Intensive therapy of late toxicosis of pregnant women

In intensive therapy of late toxicosis, two aspects should be distinguished: preventive and curative.

According to a recent study, in 57%, it is possible to prevent late toxicosis if it begins after 20 weeks of gestation, that is, virtually detecting initial, sometimes difficult to detect symptoms and preventing its severe forms.

Based on the study of literature data and our own studies, we consider it expedient to use the following pharmacological protection in order to prevent the development of late toxicosis in pregnant high-risk groups: magnesium sulfate in combination with beta-adrenomimetics, calcium preparations and calcium antagonists. Most shown these drugs in pregnant women:

• with unfavorable (burdened) obstetric anamnesis;
• with premature ripening of the cervix, which should be determined in 28 and 32 weeks of pregnancy;
• with obstetric hemorrhages in the second trimester of pregnancy;
• with positive tests for toxicosis;
• at a suspicion on a fetal hypotrophy.

Magnesium sulfate. The drug is administered intramuscularly in a dose of 10 ml of 20 or 25% solution for 7 days, in combination with small doses of beta-adrenomimetics (bricanil, partusisten) 1/2 tablet twice a day at intervals of 6-8 hours. Synthesis of clenbuterol (FRG), which does not give adverse reactions from the cardiovascular system and is slowly absorbed in the gastrointestinal tract, the latter can be given twice a day at intervals of 12 hours.

More preferable and convenient, especially in outpatient settings, is the use systematically inside small doses (1-2 g per half-cup fasting water) of magnesium sulfate in combination with beta-adrenomimetics for 2-3 weeks. The basis of this recommendation was the data of experimental and clinical studies in which it was shown that, when magnesium is combined, sulphate and beta-adrenomimetics potentiate each other and have a preventive and curative effect in late toxicosis or in the threat of termination of pregnancy in this contingent of pregnant women. These data were confirmed in foreign literature.

Calcium gluconate and calcium lactate. Preparations appoint before meals of 0.5 g 4 times a day (daily dose of 2.0 g). Calcium lactate is better tolerated, since it does not irritate the mucous membrane of the stomach. In addition, compared to calcium calcium gluconate, lactate is more effective when administered orally, since it contains a higher percentage of calcium. It is important to note that the magnesium cation is the second most abundant in the cell, just as calcium is outside of it. In mammals, the level of calcium circulating in the blood is regulated by thyroid and parathyroid hormones.

Calcium antagonists. These include dihydropyridines (nifedipine, etc.), papaverine derivatives (verapamil, etc.), benzothiazepines (diltiazem), piperazine derivatives (cinnarizine, etc.) and some other compounds. Developed indications for the use of calcium antagonists in obstetric practice, in particular, in the treatment of late toxicosis and for the prevention of its severe forms. Most preferable is the use of nifedipine (Corinfar). It is recommended to use two methods of introducing corinfar:

• administration of 30 mg of Corinfar (orally);
• intravenous administration of corinphar with microperfusion.

1. Oral administration of corinphar. In pregnant high-risk groups for the development of late toxicosis (after 20 weeks gestation), the use of coronfar inside at a dose of 10 mg 3 times a day is recommended. Duration of treatment up to 7-10 days. After 60-90 minutes after taking Corinfar, a decrease in arterial pressure by 5-10 mm Hg was noted. Art. With intravenous administration of nifedipine, there is also a transient decrease in arterial pressure by 8-10 mm Hg. Art. However, when other calcium antagonists (verapamil) are used, prolonged hypotension and bradycardia are sometimes possible. When these, more serious adverse reactions occur, the effect results in the administration of atropine, isoproterenol or calcium preparations (10-20 ml of 10% calcium gluconate solution intravenously, slowly for 2-3 min). The incidence of side effects with nifedipine is 2%.
2. Intravenous use of verapamil. It is advisable to use a microperfueur - an electromechanical device, which allows for accurate quantitative dosage of the drug administered. In addition, it allows to implement and regulate the exact rate of drug administration.

Verapamil is recommended for use in late toxicosis with a therapeutic purpose, when combined with a pathological preliminar period and abnormalities of labor (excessive fast delivery, hypertension, weakness of labor, coordinated labor). The drug has a preventive and curative effect in late toxicosis, improves the fetal condition with its hypoxia, cardiotocography, improves utero-placental circulation, reduces uterine activity.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]