Prolongation of pregnancy in early preeclampsia with continuous positive airway pressure ventilation in the complex of intensive therapy
Background. Obstructive sleep apnea syndrome (OSAS) and the phenomenon of early expiratory airway closure (EEAC) provoke progressive hypoxia and oxidative stress, which will lead to the progression of preeclampsia (PE). At the same time, PE exacerbates the course of these conditions or provokes their occurrence. In order to break the vicious pathogenetic circle, it is necessary to neutralize the manifestations of OSAS and EEAC. Continuous positive airway pressure (CIAP) therapy is the most effective treatment for these phenomena.Kalachin K.A., Pyregov A.V., Shmakov R.G., Lomova N.A., Bychkova M.S.
Case report. Patient D. aged 38 years old was admitted to the V.M. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology for early PE. Considering the premature term (30 weeks), it was decided to prolong pregnancy. Her body mass index (BMI) was 31.1 kg/m2. The patient also complained of daytime sleepiness and her husband reported his wife’s snoring. Respiratory printing with computer-assisted pulse oximetry was performed, which revealed moderate OSAS. CPAP therapy was initiated every night before delivery. During the therapy, an improvement in blood gas composition was noted; antihypertensive therapy was stabilized, and the clinical and laboratory parameters did not become worse. As a result, the pregnancy could be prolonged for 7 days; the indication for delivery was deteriorated uteroplacental blood flow. The patient was discharged in satisfactory condition on 11 days after delivery.
Conclusion. Specialists working with pregnant women must be aware of OSAS, a common condition, and be alerted towards the patients who have characteristic complaints and a high BMI, and, if necessary, timely screen OSAS, and start appropriate therapy.
Keywords
preeclampsia
prolongation of pregnancy with early preeclampsia
hypertensive disorders during pregnancy
hypertension
obstructive sleep apnea syndrome
early expiratory airway closure
CPAP therapy
respiratory therapy
blood gases
References
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Received 01.10.2019
Accepted 04.10.2019
About the Authors
Konstantin A Kalachin, doctor of the Department of Anaesthesiology and Resuscitation, assistant of the Department of Anesthesiology and Resuscitation, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov Ministry of Health of Russia. Tel.: +74954387777.E-mail: konstantin.kalachin@yandex.ru; ORCID.org/0000-0002-3240-3715
117997, Russia, Moscow, Ac. Oparina str. 4.
Aleksey V. Pyregov, MD, PhD, Chair of Anesthesiology and ICU; Chair of Department of Anesthesiology and Reanimatology, National Medical Research Center for Obstetrics,
Gynecology and Perinatology named after Academician V.I. Kulakov Ministry of Health of Russia. Tel.: +74954387777. E-mail: a_pyregov@oparina4.ru;
ORCID.org/0000-0001-8382-9671
117997, Russia, Moscow, Ac. Oparina str. 4.
Roman G. Shmakov, MD, PhD, professor, director of the institute of Оbstetrics , National Medical Research Center of Obstetrics, Gynecology and Perinatology named after Acad. V.I. Kulakov, Ministry of Health of Russia, Moscow. Tel.: +74954387200. E-mail: r_shmakov@oparina4.ru; ORCID.org/0000-0002-2206-1002.
117997, Russia, Moscow, Ac. Oparina str. 4.
Natalia A. Lomova, MD, PhD, research fellow, obstetrics department, National Medical Research Center of Obstetrics, Gynecology and Perinatology named
after Acad. V.I. Kulakov, Ministry of Health of Russia, Moscow. Tel.: +74954387200. E-mail: natasha-lomova@yandex.ru ORCID.org 0000-0002-6090-586Х.
117997 , Russia, Moscow, Ac. Oparina str. 4.
Mariya S. Bychkova, 5th year student, Pirogov Russian National Research Medical University . Tel.: +74954340543. E-mail: mashabichkova@gmail.com
117997,Russia, Moscow, Ostrovityanova str, d.1
For citation: Kalachin K.A., Pyregov A.V., Shmakov R.G., Lomova N.A., Bychkova M.S. Prolongation of pregnancy in early preeclampsia with continuous positive airway pressure ventilation in the complex of intensive therapy.
Akusherstvo i Ginekologiya/ Obstetrics and gynecology. 2019; 12: 202-6.(In Russian).
https://dx.doi.org/10.18565/aig.2019.12.202-206
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