STELLA S.LUBYANAYA, RUSLAN A.LYTKIN, OKSANA V.TKACHENKO DEPARTMENT OF OBSTETRICS, GYNECOLOGY AND PERINATOLOGY, LUGANSK STATE MEDICAL UNIVERSITY, UKRAINE A NEW APPROACH TO THE PLACENTAL DYSFUNCTION THERAPY WITH THE USE OF L-ARGININE

Introduction Placental dysfunction is included in the International Classification of Diseases, Injuries and Causes of Death as a primary diagnosis of pathological condition of the fetus and newborn. Almost all the complications of pregnancy are accompanied by the development and growth of placental dysfunction (PD).

The prevalence of placental dysfunction The incidence of this pathology in miscarriage is 50 to 77% Extragenital pathology – 45%Preeclampsia – 32% The fetus, developing in low placental perfusion…

Causes of Placental Dysfunction Early IUGR/PELater IUGR Placental hypoperfusion Maternal predisposition Different pathogenic pathways

Тhe "mother-placenta-fetus" system Тhe physiological balance of vasoconstrictors and vasodilators

.

The manifestations of endothelial dysfunction intravascular thrombosis in the fetoplacental complex errors of metabolism NO enhanced adhesion and aggregation of platelets complications of pregnancy

Synthesis of nitric oxide

Since 1992, when Nitric oxide was named "Molecule of year a large number of clinical studies in Perinatology have been made. 9

System L-arginine-NO 10

The endothelium-dependent mechanisms of L-arginine

Тіvortin ® - donator of nitrogen oxide! 12

The purpose of the study - is to evaluate the effects of L-arginine (4.2 g / day) in the treatment of placental dysfunction in pregnant women.

Study Design 79 women age at the term of w of pregnancy with impaired blood flow in utero-placental pool Control group n= 26 with uncomplicated obstetric history and no signs of FPD in w 2 nd group (comparison) n=26 with a basic standard therapy of FPD 1 st group (main) n=53 who received a sequential therapy with Tivortin®

Methods of research 4 clinical analysis of pregnancy and childbirth (n=79) identification marker NO in the blood serum ultrasound and Doppler study of the utero-placental blood flow at 16 w, of fetal- placental blood flow at 24 w estriol levels in venous blood at w gestation by IFA 5 mathematic analysis of the results

The frequency of complications of pregnancy in women

Results of pregnancy outcomes

Doppler study

Frequency of the blood flow disturbances Blood flow disturbances Before the treatment at weeks After the treatment at weeks 1st group (n=53) 2nd group (n=26) 1st group (n=53) 2nd group (n=26) Only the uterine arteries 9/17%5/19.2%3/5.7%*3/11.5% Umbilical artery 6/11.3%4/15.3%2/3.8%3/11.5% Middle cerebral artery 3/5.7%2/7.7%- Umbilical artery and uterine arteries 7/13.2%3/11.5%2/3.8%2/7.7% Violations at all levels 2/3.8%1/3.8%- Total27/50.9%15/57.7%7/13.2%*11/42.3%

Doppler study The main (1st) group

The blood flow violations

Estriol (at weeks)

Perinatal pathology

Weight of newborns

Damaging the endothelium Decreased glomerular filtration rate and renal blood flow Activation of the hemostatic system Reduction of oxygen transport function of erythrocytes Decreased functionality of the placenta

Mechanism of L-arginin action NORMALIZATION OF THE UTERO-PLACENTAL BLOOD FLOW NORMALIZATION OF THE UTERO-PLACENTAL BLOOD FLOW NO SDR the speed of blood flow

Conclusion 1 The new approach in the fetoplacental dysfunction treatment and the perinatal complications prevention in pregnants is the use of L-arginin solution in sequential therapy. It helps to reduce the frequency of FPD in 4.5 times, IUGR in 4 times, preeclampsia in 1.7 times, preterm birth in 2 times, and fetal distress during pregnancy by 9.6% and improved the quality of utero-fetal- placental blood flow after treatment by 37.7%.

Conclusion 2 1 step а solution of 4,2% Tivortin® ( L-arginine hydrochloride) to 100ml intravenously for 10 days 2 step Tivortin® ( L-arginine aspartate) orally 5 ml 3 times per day for 14 days

Conclusion 3 Tivortin has a great future in obstetric practice because is one of the few drugs that have been certified for use in pregnancy. But to reveal all its therapeutic possibilities we need further studies.

No matter what causes the disease, it is important what eliminates it. Aulus Cornelius Celsus.