CLINICAL REPORT: USE OF ORAL ADSORBENT ENTEROSGEL IN
THE COMPLEX TREATMENT OF GESTOSIS
Karalkina Е.А.
Institute of pediatrics, obstetrics and gynecology, Ukrainian National Academy of Medical
Sciences, Kyiv, Ukraine
PhD studies, Kyiv, 1991
Summary
Treatment of gestosis remains a challenge while it is the cause of serious complications for both
mother and fetus.
A chain of pathological reactions during gestosis is usually triggered by humoral factors due to
ischemia of the placenta and uterus. Increased concentrations of medium-weight compounds,
myoglobin, circulating immune complexes (CIC) and the development of autoimmune processes
correlates with the severity of endogenous toxic syndrome during gestosis.
The use of medication and physical therapy is not always effective in treating gestosis, so
currently new, safe treatments are being researched and developed. Currently we have unique
data on detoxification therapy of intestinal adsorption method used in gynecologic and obstetric
practice.
Objectives
To form a set of therapeutic measures for treatment of pregnant women with gestosis, including
intestinal sorption with Enterosgel.
To evaluate the effectiveness of use of Enterosgel in the complex treatment of late pregnancy
gestosis by monitoring the levels of some toxic metabolites (medium-weight compounds,
myoglobin), as well as immunological parameters (CIC and IgЕ).
Materials and Methods
In the reference group there were 204 patients in the week of pregnancy from 28 to 37: of them
184 had gestosis and 20 were healthy. Women with gestosis (n = 184) were divided into two
groups according to the applied therapy.
Group 1 (control) included 124 pregnant women who received conventional basic therapy
corresponding to methodological recommendations for the care of pregnant women with late
gestosis.
Group II (experimental) comprised 60 women who received comprehensive treatment: a
standard base therapy and absorbent Enterosgel
Women with the normal pregnancy (n = 20) formed Group 3 (control).
In addition to routine clinical and laboratory monitoring, special examinations were conducted
before and after treatment: determination of IgE, CIC, level of medium-weight compounds and
myoglobin in the blood plasma, assessment of regional blood flow in the uterus and fetal
biophysical profile using ultrasound scan.
Results
On monitoring before treatment, nephropathy was detected in 86 women in the first group of
pregnant detected; in Group 2, in 47 women. On admission in women with gestosis CIC level
was increased (max. 3.5 times, min 2.5 times), myoglobin levels elevated twice, and amount of
secondary molecules increased by average 1.75 times.
Due to treatment performed, all the subjects began to feel better, swelling reduced, arterial
pressure decreased, and these changes took place rapidly in women of the second group, where
adsorbent Enterosgel was the part of treatment.
It was noted that by Day 7 of treatment in all patients of Group 2 (taking Enterosgel) values
of endogenous toxic syndrome in blood plasma decreased:
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level of medium-weight compounds reduced twice; within 14 days, these levels
corresponded to those of healthy women;
number of large and small CIC decreased twice, and 2.5-fold in 14 days - at this level it
was maintained until the end of treatment. In Group 1, the level of CIC substantially
changed in only 14 days, the level of large CIC decreased to 8.35 IU, small - to 19.87
IU;
content of IgЕ significantly decreased by 1.8 times, and within 14 days its level
normalized. In the first group IgE levels in the blood of patients remained increased to
the delivery date f;
myoglobin levels by day 7 decreased by 1.5 times and reached complete norm by day 10
-14 of treatment, while in conventional basic therapy they remained significantly
elevated in this period for all gestosis forms.
In pregnant women from Groups 1 and 2 spastic condition of uterine vessels and hindered blood
flow to the uterus was found before treatment. Within 7 days of administration of Enterosgel
blood flow of uterine vessels of medium and small diameter significantly improved. Treatment
based on the current scheme did not lead to improved blood flow to the uterus within 7 days,
after 14 days of treatment a slight improvement was observed.
Examination of the fetal biophysical profile before treatment showed presence of distresssyndrome of the fetus in Groups 1 and 2, which could be due to disruption of blood circulation of
uterus and placenta and the development of metabolic acidosis in the fetus. During treatment,
transformation of non-stress non-reactive test for reactive non-Stress test was determined in
Group 2 of pregnant patients already by Day 7 from the start of treatment, in the control group by Day 14.
Conclusions
1. Gestosis is characterized by the development of endotoxic syndrome, which manifests itself
by increased level of myoglobin and medium-weight compounds in blood plasma.
2. In case of gestosis higher IgЕ and CIC levels are recorded, suggesting active autoimmune
processes.
3. In pregnant women with gestosi,s blood flow between the uterus and placenta is reduced at the
expense of increasing tone of medium and small vessels.
4. Complex therapy involving use of Enterosgel helps to detoxify the body effectively (reduced
myoglobin content and middle molecules in the blood), which leads to the fact that in the
pregnant women the load on liver and kidneys reduces.
5. Enterosgel helps to reduce the activity of autoimmune processes by Day 14 of treatment.
6. During therapy in combination with Enterosgel the performance of uterine blood vessels
slightly improves (due to the decrease of peripheral spasms).
7. During therapy in combination with Enterosgel fetal status improves 1.3 times faster by
improving the blood flow between the uterus and placenta.
8. Due to its safety and effectiveness Enterosgel can be recommended in obstetric practice.
Keywords: adsorbent, gestosis, nephropathy, medium-weight compounds, gestational toxicosis,
Enterosgel