Method for pregnancy management in women with pelvic varicose veins

Abstract

FIELD: obstetrics.SUBSTANCE: used for pregnancy management in women with varicose veins of the pelvis. At 12–13 weeks of pregnancy, an ultrasound is performed: if the placenta has normal microcirculation, “Basic Therapy” is prescribed; if perfusion is reduced and there is venous congestion, “Stage 1 Therapy” is added. At 20–21 weeks, microcirculation is assessed and placental elastography is performed: if the indicators are stable / improved and elastography is normal, “Stage 1 Therapy” is continued with monitoring after 6–8 weeks. In the absence of microcirculation dynamics and normal elastography, proceed to “Stage 2 Therapy”. In case of persistent / increasing disorders and decreased elasticity according to elastography, “Stage 3 Therapy” is prescribed.EFFECT: method allows for personalized pregnancy management and a reduction in the risk of obstetric and perinatal complications through dynamic monitoring of the placenta.1 cl, 4 ex

Description

[0001] This invention relates to medicine, specifically obstetrics, and concerns a method for diagnosing and determining pregnancy management strategies in women with pelvic varicose veins (PVVS), aimed at preventing the development of placental insufficiency in this group of pregnant women. This is accomplished through a combination of diagnostic measures, including ultrasound assessment of placental microcirculation and placental elastography, as well as step-by-step treatment measures: physical therapy, lower extremity compression, phlebotonics, dipyridamole, phytosedatives, polyunsaturated fatty acid preparations, and antioxidant vitamins.

[0002] It is known that changes in the hemostatic system occur during pregnancy, contributing to the development of chronic venous insufficiency due to hypercoagulation and endothelial dysfunction [1]. These changes lead to an increase in the length and diameter of veins, irreversible dilation of their lumen and valve insufficiency [2], which leads to the development of venous congestion syndrome [3]. A persistent increase in venous pathology during pregnancy increases the risk of complicated gestation and adverse perinatal outcomes [4].

[0003] Women with PVD are more likely to experience threatened miscarriage, premature rupture of membranes, cervical insufficiency, placenta previa, fetoplacental insufficiency, and severe gestosis. These complications are associated with venous congestion, impaired placental perfusion, and placental tissue remodeling.

[0004] Pregnancy management methods for women with VVMT are based on assessing umbilical artery blood flow. However, these methods are primarily focused on identifying established fetoplacental blood flow disturbances and do not provide early, step-by-step interventions for placental microcirculation disorders and changes in placental elasticity.

[0005] The technical result consists of treating pregnant women with VRVMT starting at 12-13 weeks when signs of impaired placental microcirculation appear, and starting at 20-21 weeks when decreased placental elasticity is detected, thereby preventing the development of signs of placental insufficiency. This proactive approach allows for addressing key factors in the pathogenesis of placental insufficiency in VRVMT: venous congestion, impaired perfusion, and placental tissue remodeling.

[0006] The method is carried out as follows.

[0007] At 12-13 weeks of pregnancy, an ultrasound examination of placental microcirculation is performed. If placental microcirculation is normal, a course of "Basic Therapy" is administered: knee-elbow position 3-4 times a day for 15 minutes, swimming, walking, avoiding constipation, wearing Class 1 compression hosiery, consultation with a phlebologist, and the use of phlebotonics at a prophylactic dose.

[0008] In case of decreased perfusion and signs of venous congestion at 12-13 weeks of pregnancy, a course of “Basic Therapy” and “Stage 1 Therapy” is administered: phlebotonics in a therapeutic dose for a course of 1-2 months with repetition, acetylsalicylic acid at a dose of 60-100 mg / day for 4-5 weeks, dipyridamole, phytosedatives to correct vegetative tone.

[0009] Then, at 20-21 weeks of pregnancy, a repeat assessment of placental microcirculation is performed and additional placental elastography is performed.

[0010] If microcirculation parameters are stable or improving, and elastography data are within normal limits, a course of “Stage 1 Therapy” is carried out and monitoring is carried out after 6-8 weeks.

[0011] If microcirculation remains without positive dynamics, and the elastography data are within the normal range, a course of “Stage 2 Therapy” is carried out: the phlebotonic drug is changed or added, and treatment with Actovegin is carried out orally.

[0012] If microcirculation disorders persist or worsen and, according to elastography data, signs of decreased placental elasticity appear, a course of “Stage 3 Therapy” is administered: Actovegin intravenously by drip, phlebotonics, preparations of polyunsaturated fatty acids (Omega-3), antioxidant vitamins C and E.

[0013] Diosmin or hesperidin are used as phlebotonics. Motherwort or valerian preparations are used as phytosedatives.

[0014] Specific examples of the application of the method of pregnancy management in women with VRVMT.

[0015] Example 1. Pregnant woman N., 32, presented to the antenatal clinic of the State Healthcare Institution "St. Andrew the First-Called City Clinical Hospital" in Ulyanovsk in 2024 with the following diagnosis: third pregnancy, 8 weeks; pelvic varicose veins. Past medical history: varicose veins since age 23. At 12 weeks, during the first screening, which included an assessment of placental microcirculation, placental blood flow was within normal limits. Basic therapy was administered: knee-elbow position 3-4 times a day for 15 minutes, swimming, walking, avoiding constipation, wearing class 1 compression hosiery, consultation with a phlebologist, and the use of phlebotonics in a prophylactic dose. At 20-21 weeks, repeat assessment of placental microcirculation and placental elastography revealed no negative dynamics. The pregnancy culminated in the birth of a full-term girl with an Apgar score of 8-9, weighing 3500g, and measuring 54 cm in length.

[0016] Example 2. Pregnant woman D., 28, visited the antenatal clinic of the State Healthcare Institution "St. Andrew the First-Called City Clinical Hospital of Ulyanovsk" in 2024 with the diagnosis: second pregnancy, 9 weeks; pelvic varicose veins. Past medical history: has suffered from varicose veins since the age of 25. At 12 weeks, during the first screening, which included an assessment of placental microcirculation, placental blood flow was reduced. "Basic Therapy" and "Stage 1 Therapy" were administered: phlebotonics at a therapeutic dose for a course of 1-2 months with repetition, acetylsalicylic acid at a dose of 60-100 mg / day for 4-5 weeks, dipyridamole, phytosedatives to correct vegetative tone. At 20-21 weeks, repeat assessment of placental microcirculation and placental elastography revealed no negative changes. The pregnancy culminated in the birth of a full-term girl with an Apgar score of 8-9, weighing 3,350 g, and measuring 54 cm in length.

[0017] Example 3. Pregnant woman R., 30, presented to the antenatal clinic of the State Healthcare Institution "St. Andrew the First-Called City Clinical Hospital" in Ulyanovsk on March 6, 2024, with a diagnosis of first pregnancy, 7-8 weeks; pelvic varicose veins. Past medical history: varicose veins have been present since the age of 26. At 12 weeks, during the first screening, which included an assessment of placental microcirculation, placental blood flow was within normal limits, and therefore "Basic Therapy" was administered. At 20-21 weeks, a repeat assessment of placental microcirculation and placental elastography revealed decreased microcirculation and signs of decreased placental elasticity. Stage 3 therapy was administered: Actovegin intravenously, phlebotonics, polyunsaturated fatty acid preparations (Omega-3), and antioxidant vitamins C and E. The pregnancy resulted in the birth of a full-term boy with an Apgar score of 7-8 points, weighing 3050 g and measuring 52 cm in height.

[0018] Example 4. Pregnant woman G., 31, presented to the antenatal clinic of the State Healthcare Institution "St. Andrew the First-Called City Clinical Hospital" in Ulyanovsk on March 14, 2024, with the following diagnosis: third pregnancy, 10 weeks; pelvic varicose veins. Past medical history: varicose veins since age 22. At 12 weeks, during the first screening, which included an assessment of placental microcirculation, placental blood flow was reduced. "Basic Therapy" and "Stage 1 Therapy" were administered. At 20-21 weeks, a repeat assessment of placental microcirculation and placental elastography revealed persistent microcirculation disorders and signs of decreased placental elasticity. Stage 3 therapy was administered: Actovegin intravenously, phlebotonics, polyunsaturated fatty acid preparations (Omega-3), and antioxidant vitamins C and E. The pregnancy resulted in the birth of a live child with an Apgar score of 7-8 points, weighing 2010 g and measuring 49 cm in height.

[0019] Thus, the clinical examples presented demonstrate the feasibility of the proposed method of pregnancy management in women with VVDMT. Treatment, starting at 12-13 weeks if impaired placental microcirculation is detected, and starting at 20-21 weeks if signs of decreased placental elasticity are detected, helps prevent the development of placental insufficiency. The proposed method is simple, readily available for use in antenatal clinics and obstetric hospitals, and can be applied in practical healthcare.

[0020] Sources of information:

[0021] 1. Marizoeva M.M., Sadriev O.N., Kalmykov E.L. [et al.] The course of labor in women with varicose veins. Pavlov Russian Medical and Biological Bulletin. 2017; 25 (1): 97-102. DOI: 10.2388 8 / PAVLOVJ2017197-102.

[0022] 2. Bogachev V.Yu. Varicose veins during and after pregnancy. Gynecology. 2006; 8 (5): 26-30. URL: https: / / gynecology.orscience.ru / 2079-5831 / article / view / 27797.

[0023] 3. Gereikhanova E.G., Omarova H.M., Ibragimova E.S.A. [et al.] Pregnancy as a cause of varicose veins of the genitals. Ural Medical Journal. 2019; 171 (3): 44-49. URL: https: / / elibrary.ru / item.asp?id=37240686.

[0024] 4. Valts I.A., Abukerimova A.K. Pathology of veins in women during pregnancy and childbirth / / Actual problems of theoretical, experimental, clinical medicine and pharmacy: materials of the 53rd annual All-Russian conference of students and young scientists dedicated to the 90th anniversary of Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Natural Sciences Byshevsky A.Sh. Tyumen, March 27-28, 2019. Tyumen: RIC "Aivex", 2019. pp. 391-392.

[0025] 5. Budanov P.V., Lebedev V.A. Features of prevention and treatment of varicose veins in pregnant women. Difficult patient. 2008; 6(1): 27-29. URL: https: / / cyberleninka.ru / article / n / osobennosti-profilaktiki-i-lecheniya-varikoznoy-bolezni-ven-u-beremennyh.

Claims

A method of pregnancy management in women with pelvic varicose veins, including ultrasound examination (US) of placental microcirculation, characterized in that the ultrasound is performed at 12-13 weeks of pregnancy; with normal placental microcirculation indices, a course of "Basic Therapy" is carried out: the knee-elbow position 3-4 times a day for 15 minutes, swimming, walking, wearing class 1 compression hosiery, phlebotonics in a prophylactic dose; with decreased perfusion and signs of venous congestion, a course of "Basic Therapy" and "Stage 1 Therapy" is carried out: phlebotonics in a therapeutic dose for a course of 1-2 months with repetition, acetylsalicylic acid at a dose of 60-100 mg / day for 4-5 weeks, dipyridamole, phytosedatives to correct vegetative tone; then, at 20-21 weeks of pregnancy, a repeat assessment of placental microcirculation is performed, and additional placental elastography is performed;If microcirculation parameters are stable or improving, elastography is normal, a course of "Stage 1 Therapy" is carried out, control is carried out after 6-8 weeks; if microcirculation is unchanged, elastography is normal, a course of "Stage 2 Therapy" is carried out: the phlebotonic is changed or added, Actovegin orally; if microcirculation disorders persist or worsen, according to elastography data there are signs of decreased elasticity, a course of "Stage 3 Therapy" is carried out: Actovegin intravenously drip, phlebotonics, Omega-3 preparations, antioxidant vitamins C, E.