APPLICATION OF HBO FOR TREATING OF DIABETES OF PREGNANTS.

Practical recommendations.

Diabetes of pregnants - is one of principal problems of perinatology: it causes hard complications of pregnant and fetus.

Latest investigations present that damaging of homeostasis of sicks is the result of hypoxy caused by a complex of various internal interactions.

Hypoxy caused by diabetes can be realize in many forms; but the principle is the insuline or substate one, which results in complete disorder of cellar bioenergetics. It is characterised by:

a)  transgressions in utiltsation of glucose;

b) violations of flesh respiration caused by reduction of activity of enzymes of anaerobic and aerobic glycolis;

c)production of different forms of hemoglobin; in particular of glycolised hemoglobin - HbAlc. Unfermental glycolisation of hemoglobin in erytrocites results in reduction of propagation of oxygen from blood to flesh, as HbAlc is weaker dissociating. The result of all of this is the reduction of tension of oxygen in blood; d) appearing of diabetic microangiopaties, development of flesh hypoxy.

Damages in transcapillar interactions, as a diabetic phenomenon, appear everywhere, in functional system mother-child; in this way the hypoxy is translated to the child.

As the responce the cell begins to gather uncompletely oxidised intermediate compounds (lactat, piruvat), lessens the production of macroerges and destruction of cell membranes and macromolecules, caused by activisation of processes of peroxidal form of oxidation of lipides (POL).

Such complications of pregnancy can result in hypoxy of fetus and sometimes in fetus death. Thus the prevention of hypoxy of pregnants is an important branch of complex antidiabetic therapy.

Many methods can be recommended to lessen the diabetes; these are medicines: antihypoxants, antioxidants; oxygenotherapy, physical methods, etc. HBO - is one of the most effective metods of healing of diabetic hypoxy. This method insistingly improves the concentration of oxygen in body by means of respiration in improved aerial tension of oxygen. The blood is sequientually saturated with oxygen idependent on the concentration of hemoglobin. The improvement of partial pressure of oxygen permites to regulate its concentration in tissue and normalise the respiratory metabolism (if the hypoxia is yet reversable).

HBO - is a new method in midvifal practice.

This is a strong method of influence on patient; it should be used carefully - oxygen can be a toxin in come cases; it can damage POL or other natural protective processes.

Reasons for use of HBO.

HBO is applied for the treating of diabetes, independent on its form and the degree of compensation.

1. If diabetes is slight, HBO therapy is a part of complex treatment and reduction of hypoxia (supported with disorder of acid-alkaline balance and of respiratory mix of blood, as well as by improvement of the joint concentration of xantin and guanin in blood up to 60 mmol/l).  The course on all the pregnancy period should include three everyday blocks of six procedures with the saturation of 0,3-0,5AT. 2. If diabetes is of middle degree, the HBO is compulsory to everybody; the pregnancy period should include three everyday blocks of six procedures (0,3-0,5AT each).

3. If diabetes is a hard, the HBO is also compulsory to everybody; the pregnancy period should include three or four everyday blocks of seven or eight procedures (0,7-0,8AT each) .  The procedures should be held just after the reception of food; special attention should be paid for sick with an accompanying hyperglikemia.

Contraindications.

There are absolute and conditional contraindications. The absolute are: epilepsy; damages in lung; otorhinolaryngologic diseases ; claustophobia. The conditional are: active reumatizm; acute infections; lung hypertension (3 class); nephropathy (3 class); preeclamy; eclumpsy.

The contraindications are as usual.

The method of persuing of HBO.

The procedures can be held in such chambers as: "Oka-MG"; "BL-T"; "BL-3", "BLK-3S"; "Enisey-3"; "Irtysh-MT" and other ones. The beginning of the first block should be no earlier than on 12-14-th week; other two or three ones - in critical periods: second one - on 24-26-th week; third - on 28-32-nd week; fourth (if needed) ­directly before the birth. Average exposition of the procedure would be 45-60 minutes; for every patient the exact exposition would be selected individually.

Before the course an investigation by therapeut, otorhinolaryngologist and endocrinologist should be held. Besides that other contraindications can be investigated.

HBO stuff should also compulsorily investigate the pregnant - that is to determine possible contraindications and to explain the woman what she should do and what shouldn't do in the chamber. Then the probe procedure for 20-30 minutes takes place.

Just before and after the procedure the following investigations would be done: blood tension; pulse index; electrocardiogram (for pregnant and fetus); if pressure is above 180/100 the procedure shouldn't be held. Ultrasonar investigations are also desirable.

The dress of pregnant should be made from cotton; all oils and creams should be removed from the skin.

The communication should be terminated for all the time of the procedure (by phone).

If the pain in ears appears, the speed of compression should be lessened; if that is useless, an otorhinolaryngologist should permit or not the continuation of the course.

The toxic influence of oxygen is displayed in peroxidal resistancy of eritrocites (PRE), according to Pocrovsky and Arbatov (1964), or outoerythrocitar hemoglobin, according to Karakashev and Vichev (1971). These methods are advantageous because free-radical oxidation of lipids results in destruction of membranes and liberation of hemoglobin from erythrocites.

The pregnants posess some outoerythrocital hemoglobin (so-called degree of "physiological hemolysis". All people posess such

hemoglobin, but the pregnants with accompanied diabetes - some more than others (because some eritrocites are weakly stable). HBO strengthens the membranes and killes these weak eritrocites. Thus, the PRE improves by 10-12%; the VEG value - by 10-15%.

If PRE is less than 8%, the membranes are stabile; the VEG is less 100 g/l or more 400 g/l; the oxigental intoxication is present. Then HBO is contraindicated.

The toxic influence of oxygen can be realised in form of direct or indirect intoxication.

The indirect form causes moderate giddiness; headache; PRE improves by 20% and even more, VEG - by 25% after three procedures, comparetively the very beginning of therapy. Continuation of HBO course can cause the direct intoxication; the course should be interrupted, the sequences of indirect intoxication usually disappear without the special medicinal therapy.

Direct intoxication causes acute headache and giddiness; tachycardia; respiration complications. The course should be immediately interrupted and a special therapy is compulsory (including spasmolytics, antioxidants, antihypoxants, analgetics and sedative medicines). Direct intoxication causes acute hemolysis: PRE improves by 30%; VEG - by 40%.

Besides the interruption of HBO course and application of medicines, oxygental intoxication also needs the application of biochemical control of membranes, or POL-processes, or the level of antioxidantal protection of cells.

Vitamin E, being a strong antioxidant is very applicable; it is recommended to all the pregnants with accompaning diabetes during the HBO course. It can be delivered in oil solution of alfacoferol in concentration of 10 or 30%; with doses of 100-150mg injected into tissue once a day during all the course.

That scheme was worked out in Rostov Institute of Midwifery and Pediatry and is applied since 1981. The results represent the lessening of intranal lethality by 1,4 times; reduction of complications; prolongation of the pregnancy period and as the result - burth of healthy children.