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Intensive therapy of late toxicosis of pregnant women
Last reviewed: 08.07.2025
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In intensive care of late toxicosis, two aspects should be distinguished: preventive and therapeutic.
According to recent studies, in 57% of cases it is possible to prevent late toxicosis if it is started after 20 weeks of pregnancy, i.e. practically identifying the initial, sometimes difficult to determine symptoms and preventing its severe forms.
Based on the study of literature data and our own research, we believe it is appropriate to use the following pharmacological protection for the purpose of preventing the development of late toxicosis in high-risk pregnant women: magnesium sulfate in combination with beta-adrenergic agonists, calcium preparations and calcium antagonists. These drugs are most indicated in pregnant women:
- with an unfavorable (burdened) obstetric history;
- in case of premature ripening of the cervix, which should be determined at 28 and 32 weeks of pregnancy;
- with obstetric bleeding in the second trimester of pregnancy;
- in case of positive tests for toxicosis;
- if fetal malnutrition is suspected.
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-adrenergic agonists (brikanil, partusisten) 1/2 tablet twice a day at intervals of 6-8 hours. Due to the synthesis of clenbuterol (FRG), which does not cause side effects 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 systematic use of small doses (1-2 g per half a glass of water on an empty stomach) of magnesium sulfate in combination with beta-adrenergic agonists for 2-3 weeks. The basis for this recommendation was the data of experimental and clinical studies, which showed that when combined, magnesium sulfate and beta-adrenergic agonists potentiate each other and have a preventive and therapeutic effect in late toxicosis or in the event of a threat of termination of pregnancy in this contingent of pregnant women. These data were confirmed in foreign literature.
Calcium gluconate and calcium lactate. The drugs are prescribed before meals at 0.5 g 4 times a day (daily dose 2.0 g). Calcium lactate is better tolerated, as it does not irritate the gastric mucosa. In addition, compared to calcium gluconate, calcium lactate is more effective when taken orally, as it contains a higher percentage of calcium. It is important to note that the magnesium cation is the second most common cation inside the cell, just as calcium is outside 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. Indications have been developed 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. We consider the use of nifedipine (corinfar) to be the most preferable. It is recommended to use two methods of administering corinfar:
- administration of 30 mg corinfar (orally);
- intravenous administration of corinfar using a microperfusor.
- Oral administration of corinfar. In pregnant women at high risk of developing late toxicosis (after 20 weeks of pregnancy), it is recommended to take corinfar orally at a dose of 10 mg 3 times a day. The duration of treatment is up to 7-10 days. 60-90 minutes after taking corinfar, a decrease in blood pressure by 5-10 mm Hg is noted. With intravenous administration of nifedipine, a transient decrease in blood pressure by 8-10 mm Hg is also observed. However, with the use of other calcium antagonists (verapamil), prolonged hypotension and bradycardia are sometimes possible. If these more serious side effects occur, the effect is achieved by administering atropine, isoproterenol or calcium preparations (10-20 ml of 10% calcium gluconate solution intravenously, slowly for 2-3 minutes). The incidence of side effects when taking nifedipine is 2%.
- Intravenous administration of verapamil. It is advisable to use a microperfuer - an electromechanical device that allows for precise quantitative dosing of the administered drug. In addition, it allows for the precise rate of administration of the drug to be controlled.
Verapamil is recommended for use in late toxicosis for therapeutic purposes, in combination with a pathological preliminary period and abnormalities of labor (excessively rapid labor, hypertensive form of weakness of labor, coordinated labor). The drug has a preventive and therapeutic effect in late toxicosis, improves the condition of the fetus in its hypoxia according to cardiotocography, improves uteroplacental blood circulation, and reduces uterine activity.
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