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The use of complex metabolic therapy in the treatment of patients with polycystic ovary syndrome. Types and features of therapy for pregnant women Metabolic therapy when planning pregnancy scheme

The body of a healthy person is a balanced system of a huge number of metabolic processes. The substances that participate in them are called metabolites. Metabolic therapy is the treatment of various ailments at the cellular level using a group of effective agents - natural metabolites.

What is metabolic therapy?

Today, metabolic therapy is one of the few ways to restore the normal functioning of all vital systems and organs. It helps to bring reserve cells out of “sleep” and they begin to perform the functions of damaged or dead ones. Very often, metabolic therapy is used for multiple sclerosis and various hereditary and genetic diseases. In addition, it is used to treat:

  • monogenic syndromes;
  • decreased spinal cord function;
  • mitochondrial diseases;

Vascular-metabolic therapy is widely used to treat disorders. This method also shows good results in the fight against serious diseases of the nervous system. In combination with other methods, metabolic therapy helps restore hormonal balance in overweight patients. And for endometriosis and menopausal disorders, the clinical effect of this type of treatment is achieved in just 2-3 weeks.

Precautions when using metabolic therapy

Metabolic therapy in cardiology, gynecology and neurology gives a positive effect in most cases. But the treatment process must begin as early as possible after diagnosis, since the time factor plays a very important role in it. For example, it is advisable for patients to start taking medications within a year, only then can they count on an almost complete recovery.

In gynecology and neurology, metabolic therapy is often used because it has no side effects.

But still, some precautions must be observed when using it:

  1. Firstly, you should not self-medicate. Only a doctor can determine which medications a patient needs.
  2. Secondly, metabolic therapy in neurology and cardiology should be carried out only in a comprehensive manner! If even one drug is excluded from the treatment system, complete recovery may never occur.

According to medical statistics, placental insufficiency develops in approximately 24% of expectant mothers. There are a number of special medications available to treat this pregnancy complication.

The placenta (the so-called baby's place) is the organ through which nutrition, respiration of the fetus and the removal of processed metabolic products occur. Two complex systems of blood vessels converge in this organ. One of them (maternal) connects the placenta with the vessels of the uterus, the other (fetal) passes into the umbilical cord arteries leading to the fetus. Between the two vascular systems there is a membrane (one layer of cells), which acts as a barrier between the body of the mother and the child; Thanks to this membrane, the blood of the mother and fetus does not mix.

The placental barrier is impenetrable to many harmful substances, viruses, bacteria. At the same time, oxygen and substances necessary for life pass without problems from the mother’s blood to the child, just as waste products from the fetus’s body easily enter the mother’s blood and are then excreted through her kidneys. The placental barrier performs an immune function: it allows the protective proteins (antibodies) of the mother to pass through to the child, ensuring its protection, and at the same time delays the cells of the mother’s immune system that can cause a reaction of rejection of the fetus, recognizing it as a foreign object. In addition, the placenta produces hormones that are important for successful pregnancy, and enzymes that destroy harmful substances.

What is placental insufficiency?

During an unfavorable pregnancy, the function of the placenta may be impaired. So-called placental insufficiency occurs, in which the process of placental maturation is disrupted, uteroplacental and fetal-placental blood flow is reduced, gas exchange and metabolism in the placenta is limited, and the synthesis of its hormones is reduced. All these changes determine the insufficient supply of oxygen and nutrients to the fetus, slow down its growth and development, and aggravate existing pregnancy complications.

Placental insufficiency syndrome occurs at different levels, so several forms of this disease are defined:

  • hemodynamic, caused by disturbances in the vessels of the utero-placental-fetal blood flow;
  • placental-membrane, characterized by a decrease in the placenta’s ability to transport various substances and oxygen;
  • cellular, associated with metabolic disorders in the cells of the placenta. There are primary and secondary placental insufficiency.

Primary(early) placental insufficiency develops before 16 weeks of pregnancy, occurring during the formation of the placenta. Its causes are often uterine pathology: uterine fibroids (benign tumor), uterine malformations (saddle-shaped, small, bicornuate), previous abortions, hormonal and genetic disorders. In some cases, primary placental insufficiency becomes secondary.

Secondary(late) placental insufficiency, as a rule, occurs against the background of an already formed placenta after 16 weeks of pregnancy. In the occurrence of late placental insufficiency, infections, gestosis (complications in which the functioning of all organs and systems of the pregnant woman’s body are disrupted, most often they are manifested by increased blood pressure, the appearance of edema, protein in the urine), the threat of miscarriage, as well as various diseases of the mother (arterial hypertension, dysfunction of the adrenal cortex, diabetes mellitus, thyrotoxicosis, etc.).

Regardless of the factors contributing to the development of placental insufficiency, it is based on circulatory disorders in the uteroplacental complex, leading to disruption of all functions of the placenta.

A change in the respiratory function of the placenta is indicated by symptoms of fetal hypoxia - insufficient oxygen supply to it. At the same time, at the beginning of the disease, the woman pays attention to increased (erratic) motor activity of the fetus, then to its decrease. Chronic fetal hypoxia and disruption of the nutritional function of the placenta lead to intrauterine growth retardation. Manifestation of intrauterine retention fetal development is a decrease in the size of the pregnant woman’s abdomen (abdominal circumference, height of the uterine fundus) compared with indicators characteristic of a given period of pregnancy. Violation of the protective function of the placenta leads to intrauterine infection of the fetus under the influence of pathogenic (disease-causing) microorganisms penetrating the placenta. A fetus whose development occurs under conditions of placental insufficiency is at a much greater risk of trauma during childbirth and morbidity during the neonatal period.

Diagnosis of placental insufficiency

To diagnose placental insufficiency, the following are used:

  • Assessment of fetal cardiac activity. In addition to simply listening with an obstetric stethoscope, the most accessible and common method for assessing fetal cardiac activity is cardiotachography, which is based on recording changes in fetal heart rate depending on uterine contractions, the action of external stimuli or the activity of the fetus itself in the period after 28 weeks of pregnancy.
  • Ultrasound examination (ultrasound). At the same time, the size of the fetus and its correspondence to the gestational age are determined, the location and thickness of the placenta, the correspondence of the degree of maturity of the placenta to the gestational age, the volume of amniotic fluid, the structure of the umbilical cord, and possible pathological inclusions in the structure of the placenta are assessed. In addition, the anatomical structure of the fetus is studied to identify abnormalities of its development, as well as the respiratory and motor activity of the fetus.
  • Doppler. This is a variant of ultrasound examination, which evaluates the speed of blood flow in the vessels of the uterus, umbilical cord and fetus. The method allows you to directly assess the state of blood flow in each of the vessels in the second half of pregnancy.
  • Laboratory methods. They are based on determining the level of placental hormones (estriol, human chorionic gonadotropin, placental lactogen), as well as the activity of enzymes (oxytocinase and thermostable alkaline phosphatase) in the blood of pregnant women at any stage of pregnancy.

Based on a comprehensive examination, a conclusion is made not only about the presence or absence of placental insufficiency, but also about the severity of such a disorder. The tactics of pregnancy management for different degrees of severity of placental insufficiency are different.

Prevention and treatment

At present, unfortunately, it is not possible to completely relieve a pregnant woman from placental insufficiency using any therapeutic interventions. The means of therapy used can only help to stabilize the existing pathological process and maintain compensatory and adaptive mechanisms at a level that allows for the continuation of pregnancy until the optimal date of delivery. Therefore, it is very important to carry out prevention in women who have risk factors for developing placental insufficiency.

The leading place in prevention is the treatment of the underlying disease or complication, which may lead to placental insufficiency. An important condition is for the pregnant woman to follow an appropriate regimen: adequate rest (sleeping on the left side is preferable), elimination of physical and emotional stress, staying in the fresh air for 3-4 hours a day, and a rational, balanced diet. The course of prevention includes multivitamins, iron supplements, breathing exercises to increase oxygen delivery through the lungs, the use of amino acids, glucose, Galascorbine, potassium orotate, ATP, which serve as a direct source of energy for many biochemical and physiological processes.

With initial signs of placental insufficiency, treatment is possible in a antenatal clinic with a repeat ultrasound examination with Doppler 10-14 days after the start of treatment. With more severe placental insufficiency, especially in combination with other complications of pregnancy or general diseases of the mother, hospitalization in a hospital is required. The duration of therapy should be at least 6 weeks (in a hospital, with continuation of therapy in a antenatal clinic). If this pathology is detected and appropriate therapy is carried out in the second trimester, to consolidate the effect of the first course, treatment should be repeated at 32-34 weeks of pregnancy.

If indicators deteriorate during treatment, signs of decompensation of placental insufficiency appear, determined by a sharp deterioration in the condition of the fetus and the possibility of its death, emergency delivery by cesarean section is indicated, regardless of the gestational age.

Special drug therapy

With initial signs of placental insufficiency, treatment is possible in a antenatal clinic.

Currently, for the treatment of placental insufficiency, there are a large number of medications aimed at eliminating disturbances in the uteroplacental-fetal blood flow and increasing the fetus’s resistance to oxygen starvation. Each of these drugs has its own point of application, its own mechanism of action.

Drugs that help relax the uterine muscles (tocolytics) - Partusisten, Ginipral, Magne-B 6. Periodic increases in uterine tone contribute to circulatory disturbances in the placenta, while small doses of tocolytics reduce vascular resistance at the level of small arteries and lead to a significant increase in uteroplacental blood flow . When using Ginipral and Partusisten, an increase in the mother's heart rate (tachycardia), a decrease in blood pressure, tremor of the fingers, chills, nausea and anxiety are possible. To prevent tachycardia, Verapamil and Isoptin are prescribed in parallel with medications. Contraindications to the use of Ginipral and Partusisten are thyrotoxicosis (increased thyroid function), heart disease, and bronchial asthma.


Eufillin and no-spa have a vasodilating effect and reduce peripheral vascular resistance. Trental (pentoxifylline), in addition to its vasodilating effect, can improve the rheological properties (fluidity) of blood and circulation in small capillaries (microcirculation). Side effects of these drugs are heartburn, nausea, vomiting, and headache. Contraindications to the use of pentoxifylline are low blood pressure (hypotension), Euphylline is an increased function of the thyroid gland, heart disease, epilepsy.

With placental insufficiency, there is a chronic disorder of blood coagulation (increased activity of platelets and plasma clotting factors). Therefore, for treatment, drugs are used that prevent the formation of blood clots in blood vessels - antiplatelet agents (Aspirin, Curantil). These drugs, in addition to improving blood rheology, have a dilating effect on small arteries, causing a significant increase in blood flow speed. They do not cause dilation of all blood vessels and the associated relative drop in blood pressure, and at the same time increase metabolism without a simultaneous increase in oxygen consumption. Curantil can be taken starting from the first trimester of pregnancy. Antiplatelet agents are contraindicated in women with gastric and duodenal ulcers, bleeding and recent surgical interventions. Due to the risk of bleeding during childbirth, these drugs are discontinued at 34-36 weeks of pregnancy.

Actovegin increases the resistance of the brain and fetal tissues to hypoxia, activates metabolism, increases glucose consumption, and stimulates the renewal of fetal cells. In addition, the drug increases blood circulation in the mother-placenta-fetus system and promotes better tolerance of the birth act to the fetus. Treatment with Actovegin has a pronounced effect on the condition of the fetus. This is reflected in improved blood flow and improved fetal growth, which reduces the incidence of forced early delivery. The drug is obtained from the blood of calves, has a minimum of side effects, and allergic reactions are quite rare. Contraindications to the use of the drug are heart failure and pulmonary edema. In women with recurrent miscarriage and serious diseases (diabetes mellitus, arterial hypertension, pathology of the thyroid gland, heart, liver), Actovegin is prescribed to prevent placental insufficiency in courses of 2-3 weeks, 2-3 times per pregnancy.

Considering the most important neutralizing function of the liver, as well as its decisive role in the production of proteins and blood coagulation factors, in the complex treatment of placental insufficiency it is advisable to use hepatoprotectors - drugs that protect the liver (Essential-ale, Hepatil). They have a normalizing effect on the metabolism of fats, proteins and liver function. The drugs have minimal side effects; some patients report discomfort in the stomach and liver. Chophytol is a purified extract of field artichoke leaves. In addition to its hepatoprotective properties, Hofitol contains many macro- and microelements, including iron, manganese, phosphorus, vitamins A, B and C. In addition, the drug has pronounced antioxidant properties. Hypoxia, which occurs against the background of placental insufficiency, leads to an increase in the number of free radicals, which have a damaging effect on cells. Hofitol improves protection against free radicals, which has a positive effect on placental function. Hofitol is contraindicated in case of cholelithiasis, acute diseases of the liver, biliary and urinary tract.

An important condition is adequate rest.

Instenon is a combined drug that improves cerebral circulation, heart function and metabolism in the fetus under hypoxic conditions. It is used in combination with other drugs for the treatment of placental insufficiency in order to avoid the negative consequences of hypoxia on the fetal nervous system. While taking the drug, you should avoid drinking coffee and tea, as they weaken its effect. The most common side effect with its use is headache. Instenon should not be used in a state of severe agitation and convulsions, manifestations of increased cerebral pressure (its signs: prolonged headache, vomiting, blurred vision), epilepsy.

The indications for choosing a particular drug are determined by the doctor, based on the form of placental insufficiency. If the main cause is circulatory disorders, then drugs that affect blood vessels are prescribed. If the basis is cellular disorders, then drugs that affect tissue metabolism. Combinations of several drugs are often used.

In conclusion, I would like to emphasize: placental insufficiency is a serious complication of pregnancy, in which independent use and withdrawal of even the most harmless medications is unacceptable. This pathology requires close medical supervision.

Ekaterina Svirskaya,
obstetrician-gynecologist, Minsk

2010-01-14 12:39:23

Galina asks:

Hello. I am 35 years old. When planning a pregnancy, the doctor prescribed Aevit as part of metabolic therapy, 1 capsule 2 times a day, from days 5 to 15 of the cycle. So that the eggs are complete. And now, it seems, the long-awaited pregnancy has arrived. And I learned that retinol in such a huge dose is poorly excreted from the body and causes serious deviations in the development of the fetus. The gynecologist, with a professorial title, did something stupid, and it was me and the child who had to pay. Tell me, is everything so terrible or is there at least some hope? Pregnancy, approximately 2.5 weeks.

Answers Silina Natalya Konstantinovna:

Good afternoon. 2 capsules of Aevit do not contain a huge dose of retinol, so take it easy and enjoy your pregnancy. In addition, undergo prenatal biochemical screening at 9-14 weeks.

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The human body is an extremely balanced system of millions of metabolic processes. Metabolic reactions are interconnected by a self-regulation mechanism. Obviously, a deviation or defect in any reaction can be the cause of the disease. It is also obvious that the treatment of such a disease must act specifically on the damaged link in the metabolic chain. This effect is best achieved by using metabolic drugs of natural origin. Therefore, all these drugs are safe, do not cause complications and have no side effects.

I recently learned about metabolic therapy. I decided to try my own regimen, taking into account the fact that in addition to preparing for pregnancy, I need to strengthen my blood vessels (my eyes often turn red) and my heart (tachycardia, etc.). I need to start metabolic therapy 3 months before the planned conception.

So, my scheme:

1. Combination cocarboxylase-riboflavin-lipoic acid. You can give injections, you can use suppositories Korilip, all this is contained there, 1 time per day. These candles are inexpensive, 40 rubles. You need to use them for 10 days, then take a break for 20 days. My husband takes lipoic acid tablets, it really helps to lose weight, I took the tablets for several days, my appetite calmed down a lot, I had a feeling of lightness in my stomach and good digestion. I will drink it during the break between courses of suppositories.

2. Vitamin E-one capsule per day. My husband drinks capsules, I drink Vetoron-water-soluble vitamins E, A and C, 10 drops in half a glass of water once a day. Regarding the fact that vitamin E contains Ponceau dye, many people say, “Why are they pushing dyes everywhere?” But vitamin E is destroyed very quickly in light, and in order to protect it as much as possible from destruction, the capsules are painted with this dye, and the bottle is also made of dark glass. I think there is nothing dangerous in such a dose of dye. In addition, in cheap capsules (in blisters), the capsules are also red, but the dyes are not indicated in the composition! These vitamins cost 300 rubles for 30 capsules, dosage 400 mg (maximum daily dose!!!). During pregnancy, even if I take vitamin E as prescribed by the doctor, only in the minimum dosage, because The benefits of these vitamins have not been proven.

3.Folic acid. Of course everyone knows about her. But I bought Folio, which contains the daily requirement of folic acid, specifically for those planning a pregnancy, and iodine. My husband drinks them, while I take an American vitamin B complex, it contains folk. Before using Folio, I will consult with an endocrinologist, because... there are problems with the thyroid gland. These tablets cost 300 rubles.

4. Askorutin. A combination of ascorbic acid and rutin. I take 1 tablet 2-3 times a day to protect blood vessels. They cost 30 rubles for 30 pieces.

5. Carniton. Well-known L-carnitine, used for male infertility, increased physical activity, for weight loss and stress. It is better to consume it in liquid form, so it is better absorbed. I haven’t bought any drops yet, the drops cost 250 rubles.

6. Riboxin- a drug that has a positive effect on the metabolism and energy supply of body tissues. Taking this drug leads to a decrease in tissue hypoxia, and therefore women are often prescribed Riboxin during pregnancy. The drug has an antiarrhythmic effect (normalizes heart rhythm), normalizes coronary circulation, and also helps to increase the energy balance of the myocardium. Riboxin is involved in glucose metabolism and stimulates metabolic processes in the absence of ATP and in the presence of hypoxia.

I take it for my heart, my cardiologist prescribed it to me, but it is also included in the standard regimen. It is taken BEFORE meals, unlike all other tablets.

succinic acid-It’s not included in the regimen, but I take it for 30 days, then a 30-day break. Can be combined in different ways with equal breaks. Speeds up metabolism, helps with mental and physical stress (and with hangovers:)) During the research, it was found that the use of succinic acid allowed living cells to absorb oxygen more intensively. It has also been proven that it increases the body's resistance to external adverse factors. It relieves stress, normalizes the production of new cells, and restores energy metabolism.

Also in the diagram there is Actovegin, it’s expensive, I haven’t started using it yet, I’ll still consult with a doctor to see if it’s worth it.

Magne B6 is in this scheme, because the doctor prescribed it for me Panangin to maintain cardiac function, and it contains potassium and magnesium.