Ведение беременных с дефицитом магния: фармакоэпидемиологическое исследование

Background: no multicenter studies to assess the prevalence of Magnesium (Mg) deficiency in the general population, particularly among pregnant women have been previously conducted in Russia. Objectives: to evaluate Mg deficiency incidence and management in a pregnant population monitored in Russian polyclinics. Materials and Methods: pregnant women (at any trimester) aged over 18 years were included. Mg deficiencies due to any other concomitant condition were exclusion criteria. Data coming from medical records were collected at Visit 1 and visit 2 (1 month +/- 1 week): complete medical history; diagnosis of Mg deficiency confirmed by serum Mg level (<0.7 mmol/l) routine laboratory tests performed in the course of current practice (blood count, Mg plasma determination and urinalysis) and evaluation of total score (superior 30) using a structured 28 questions self-administrated Magnesium Deficiency Questionnaire (MDQ). Spontaneous reports of adverse reactions were collected. The statistical tests were applied according to type of variable distribution (the Shapiro-Wilkestest) and the estimation of equality of variances (Levene's test of Homogeneity of Variance). If two terms were true the Student’s t-test was used, alternatively the Wilcoxon-Mann-Whitney-Test was used. Paired samples t-test or Wilcoxon test were run for the comparison of changes in study continuous variables. Chi-square (χ2) and Fischer's exact tests were used for comparisons of categorical data. Results: 1130 pregnant women, mean age 28.95±5 years were included. Estimated combining prevalence of Mg deficiency according to the blood plasma levels (<0.7 mmol) and MDQ was 81,2%. It was observed that physicians commonly prescribe different organic Mg salts to pregnant women with Mg deficiency as a routine practice. Thus, Mg was prescribed to 1110 pregnant women: 84.1% received Mg Citrate (933/1110) and 21.3% (177/1110) Mg lactate. At the 1 visit the Mg deficiency according to MDQ score analysis was observed in 80.3% (870/1083) and at the end of the program only 5.75% (62/1083; р<0,001) presented Mg deficiency. An improvement of Mg deficiency signs evaluated using a MDQ was observed. Thus, the mean MDQ score significantly decreased by 22.6±11.9 points (Baseline: 15.8±7.9; Final visit 38.3±13.4 points; р<0,001). During the observational registry period one ADR was reported as an allergic dermatitis in a woman receiving Mg Citrate. Conclusions: the study identified a high prevalence of Mg deficiency in pregnant women population. The prevalence of Mg deficiency was 81.2%. It was observed that organic Mg salts are commonly prescribed by physicians to pregnant women with established Mg deficiency and statistically significant improvement in Mg deficiency signs in pregnant women receiving organic Mg salts was observed. To confirm these findings in other populations leaving across the Russian Federation, it is necessary to conduct an additional study with increased sample size, especially considering the age distribution of the population (women of childbearing age) and the life style.Многоцентровые исследования по оценке распространенности дефицита магния у беременных женщин в России ранее не проводились. Цель: оценка распространенности дефицита магния и особенностей амбулаторного ведения врачами беременных пациенток с дефицитом магния в реальной медицинской практике. Материалы и методы: в исследование были включены беременные женщины старше 18 лет (в любом триместре беременности). Дефицит магния в связи с другими причинами являлся критерием исключения. Сбор данных проводился в течение двух визитов (2-й визит – через 1 мес. +/- 1 неделя после первого). Дефицит магния оценивался при помощи стандартизированного опросника (28 вопросов) и подтвержден данными объективных тестов. Статистические данные обрабатывались в соответствии с типом переменной распределения (тест Шапиро-Уилкса) и оценки равенства дисперсий (критерий Левена – однородности дисперсии). Результаты: в исследовании приняли участие 1130 беременных женщин, средний возраст – 28,95±5 лет. Распространенность дефицита магния у беременных по общей оценке уровня магния в плазме крови (<0,7 ммоль) и данных анкетирования составила 81,2%. Врачи для беременных женщин с дефицитом магния в рутинной практике часто назначают различные органические соли магния. Таким образом, препараты магния были назначены 1110 беременным женщинам: 933 получили цитрат магния и 177 – лактат магния. Дефицит магния, по результатам анкетирования, значительно уменьшился: с 15,8±7,9 балла на первом визите до 38,3±13,4 балла на последнем; р<0,001. Выводы: исследова ние выявило высокий уровень распространенности дефицита магния у беременных женщин. Распространенность дефицита магния составила 81,2%. Для беременных женщин с установленным де-фицитом магния врачами назначаются органические соли магния в комбинации с пиридоксином, характеризующиеся высокой эффективностью и безопасностью

SAFETY ASPECTS OF USING DROTAVERINE IN OBSTETRIC PATIENTS

Summary Safety of pharmacotherapy during pregnancy is of paramount importance for the woman and the fetus. There is an increasing number of pediatric diseases with unclear or presumably genetic etiology (autism, mental illness, oncology, obesity, diabetes, etc.). In this respect, more attention is being paid to the epigenetic or fetal programming, and the safety of pharmacotherapy during the gestation period and lactation, as well as 3-9 months before conception (periconception period)

Oxidative stress, endothelial dysfunction, cytokine imbalance, gonadotropic synergism, or all about tocopherol in the practice of an obstetrician-gynecologist

Generation of reactive oxygen species (ROS) occurs in every human. The condition of oxidative stress develops when the human antioxidant defenses including the enzymes superoxide dismutase, peroxidases etc., and biological antioxidant molecules, are insufficient. Vitamin E is part of the antioxidant family. It plays a key role in neutralizing ROS, and its scope of activity ranges from the inhibition of heme biosynthesis and lipid peroxidation to maintaining the collagen/elastin balance. Vitamin E deficiency may be either primary or secondary; both shift the balance towards the development of oxidative stress, which may affect the normal course of pregnancy. As a result, pregnancy loss or preterm birth may ensue. Moreover, the oxidative stress can have a negative impact on the development of a fetus. In addition, the oxidative stress may play a role in various female reproductive disorders, eventually leading to infertility. In the today’s world, the popular commitment to low-cholesterol and low-fat diets often leads to an increasing number of women with vitamin E deficiency. In order to maintain normal pregnancy, this imbalance requires an adequate correction starting at the stage of preconception care

CLINICAL CASE OF EXTRAUTERINE PREGNANCY, LOCATED IN RUDIMENTAL UTERINE HORN AT 21-22 WEEK OF GESTATION

In article the question is a case of extrauterine pregnancy in term of 21-22 weeks in the rudimentary horn of a uterus in term of 21-22 weeks interrupted because of break of a horn with an intrabelly bleeding. The operation and tactical approaches to conducting the given case are described