The Specific Features of the Course and Efficiency of Preventive Therapy for Gestosis in Multiple Labors

Abstract

Objective: to study the course of gestosis in multiple labors and the impact of preventive therapy (a prospective study). Subjects. A hundred and fifty-eight females in the third trimester, including 108 multiparas with gestosis were examined (a study group). The study group was also divided in 2 subgroups: 1) 58 multipara pregnant females having a complete prenatal preparation in accordance with the current reasons for the treatment of gestosis and for the prevention of its complications; 2) 50 multipara pregnant females having a partial antenatal preparation due to late admission or to the onset of labor activity, which required accelerated delivery. A control group comprised 50 multiparas without gestosis. Methods. Clinical, statistical, and calorimetric studies using sets of commercial reagents (Boenringer Mannheim (Germany)); plasma hematocrit (determination of OTsK) and calculation (determination of OPTs and OTsE) methods. Results. Complex preventive therapy used in multiparas with gestosis promoted the occurrence of clinical remission in 82.7% of subgroup 1 pregnant females. After therapy, the critical forms of gestosis, diagnosed in 16% of subgroup 2 pregnant females, were observed in only 5.2% of subgroup 1 females. However, in patients with baseline severe nephropathy, the effect was temporary, which testified to a severe impairment of protective and adaptive mechanisms and to significant catabolism in multiparas with gestosis. The values of OTsK, OPTs, and OTsE in multiparas tended to decrease particularly in subgroup 2 of the study group. In multipara, progressive gestosis was accompanied by a pronounced decrease in the blood levels of proteins with a relatively compensatory rise in their concentration and, to a lesser extent, in that of globulins, suggesting the tension of metabolic processes in the body. Gestosis in multipara was attended by impairments in all hemostatic links, as compared to the control group. There was a significant decrease in the venous blood count of platelets, an increase in the level of hematocrit, and a reduction in the times of clotting and recalcification; there were also rises in the prothrombin index and fibrinogen levels. Conclusion. The findings lead to the conclusion that hemodynamic and hemostatic disorders are reversible when the treatment for mild and moderate gestosis is correct and is initiated in due time. At the same time, no benefit from the performed therapy testifies to the stability and refractoriness of metabolic shifts in severe gestosis during multiple labors.