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Use of essentiale Forte n in complex treatment of Antiphospholipid syndrome in women
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-103-105
Maniyozova Gulnoza Murodovna, the Andizhan State medical institute, the senior research assistant the competitor of chair of obstetrics and gynecology, Uzbekistan Negmatshaeva Habiba Nabievna, Andijan State Medical Institute, docent of department of Obstetrics and Gynecology, Uzbekistan.
E-mail: gmaniyozova@mail.ru
Use of essentiale Forte n in complex treatment of Antiphospholipid syndrome in women
Abstract: Research of autoimmune response impacts (formation of antibodies to certain proper phospholipids) on implantation, growth, fetal and fetus development processes, gestation course and outcome of labor is taking on special significance in studying function of immune-associated processes and in pathogenesis habitual noncarrying of pregnancy.
Keywords: Antiphospholipid syndrome; Reproductive losses; Autoimmune response; Essential's phospholipid.
Introduction: Obstetric complications developing at antiphospholipid syndrome are serious medical-social problem. Seeking of the treatment methods sets conditions for urgency of the article reviewed. Essentiale forte N is widely applied for treatment of women with reproductive losses and coagulation system changes. However mechanism of action of preparations containing proteolytic enzymes is unclear, there are no well-grounded indications for their application and objective monitoring of treatment efficiency [1; 2; 3].
Antiphospholipid antibodies have multifarious influence on haemostasis system by damaging its entire protective links: endo-
thelial barrier, function of natural anticoagulants, and endogenous fibrinolysis by activating platelet link of haemostasis and procoagulant factors.
At present specialists of all medical sectors are involved in studying ofAPS. It's time to apply this knowledge in interpretation of diversified clinical picture of APS, studying critical conditions, recurrent thromboses which contribute to progress of obstetric and perinatal complications [2; 4; 5].
As far as pregnancy progression with diseases proceeding with haemostasis system disturbance the risk of blood clot development in vessels of placenta, fetus, maternal body increases.
Sectiom 6. Medical science
Research objective was in clinico-laboratorial evaluation of Es-sentiale forte N drug impact in APS in women with reproductive losses of Ferghana Valley (Andijan, Ferghana and Namangan regions of Uzbekistan).
Materials and methods
Data of43 women in the non-pregnancy state with reproductive losses (RL) in past history with revealed APS (main group) had been studied by us. Main group was divided into two groups depending on treatment. The study included only women with the Fergana Valley: Andijan, Namangan and Fergana regions the Republic of Uzbekistan. In group I (n = 20) the patients had received conventional anticoagulant, antiaggregant and antioxidant therapy. The patients of group II (n = 23) in addition to conventional therapy had received preconceptively Essentiale forte N (manufactured by sanofi aventis, Germany) at course dose in 1 tablet 10 t. i.d. within 1 month prior to estimated pregnancy with further maintaining dose depending on haemostasis indices over a period ofpregnancy and enzymatic preparation Serrata. Essentiale forte H does not have teratogenic effect; it has fibrinolytic, anti-inflammatory and anti-edematous activity as well as regenerates microcirculation and oxygenation of tissues.
It is known that a surfactant substance vital to lung by more than 80% of the EFL; however the drug promotes the formation of normal lung tissue and preventing distress syndrome in newborns. Timely application of EFL in complicated gestation removes lipid metabolism — one of the factors in the development ofmalnutrition and fetal hypoxia. Choosing Essentiale forte N is based on its ability to influence hemocoagulation, blood rheology due to the effect on the endothelium of blood vessels, preventing the development of obstetric complications. Distinctive qualities of the mechanism of drug action are the ability to have an impact on blood flow in the mother-placenta-fetus, then when a number of drugs affect only the mother-placenta or placenta-fetus. It is possible to ensure optimal conditions for placentation, development of the ovum and embryo prevent placental abnormalities.
Control group (III) was comprised of 10 women (n = 10) with physiologically proceeding pregnancy and without APS at the same terms of gestation. Groups were comparable by age, number of ges-
tation and childbirth in past history. Determination of lupus anticoagulant (LA) in plasma had been carried out with 6-8 weeks interval according to Scientific and Standardization Committee of International Society on Thrombosis and Haemostasis since LA determination according to literary data in 75 per cent of cases is reliable while the concentration of anticardiolipin antibodies is reliable only in 65 per cent of cases. Basis of test on LA (lupus-test) was taken its property to inhibit phospholipids by extending the coagulation time in APTT tests, the dilute Russell's viper venom time, PT and the activated recalcification time.
Diagnosis of thrombophilic state of the blood was included determination of platelet aggregation: detection of fibrin monomers soluble complex concentration (FMSC), D-dimer (fibrin polymerization). Determination of the main links of haemostasis system before and after treatment that included the following parameters: prothrombin time (PT, s), International Normalized Ratio (INR, units), Prothrombin Index (PI,%), Activated Partial Thromboplastin Time (APTT, s), Fibrin Monomers Soluble Complex (FMSC, mg/100 ml), Fibrinogen (g/l).
All observations had been carried out on the basis of central research laboratory (CRL) of the Andijan State Medical Institute.
Findings had been exposed to statistical data processing on personal computer Pentium-IV by means of Microsoft Office Ex-cel-2003 software package including use of embedded functions for statistical manipulation.
Results and their review
Activation of plasmatic links of haemostasis system had been observed when compared indices ofhaemostasiogram before treatment of women with RL caused by APS as compared with control group (table 1).
Study of haemostasis system shows general trend to hyper-coagulation of procoagulant link. Trend to extension of APTT is observed in patients from group I for 1.4 times as compared with control group while in group II for 1.2 times when plasma procoagulant activity was evaluated. Parameters of D-Dimmer indices in both groups were higher for 5 times. However, other indices were also higher in patients of the main group as compared with control group.
Table 1. - Parameters of haemostasis system indices in women with APS before treatment
Index n=23 n=20 n=10
PT. s 19.96+1.09***** 19.9+0.25*** 17.5+0.42
INR. unit 1.15+0.09* 1.23+0.01**** 1+0.02
PI.% 102.65+3.38***** 107.25+0.63** 94.1+1.30
APTT. s 37.52+1.42*** 44.6+0.50*** 31.9+0.56
FMSC. mg/100 ml 4.93+0.30*** 5.85+0.14***** 3.93+0.08
Fibrinogen. g/l 3.07+0.19 3.43+0.13* 3.0+0.13
D-Dimmer. mg/ml 1164.35+104.52*** 1342.5+35.98**** 233.3+22.57
Index n=23 n=20 n=10
PT. s 16.04+0.53 19.65+0.43**** 18.5+0.42
INR. unit 0.92+0.03 1.18+0.01*** 1+0.02
PI.% 77.26+1.63** 105+0.81*** 94.1+1.30
APTT. s 32.48+1.37 43+0.63** 31.9+0.56
FMSC. mg/100 ml 3.47+0.13* 5.5+0.16** 3.93+0.08
Fibrinogen. g/l 2.98+0.2 3.13+0.14 3.0+0.13
D-Dimer. mg/ml 240.13+21.63 1305+38.79** 233.3+22.57
* - reliable P<0.01; ** - P<0.001; *** - P<0.002; **** - P<0.05 as compared with control group.
* - reliable P<0.1; ** - P<0.01; *** - P<0.001; *** - P<0.02; **** - P<0.002; ***** - P<0.05 as compared with control group. Laboratory test values of groups I and II had been compared with control group (table 2) after completion of therapy course. Table 2. - Parameters of haemostasis system indices in women with APS after treatment
Assessment of functional status cardio-vascular system in pregnant women with obesity
Number of distinction had been detected in surveyed patients during evaluation of haemostasiogram indices first of all in platelet link. Indices were acquired values to be typical for physiological gestation. It should be noted that normalization of these values occurred faster in surveyed group II as compared with surveyed group I. Markers of thrombophilia became normal values faster in women from group II in relation to control group than in women from group I respectively.
Thus, conducted therapy with Essentiale forte N was conductive to haemostasis. Conducted researches confirm the safety of application. Elevation of D-Dimmer and FMSC levels is the reflection of haemostasis system since such factors in APS and thrombophilia are elevating long before estimated pregnancy and markers of such processes.
If to take into account that increase in coagulation potential is an adaptive response for haemostasis system during physiologically proceeding pregnancy then thrombophilic type disturbance of gestational adaptation to be observed in APS often points to advisability to study of co agulation system and devise of preconceptive therapy long before the estimated pregnancy.
Enabling the use of Essentiale forte N in the complex therapy of women with APS promotes bringing the pregnancy to term. The most effective application of the methodology in the pregravid period, it reduces the incidence of miscarriage, intrauterine growth retardation, perinatal morbidity and mortality.
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1. Balasch J., Carnwna F., Lopez-Soto A. et al. - 1993. Hum. Reprod. - Vol. - 8. - N12. P. 2234-2239.
2. Linnikov V. I. - 2013. Immunotherapy in complex treatment of antyphospholipid syndrome//Reprodact endocrin. - 10:2. - P. 23-26.
3. Linnikov V. I. 2005. Diagnostics, principles of treatment and prevention of thrombophilic conditions associated with primary an-tiphospholipid syndrome in pregnancy, childbirth and postpartum women dissertation for the degree of MD, - Moscow. - P. 33-35.
4. Makatsaria A. D. Bicadze V. O., Baymuratova S. M. Antiphospholipid syndrome - immune thrombophilia in obstetrics and gynecology. - 2007. Triada-X, - Moscow. - P. 1112.
5. Sidelnikova V. M. - 1986. Noncarrying of pregnancy, - Moscow. P. 75.
DOI: http://dx.doi.org/10.20534/ESR-16-9.10-105-108
Matlubov Mansur Muratovich, Samarkand State Medical Institute. Head of the Department of Anesthesiology and Rehanimatology. Associate professor.
E-mail: mansur.matlubov@mail.ru Semenihin Arseniy Arsenevic, Republican Scientific-Practical Center of Obstetrics and Gynecology of the Ministry of Health of the Republic of Uzbekistan. Professor of the Department of Anesthesiology and Rehanimatology.
E-mail: prof_saa@list.ru Najmutdinova Dilorom Kamaritdinovna, Director of Republican Scientific-Practical Center of Obstetrics and Gynecology of the Ministry of Health of the Republic of Uzbekistan, professor E-mail: obs_gyn@mail.ru Goyibov Salim Saydullaevich, Samarkand State Medical Institute Assistant Professor of the Department of Anesthesiology and Rehanimatology E-mail: anesvaren@mail.ru Kim Olga Vitalevna, Samarkand State Medical Institute Assistant Professor of the Department of Anesthesiology and Rehanimatology E-mail: mirabilis87@mail.ru
Assessment of functional status cardio-vascular system in pregnant women with obesity
Abstract: 124 pregnant women at the age from 23 to 28 years old in gestation periods of37-39 weeks have been examined with the aim of investigation of hemodynamic status of pregnant women with obesity. All examined patients have presented in 6 groups. In all observed patients pregnancy, according to the consultations of obstetric-gynecologists, was accepted as uncom-
