremennosti. Zdorove zhenschiny 2: 73–76.

5. Hoida NH, Moiseienko RO, Maistruk HP. 2016. Osnovni dosiahnennia vykonannia Derzhavnoi prohramy «Reproduktyvne zdorovia natsii» za 2005–2015 rr. Zdorove zhenshchiny 4: 14–16.

6. Vdovychenko YuP, Tanko OP, Samoilova MV, Sharashydze KZ. 2017. Zatrymka rostu ploda: kliniko-patohenetychni skladovi ta zasoby poperedzhennia. Adaptatsiia do mizhnarodnykh klinichnykh ustanov.K: 43.

7. Nedelskaya SN, Mazur VI, Solodova IV i soavt. 2008. Ispolzovanie preparatov antioksidantnogo deystviya v pediatrii. Zaporozhskiy meditsinskiy zhurnal 4: 26–28.

8. Katkova NYu, Panova TV. 2006. Effektivnost angioprotektorov pri lechenii beremennyih s platsentarnoy nedostatochnostyu. Consilium Medicum 8;2:28–30.

9. Klyicheva OI. 2014. Korrektsiya narusheniy sistemyi gemostaza angioprotektorami u beremennyih s platsentarnoy nedostatochnostyu. Sovremennyi nauchnyi vestnik 5;1: 71–75.

10. Klyicheva OI. 2016. Morfofunktsionalnyie osobennosti sostoyaniya fetoplatsentarnogo kompleksa u zhenschin s sindromom zaderzhki razvitiya ploda. Sovremennyi nauchnyi vestnik 10;1: 54–58.

11. Klyicheva OI, Huraseva AB. 2017. Sravnitelnyiy analiz farmakologicheskoy effektivnosti angioprotektornyih preparatov v terapii sindroma zaderzhki rosta ploda. Kurskiy nauchno-prakticheskiy vestnik «Chelovek i ego zdorove» 3: 43–48.

12. Korostil MO, Chorna OO. 2016. Zatrymka rostu ploda pry donoshenii i nedonoshenii vahitnosti. Akusherstvo. Ginekologiia. Genetyka 1: 20–23.

13. Lahno IV, Barannik EA, Tkachev AE. 2011. Novaya metodologiya izucheniya effektov diosmina v perinatalnoy meditsine. Zdorove zhenschiny 10: 108–111.

14. Potapov VO, Siusiuka VH, Zhernova HO, Shapran NF, Nechukhaieva IO. 2014.  Likuvannia i reabilitatsiia vahitnykh z varykoznoiu hvoroboiu ta profilaktyka uskladnen neiu obumovlenyh. Zdorove zhenshchyny 10:71–75.

15. Manzhula LV. 2013. Vlyianye lechenyia varykoznoi bolezny vo vremia beremennosty y posle rodov na akusherskye y perynatalnыe yskhodы rodorazreshenyia. Zdorove zhenshchyny 8: 108–110.

16. Manukhyn YB, Markova EV, Striuk RY. 2012. Optymyzatsyia kompleksnoho lechenyia beremennыkh s hestozom y fetoplatsentarnoi nedostatochnostiu. Zdorove zhenshchyny 6 (72): 26–29.

17. Markin LB, Shatylovych KL, Shakhova OV. 2004. Likuvannia platsentarnoi nedostatnosti z vykorystanniam venotonichnoho ta anhioprotektornoho zasobu Flebodia. Praktychna medytsyna X;3: 8–11.

18. Tezikov YuV, Lipatov IS, Frolova NA, Kutuzova OA, Prihodko AV. 2017. Metodologiya profilaktiki bolshih akusherskih sindromov. Zdorove zhenschiny 10 (126): 19–27.

19. Nosenko EN, Karp GDzhA, Konkov DG. 2017. Etiopatogeneticheskie printsipyi profilaktiki bolshih akusherskih sindromov. MedichnI aspekti zdorov’ya zhinky. Spetsvipusk: 28–36.

20. Grischenko OV, Lahno IV, Ovcharenko AT, Dudko VL. 2005. Obosnovanie neobhodimosti primeneniya venotonicheskih preparatov u beremennyih s fetoplatsentarnoy nedostatochnostyu. Visnik Harkivskogo natsionalnogo universitetu. im. V.N. Karazina, Ser.: Meditsina 705;11: 71–75.

21. Mazur IA, Kucherenko LI, Bielenichev IF, Khromylova OV, Siusiuka VH.  Pat. № 110597 Ukrainy, MPK A61K31/198 (2006.01). Kombinovanyi likarskyi zasib hepatoprotektornoi, kardioprotektornoi, platsentoprotektyvnoi, tokolitychnoi i NO-mimetychnoi dii. Tovarystvo z obmezhenoiu vidpovidalnistiu «Naukovo vyrobnyche obiednannia «FARMATRON». № a2015. 06388. Zaiav. 10.09.2015, Biul.№17. Opubl. 12.01.2016. Promyslova vlasnist 1. 2015.

22. Posternak GI, Tkacheva MYu, Zbarazhskiy YuV. 2006. Izuchenie effektivnosti preparata Tiotsetam pri lechenii novorozhdennyih s gipoksicheski-ishemicheskim povrezhdeniem golovnogo mozga. Meditsina neotlozhnyih sostoyaniy 4 (5): 85–88.

23. Reznichenko HI, Besarabov YuM, Reznichenko YuH, Pavliuchenko NP. 2001. Poshuk novykh patohenetychnykh pidkhodiv do likuvannia khronichnoi platsentarnoi nedostatnosti. Zbirnyk naukovykh prats Asotsiatsii akusheriv-hinekolohiv Ukrainy. K, Feniks:546–549.

24. Voytenko GN, Yakovleva NYu, Gorchakova NA, Tumanov VA, Yusko NA. 2011. Prooksidantno-antioksidantnyi status eritrotsitov pri astme u detej: osobennosti narushenij i vliyanie tiotriazolina. Fitoterapiya. Chasopis 1: 25–32.

25. Reznichenko HI, Bessarabov YuM. 2004. Efektyvnist zastosuvannia tiotryazolinu ta piratsetamu v terapii khronichnoi platsentarnoi nedostatnosti. Pediatriia, akusherstvo ta hinekolohiia 1: 110–116.

26. Reznichenko HI, Pavliuchenko NP, Reznichenko YuH. 2001. Poshuk shliakhiv do patohenetychno obhruntovanoi terapii anemii vahitnykh. Pediatriia, akusherstvo ta hinekolohiia 6: 77–81.

27. Tereshchenko AV, Hoida NH, Moiseienko RO, Dudina OO. 2014. Rezultaty diialnosti perynatalnykh tsentriv v Ukraini. Zdorove zhenshchynы 2: 21–25.

28. Rogozhina IE, Prodanova EV, Neyfeld IV. Otsenka effektivnosti primeneniya Flebodia 600 v kompleksnoy terapii fetoplatsentarnoy nedostatochnosti. Materialyi III regionalnogo nauchnogo foruma «Mat i ditya». Saratov, 30 iyunya – 2 iyulya 2009: 232.

29. SImrok VV, Cherkasova VS. 2006. Tiotsetam v kompleksnoy terapii platsentarnoy nedostatochnosti. VIsn. Hark. nats. un-tu. 720: 129–131.

30. Voloshin NA, Mazur IA, Voloshina IN, Zagorodnyiy MI, Kucherenko LI. 2015. Tiatriazolin v lechenii i profilaktike zabolevaniy serdechno-sosudistoy sistemyi. Zaporozhe: 359.

31. Boyarskaya LN, Mazur VI, Solodova IV i soavt. 2003. Tiotriazolin v kompleksnom lechenii funktsionalnyih zabolevaniy serdechno-sosudistoy sistemyi u detey i podrostkov. Provizor 6: 22–23.

32. Sabelnikov VV, Kalinskaya MI, Rutovich NV i soavt. 2009. Flebodia 600 kak komponent kompleksnoy terapii bolnyih hronicheskoy venoznoy nedostatochnostyu nizhnih konechnostey. Regionarnoe krovoobraschenie i mikrotsirkulyatsiya 8;1 (29): 68–69.

33. Frolova NA, Tezikov YuV, Lipatov IS. 2015. Obosnovanie vyibora angioprotektora diosmina v kachestve profilakticheskogo agenta preeklampsii. Izvestiya Samarskogo nauchnogo tsentra RAN. 17;2 (2): 371–375.

34. Chernyiy VI, Kolesnikov AN, Kolesnikova VV, Popkov AV, Kolesnikov NE. 2007. Perspektivy primeneniya neiroprotektorov v terapii preeklampsii. Novosti meditsiny i farmatsii 10 (214): 26–28.

35. Shevchenko AO. 2018. Zminy vmistu prohesteronu, insulinu ta kortyzolu pid vplyvom likuvannia u vahitnykh iz zahrozoiu peredchasnykh polohiv v umovakh khronichnoho stresu. Zaporozhskyj medytsynskyj zhurnal 20; 3 (108): 334–338.

36. Shostak VA. 2016. Fetoplatsentarnaya nedostatochnost: vozmozhnosti farmakoterapii. Meditsinskie novosti 10: 40–43.

37. Scherbina NA, Makarenko MV, Kuzmina IYu. 2014. Differentsirovannyiy podhod k terapii sindroma zaderzhki rosta ploda. Sb. nauchnyih trudov «Informatsionnyie tehnologii v meditsine i farmakologii». Rostov-na-Donu: 16–19.

38. Scherbina NA, Makarenko MV, Kuzmina IYu. 2014. Sovremennyie printsipyi terapii sindroma zaderzhki rosta ploda. Naukovi zapysky Mizhnarodnoho humanitarnoho universytetu: zbirnyk. Odesa, Mizhnarodnyi humanitarnyi universytet 21; II: 214–217.

39. Yaniuta HS, Savka TR, Basystyi OV. 2016. Zatrymka rostu ploda: diahnostyka ta perynatalni naslidky. Zdorove zhenshchynы 99: 99–102.

40. Yatsyshyn NH. 2006. Korektsiia okremykh imunolohichnykh pokaznykiv ta funktsionalnoho stanu fetoplatsentarnoho kompleksu u vahitnykh z nepliddiam endokrynnoho henezu v anamnezi. Halytskyi likarskyi visnyk 1: 93–95.

41. Ahmad A, Noor S. 2018. Fetal Growth Restriction: An Update on Recent Trends in Management. Pan Asian J Obs Gyn. 1 (1): 31–36.

42. Morsing E, Asard M, Ley D, Stjernqvist K, Marsál K. 2011. Cognitive function after intrauterine growth restriction and very preterm birth. Pediatrics. 127 (4): e874-82. https://doi.org/10.1542/peds.2010-1821; PMid:21382944

43. Guellec I, Lapillonne A, Renolleau S. 2011. Neurologic outcomes at school age in very preterm infants born with severe or mild growth restriction. Pediatrics. 127 (4): e883-91. https://doi.org/10.1542/peds.2010-2442; PMid:21382951

44. Hofmeyr GJ, Kulier R. 2012, Jun, 13 . Piracetam for fetal distress in labour. Cochrane Database Syst Rev. (6): CD001064. https://doi.org/10.1002/14651858.CD001064.pub2.

45. Sharma D, Shastri S, Sharma P. 2016. Intrauterine Growth Restriction: Antenatal and Postnatal Aspects. Clin Med Insights Pediatr. 14;10: 67–83. https://doi.org/10.4137/CMPed.S40070; PMid:27441006 PMCid:PMC4946587

46. Kutschera J, Urlesberger B, Maurer U, Müller W. 2002. Small for gestational age – Somatic, neurological and cognitive development until adulthood. Z Geburtshilfe Neonatal. 206 (2): 65–71. https://doi.org/10.1055/s-2002-30139; PMid:12015637