Ways to reduce perinatal losses in pregnant women with acute pancreatitis
Objective. To reduce the incidence of perinatal losses in pregnant women with acute pancreatitis (AP) through optimization of therapeutic and preventive measures.Khvorostukhina N.F., Salov I.A., Novichkov D.A.
Subjects and methods. The investigation enrolled 127 pregnant women with AP. A study group consisted of 43 pregnant women for whom a package of therapeutic and preventive measures including discrete plasmapheresis on days 1 and 3 and micronized progesterone (Invention Patent No. 2535108 dated October 8, 2014) was additionally included. A comparison group of 84 patients received standard therapy for AP. A control group included 30 healthy pregnant women. Examinations were made in accordance with the standards; hemodynamic parameters in the uterine arteries and the serum concentrations of prolactin (PRL), estradiol (E), and dehydroepiandrosterone sulfate (DEAS), progesterone (P), cortisol (C), trophoblastic beta-1-glycoprotein (TBG) and placenta-specific alpha-1-microglobulin (PAMG-1) were additionally investigated in the pregnant women.
Results. The occurrence of AP in the pregnant women was accompanied by an increase in the stress hormones PRL, C, and DEAS, maladjustment of the synthesis of placenta-specific proteins (a decrease in TBG and a rise in PAMG-1), impaired uteroplacental blood flow, which resulted in chronic placental insufficiency in 78.8% of cases during their conventional management and is complicated by acute placental insufficiency in 21.2% of cases. Pregnancy concurrent with AP increased the rate of spontaneous abortion (11.9%), non-developing pregnancy (29.8%), and preterm delivery (60.7%) and contributes to higher perinatal mortality rates (up to 281.3‰) and the percentage of total reproductive losses (up to 45.2%). The additional incorporation of discrete plasmapheresis and progesterone was found to contribute to the correction of hormonal, hemodynamic disorders in the mother-placenta-fetus system, by preventing the progression of placental dysfunction and its negative consequences for the development of a fetus/embryo.
Conclusion. The developed method decreases the rate of threatening abortion in the presence of AP by 3 times and the number of preterm deliveries by 13 times and reduces perinatal mortality rates to zero.
Keywords
pregnancy
acute pancreatitis
perinatal loss
plasmapheresis
placental dysfunction
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Received 23.09.2016
Accepted 11.11.2016
About the Authors
Khvorostukhina Natalia Fedorovna, Ph.D., associate professor, head of the department of obstetrics and gynecology of the pediatric faculty, V.I. RazumovskySaratov State Medical University, Ministry of Health of Russia.
410012, Russia, Saratov, Bolshaya Kozachya str. 112. Tel.: +79272777935. E-mail: Khvorostukhina-NF@yandex.ru
Salov Igor Arkadevich, MD, Professor, Head of the Department of Obstetrics and Gynecology of the Faculty of Physiotherapy, V.I. Razumovsky Saratov
State Medical University, Ministry of Health of Russia. 410012, Russia, Saratov, Bolshaya Kozachya str. 112. E-mail: salov.i.a@mail.ru
Novichkov D.A., Candidate of Medical Sciences, Associate Professor of the Department of Obstetrics and Gynecology, Pediatric Faculty, V.I. Razumovsky
Saratov State Medical University, Ministry of Health of Russia. 410012, Russia, Saratov, Bolshaya Kozachya str. 112. E-mail: dnovichkov@mail.ru
For citations: Khvorostukhina N.F., Salov I.A., Novichkov D.A.
Ways to reduce perinatal losses in pregnant women with acute pancreatitis.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (5): 50-7. (in Russian)
http://dx.doi.org/10.18565/aig.2017.5.50-7
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