Bila V. The preterm labour pathogenic treatment.

Preterm delivery is a severe complication of pregnancy, one of most frequent causes of perinatal mortality and morbidity. Modern science achievements let to save life to newborns up to 22 weeks gestational age. But their health status continues to be a serious problem. The question also has a financial side - medical care to small gestational age children is too expensive. According to statistic data, 30% of preterm delivery cases have a period of uterine contractions without irreversible cervix structure changes and membrane rupture. Use of effective tocolytic drug can prevent preterm delivery. Plenty of investigations devoted to problem are not enough to explain either reason of preterm contractive activity or universal ways of it's prevention. Two possible mechanisms of preterm labor are considered - infective -inflammatory and thrombophilic ones. Pregnant women with preterm uterine activity an acute or chronic inflammatory process are characterized by increased level of proinflammatory cytokines, beside them interleukin-1 and interleukin-6. Biological effects of these substances directed on eucosanoid synthesis, has as a result, preterm miometrium contraction. The other group of patients, whose complaints of rhythmic low-abdominal pain are associated with arterial or venous thrombosis, fetal loss syndrome and subclinical thrombophilie symptoms, have other proportion of cytokines. The normal or, in most cases, decreased level of proinflammatory interleukin-1 and interleukin-6 are combined with decreased level of antiinflammatory interluekin-8 and interleukin-10. Such changes and also revealed by research increased non-conjugated estradiol concentration are markers of placental endothelium dysregulation. The acquired nature of trombophilia is confirmed by definition of antiphospholipid antybodies circulation. Also the diagnostic role of mucin-16 decreased level for identification of trombophilic preterm labor pathogenesis is proved. According to pathogenic differences in preterm labor activity, an improved treatment scheme is offered. To traditional therapy, that includes betta-adrenergic receptor agonist and calcium channel blockers, in cases of preterm labor inflammatory genesis an antibiotic and cyclo-oxigenase inhibitor indomethacine were added. In complex treatment of patients with preterm labor and trombophilia symptoms a drug, that improves rheologique blood ability -dipiridamolum- additionally to traditional scheme was included Using of such pathogenic widen therapy let to improve it?s results. Among patients with inflammatory pathogenesis of preterm uterine activity by using antibiotic and indomethacine frequency of delivery in 48 hours after beginning of therapy was 2 times less, then by traditional scheme. Also higher was part of women, whose delivery occurred in physiological terms. Addition of dipyridamole to complex treatment of patients with thrombophilic mechanism of preterm labor also led to statistical decreasing of preterm delivery.