Many patients do not understand why doctors prescribe them a variety of large and small pills, if the doctor prescribed a very cheap drugs, some patients do not care to eat, that the doctor fooled him; if the doctor prescribed a very expensive drugs, some patients do not want to eat, that the doctor fooled him. So with a skeptical, hesitant mindset in taking drugs, or eat less, or even simply do not eat, in fact, these practices are wrong. Patients go to the doctor to solve the problem, and the mutual trust between the doctor and the patient is a good start to cure the disease. We analyze some of the common drugs used in obstetrics and gynecology treatment and prevention role, I believe that patients will be able to understand the big role of small drugs. A, vitamin B6 indications: in obstetrics and gynecology are mostly used for hyperprolactinemia, take oral contraceptives, pregnancy vomiting, hyperlipidemia, thrombotic state or thromboembolic disease caused by recurrent miscarriage and other conditions. Principle of action: 1. Vitamin B6 is involved in the metabolism of all amino acids in addition to neurotransmitters, glycogen, neurospherin phospholipids, heme, steroids and nucleic acids. Vitamin B6 is also involved in the metabolism of one-carbon units, vitamin B12 and folic acid salts, which can cause megaloblastic anemia if their metabolism is impaired. 2, Vitamin B6 deficiency can damage the synthesis of DNA, damage cells and affect the humoral immune function, giving vitamin B6 can improve immunity, is very important to maintain the appropriate immune function, and has a certain role in cancer prevention. 3, Vitamin B6 has a role in reducing chronic diseases. Mild hyperhomocysteinemia is considered a possible risk factor for vascular disease, and vitamin B6 intervention can reduce plasma homocysteine levels. 4. The activation type of vitamin B6, pyridoxal phosphate, has the effect of protecting vascular endothelial cells, reducing endothelial cell activation and platelet damage, inhibiting platelet agglutination and blood coagulation, inhibiting platelet production of prostaglandins and promoting vascular endothelial cell production of cycloprostane, as well as reducing morphological changes in vascular endothelial cells, which can treat atherosclerosis and thromboembolic diseases 5. 5, vitamin B6 can promote the transformation of linoleic acid into arachidonic acid, and the latter combined with cholesterol into esters easy to transfer metabolism and excretion, so it can reduce cholesterol. 6, vitamin B6 can promote the production of dopamine in the brain, so as to agitate dopamine receptors and reduce the secretion of pituitary prolactin. 7. The estrogen-like effect of contraceptives can reduce the concentration of pyridoxal phosphate and increase the body’s need for vitamin B6 and change brain amine metabolism, so it is easy to cause mental depression. Depressive symptoms can be improved with the administration of vitamin B 6. Foods rich in vitamin B6: tuna, lean steak, chicken breast, bananas, peanuts, beef, etc. Vitamin E Indications: In obstetrics and gynecology, it is used for various diseases caused by free radical damage: habitual abortion, pre-eclampsia, infertility and menopausal disorders, progressive muscular dystrophy, contraceptives, hormones or women during pregnancy and lactation. Mechanism of action: 1. Vitamin E is a very important vasodilator and anticoagulant; 2. Vitamin E promotes the secretion of pituitary gonadotropin, increases ovarian function, follicles increase, luteal cells increase, and it can enhance the role of progesterone, when the lack of reproductive organs are damaged, egg cells are not easily fertilized or cause habitual abortion. 3, vitamin E can improve lipid metabolism, lack of which leads to an increase in plasma cholesterol and triglycerides and the formation of atherosclerosis. 4, vitamin E is sensitive to oxygen and easily oxidized, so it can protect other easily oxidized substances, such as unsaturated fatty acids, vitamin A and ATP, etc.. Reduce the generation of lipid peroxide, protect the body cells from the poisoning of free radicals, and give full play to the specific physiological functions of the protected substances. 5, stabilize cell membrane and intracellular lipid fraction, reduce red blood cell fragility, prevent hemolysis, hemolytic anemia when lacking. Foods rich in vitamin E: malt, soybeans, vegetable oils, nuts, Brussels sprouts, green leafy vegetables, spinach, flour with added nutrients, whole wheat, unrefined cereal products, eggs, etc. Aspirin is an anti-platelet drug, by acetylating the serine residue at position 529 on the polypeptide bond of platelet cyclooxygenase 1, the enzyme loses its ability to convert arachidonic acid into prostaglandin peroxide, blocking the pathway of PGH2 and thromboxane A2 formation, which has the effect of preventing platelet adhesion and aggregation and improving the hypercoagulability of blood. Aspirin in pregnant women 1. Autoimmune recurrent miscarriage Aspirin, as a classical anticoagulant, has been used in the treatment of autoimmune recurrent miscarriage. For women with positive antiphospholipid antibodies and recurrent miscarriages (2 or more), or late pregnancy loss, and no history of arterial thrombosis, prenatal prophylactic aspirin is recommended (Level 1B evidence) (Note: this is Level 2B evidence in ACCP7). Low doses of aspirin are often used in patients who do not have clinical manifestations but have detectable autoantibodies in their bodies. Aspirin inhibits platelet agglutination and adhesion, thereby blocking the chorionic metaplasia interstitial hypercoagulability response and preventing the occurrence of miscarriage. 2. Pre-eclampsia Duley et al. conducted a systematic evaluation of the effectiveness and safety of using low-dose aspirin in the treatment of pre-eclampsia. Aspirin was found to reduce the incidence of preeclampsia by 17%, preterm birth by 8%, fetal or neonatal mortality by 14%, and low birth weight by 10%, indicating that low-dose aspirin has a significant effect on improving maternal and child prognosis. This systematic evaluation also pointed out that the dose of aspirin up to 75 mg per day is safe and effective, and if the dose is increased it may increase the efficacy, but its adverse drug effects, such as bleeding during/postpartum and thrombocytopenia, will also increase. National scholars also recommend therapy with low-dose aspirin throughout pregnancy in women with risk factors for preeclampsia but without a propensity for thrombosis (level of evidence 1B). Thus, low-dose aspirin is safe and effective in preventing preeclampsia in high-risk pregnant women and in treating patients with preeclampsia. For women at high risk for prosthetic heart valve implantation, the addition of low-dose aspirin 75-100 mg/d is recommended (Level 2C evidence). 3. Hypertensive syndrome of pregnancy (hypertensive syndrome of pregnancy) is associated with thrombosis, and prophylactic administration of aspirin at 1 to 2 mg/kg/day has been recommended for all pregnant women at high risk for hypertension, but it has been suggested that the most appropriate effective dose of aspirin for the prevention of hypertension in pregnant women is to prolong the bleeding time by ≥2 min, and the aspirin dose should be adjusted according to the antiplatelet effect. Dosage precautions Aspirin readily crosses the placenta. Animal studies have shown that small doses of aspirin (<150 mg daily) in the middle and second trimesters of pregnancy are safe for both fetus and mother. High dose application in the first trimester (>150 mg daily) can cause teratogenic fetuses, such as spina bifida, cephalic bifida, facial bifida, leg deformities, and hypoplasia of the central nervous system, internal organs, and bones. Long-term use in late pregnancy may cause constriction or premature closure of the fetal ductus arteriosus, resulting in persistent pulmonary hypertension in the newborn. Aspirin may be considered in the first trimester of pregnancy if its indication is proven and no other options are available. However, it needs to be used in small doses: up to 75 mg per day is safe. Regular monitoring of platelets, prothrombin time or test tube method clotting time should be performed at the time of application. Contraindications: active bleeding from ulcer disease or other causes with bleeding symptoms; hemophilia or thrombocytopenia. Side effects on the mother are mainly gastrointestinal bleeding or ulcers, bronchospastic allergic reactions, allergic skin reactions, liver or kidney function impairment. IV. Prednisone Drug description: Adrenocorticotropic hormones, with anti-inflammatory, anti-allergic, anti-rheumatic and immunosuppressive effects, the mechanism of action is: ① Anti-inflammatory effect: the product can reduce and prevent the tissue response to inflammation, thereby reducing the manifestation of inflammation. The hormone inhibits the accumulation of inflammatory cells, including macrophages and leukocytes at the site of inflammation, and inhibits phagocytosis, the release of lysosomal enzymes, and the synthesis and release of chemical mediators of inflammation. ② Immunosuppressive effects: including preventing or inhibiting cell-mediated immune responses, delayed allergic reactions, reducing the number of T lymphocytes, monocytes, and eosinophils, decreasing the ability of immunoglobulins to bind to cell surface receptors, and inhibiting the synthesis and release of interleukins, thereby reducing the conversion of T lymphocytes to lymphoblasts and attenuating the expansion of primary immune responses. It decreases the passage of immune complexes through the basement membrane and reduces the concentration of complement components and immunoglobulins. Prednisone in pregnant women The application of adrenocorticosteroids during pregnancy includes two main aspects: the first is the treatment of fetal lung maturation in preterm labor from various causes; the second is the treatment of maternal comorbidities and complications during pregnancy. The former is a short-term treatment in late pregnancy with no significant adverse effects on the mother and child. The latter, on the other hand, may require longer-term application throughout pregnancy and requires attention to the possible risks to the mother and child. If used for the treatment of combined medical diseases during pregnancy, it is appropriate to use short-acting (hydrocortisone, cortisone) or medium-acting (prednisone, prednisolone, etc.) glucocorticoids, and to use the minimum effective maintenance dose as much as possible, in principle, the daily dosage of prednisone should be < 10mg to minimize the inhibitory effect on the fetus and its adrenal function. In general, patients with SLE should be under control for 1 year and the maintenance dose of prednisone should be less than 15mg/d before considering pregnancy. Prednisone is inactivated by 11-beta dehydrogenase when passing through the placenta, and the amount of passing through the placenta is very small and has few adverse effects on the fetus. 2, Idiopathic thrombocytopenic purpura ( ITP) platelets below 50×109/ L during pregnancy, with clinical bleeding symptoms, apply prednisone 40~100mg/d, if necessary, intravenous drip hydrocortisone, and gradually reduce the dose after the condition is relieved. 3, thrombotic thrombocytopenic purpura ( TTP) can be combined with drugs, but also can be used alone. Prednisone 60mg is mostly used, depending on the condition, it can be increased to 100~200mg, and it is often effective in 48~72 hours, and the dosage can be reduced after the condition improves. 4, systemic sclerosis (SS), also known as scleroderma, adrenocorticosteroids can improve the skin, joints, blood vessels and muscle lesions, prednisone starting dosage of 20-60mg / d, after remission can be reduced to maintenance ( 5-10mg / d). 5, dermatomyositis and polymyositis Prednisone is the drug of choice, 40-60mg/d for severe disease, 30-40mg/d for mild disease, when the symptoms of muscle weakness improve, muscle enzymes decline can be gradually reduced by 5mg every 2-3 weeks until the maintenance dose (7.5~20mg/d). Adrenocorticosteroids are mainly used in patients with recurrent miscarriage due to abnormal immune mechanism, especially in patients with recurrent miscarriage due to autoimmune antibody positivity. They are administered from the time pregnancy is established and are commonly used as prednisone. Prednisone and aspirin have been used to treat ACA-positive patients with a history of recurrent miscarriages, with a pregnancy success rate of 80%. Lin Qide et al. used low-dose prednisone 5 mg daily and low-dose aspirin 60-80 mg daily to treat ACA or LA positive patients, and the pregnancy success rate was 92.9%. No complications such as Cushing's syndrome, adrenal insufficiency, secondary infection, diabetes mellitus, IUGR and bleeding were found. The study also suggested that low-dose prednisone and aspirin for recurrent abortion of unknown cause is safe and has no adverse effects on the development of the offspring. 7, pregnancy-combined dermatosis Herpes-like pustulosis, pregnancy itchy rash, pregnancy herpes and other pregnancy-combined dermatosis, the application of adrenal corticosteroid treatment has good efficacy, but pregnant women should not be the drug of choice. Prednisone can be used orally if the rash is severe and antihistamines and sedatives are not effective. 40-60mg/d for herpes pustulosis and itchy rash of pregnancy and 20mg/d for herpes of pregnancy can be used for rapid effect and control the itching of the rash, and then the dosage can be reduced to 10mg/d for maintenance. 8, pregnancy combined with hypoadrenocorticism (Addison's disease) non-treated Addison's disease is difficult to conceive, so pregnancy combined with Addison's disease is very rare, such as pregnancy maternal and child mortality rate up to 77%. Hydrocortisone is available as 20mg orally in the morning and 10mg orally in the evening, or prednisone 5mg orally in the morning and 2.5mg in the evening, and should be reduced in case of edema and hypertension. In case of acute adrenal failure, high doses of adrenocorticosteroids should be given intravenously. As labor, surgical delivery, and infection can easily trigger a crisis, the story should be prepared first: induction of labor and preoperative intravenous hydrocortisone 100mg; intraoperative continuous hydrocortisone; postoperative corticosteroid reduction, with the smallest dose to improve the symptoms as the maintenance dose. 9.Bronchial asthma in pregnancy Adrenocorticosteroids can prevent severe asthma attacks and control asthma persistence. It has the effect of relaxing bronchial smooth muscle, improving bronchial capillary permeability and inhibiting antigenic antibody response to relieve asthma. Generally, hydrocortisone 100~300mg plus 5% glucose 500ml can be used intravenously. Or dexamethasone 5~10mg plus 50% glucose 20ml, intravenously. For pregnant women with persistent asthma attacks in late pregnancy, oral prednisone or dexamethasone can be given during the remission period to control recurrent asthma attacks. For the prevention of respiratory distress syndrome, a long-acting glucocorticoid with strong efficacy and easy passage through the placenta should be chosen. Its half-life is about 38 hours. But the course of treatment should be short, otherwise it can cause serious adverse effects on the fetus. RDS is one of the most important causes of death in preterm infants. Therefore, glucocorticoids should be considered when a pregnant woman is hospitalized for preterm delivery, including those with a tendency to spontaneous preterm delivery and those who need early termination of pregnancy due to pregnancy complications or comorbidities. The drugs include dexamethasone, betamethasone, hydrocortisone, etc. The common method is dexamethasone 10mg by intravenous infusion once a day for 2~3 days and then repeated once a week until 34~35 weeks. In case of emergency, dexamethasone 10mg can be injected intra-abdominally into the amniotic cavity, and the effect of intramuscular injection is not as clear as that of intravenous injection. Precautions for use In the treatment of internal diseases in pregnancy, short-acting (hydrocortisone, cortisone) or intermediate-acting (prednisone, prednisolone, etc.) glucocorticoids are preferred, and the minimum effective maintenance dose should be used as much as possible, in principle, the daily dose of prednisone should be <10mg to minimize the inhibitory effect on the fetus and its adrenal function. Prednisone is inactivated by 11-beta dehydrogenase when it passes through the placenta, and the amount of the placenta passed through is very small, so there are few adverse effects on the fetus. Animal studies have confirmed that administration during pregnancy may increase the incidence of embryonic cleft palate, placental insufficiency, spontaneous abortion and fetal growth restriction. Teratogenic effects in humans have not been demonstrated, but attention should be paid to the presence of hyperalgesia in the newborn. Prednisone is contraindicated in patients with a history of severe psychiatric illness, active gastroduodenal ulcer, significant diabetes mellitus, and severe hypertension. Long-term use of adrenocorticotropic hormone, should pay attention to the following issues: any adrenocorticotropic hormone has a weak water-sodium retention effect, pay attention to maternal edema, weight gain, appropriate salt restriction; long-term use of adrenocorticotropic hormone, prone to osteoporosis, pregnancy is prone to calcium deficiency, pregnant women with large body weight, early calcium supplementation is recommended, wear flat shoes to avoid traumatic fractures; application of adrenocorticotropic hormone requires early screening of pregnancy Diabetes mellitus. V. Low molecular heparin Drug description The anticoagulant effect of heparin is mainly through two aspects, the inhibition of prothrombin; the inhibition of coagulation activity factor Xa. Both depend on the binding of the pentose structure of common heparin to antithrombin III. In addition to anticoagulation, heparin has hypolipidemic and anti-inflammatory effects, inhibition of vascular smooth muscle proliferation, and anti-vascular endothelial proliferation in experimental animals. Maintain the integrity of the vascular membrane, facilitate the exchange of nutrients and water; make excess hormones or cytokines reversibly bound, avoiding overstimulation of target cells; heparin itself can also inhibit the binding of many hormones or cytokines to their corresponding receptors, reducing peripheral vascular resistance; anticoagulation, antithrombotic mechanism and supplementation of endogenous heparin deficiency, release vasospasm caused by hypoxia; anti-renin activity In addition, LMWH combined with aspirin can unblock the microcirculation, improve the energy supply of the fetus and reduce the birth of low birth weight babies due to intrauterine growth restriction. LMWH, which has more clinical applications, is obtained by chemical or enzymatic depolymerization of heparin, and its pharmacological and pharmacokinetic properties are better than those of heparin. LMWH is mainly excreted by kidney, less likely to induce thrombocytopenia, shortens the time of euglobulin lysis, and helps thrombosis. Application of LMWH in pregnant women 1. Recurrent miscarriage and pregnancy prone to thrombosis Antiphospholipid antibody syndrome causes 21.8% of recurrent miscarriage, and those with obstetric complications in pregnancy should be tested for antiphospholipid antibodies and genetic propensity to thrombosis for early prevention, and LMWH is the first choice for obstetric complications. The increase of estrogen in the blood of pregnant women increases the number of various coagulation factors and platelets, and platelets aggregate and increase their adhesion to blood vessels, while inhibiting the action of antithrombin, making the blood in a hypercoagulable state. LMWH therapy has been established as a routine drug for pregnant women with thrombosis during pregnancy. In a retrospective study by Blanco Molina et al, it was concluded that those who applied LMWH prophylactically in the first trimester of pregnancy had no recurrence of thrombosis or bleeding before delivery, but the risk of thrombosis after delivery was higher than the risk of recurrence before delivery. 2. Pre-eclampsia The basic pathophysiological changes of hypertensive disorders in pregnancy are systemic small vessel spasm and reduced perfusion of all organs in all systems. In patients with preeclampsia, prevention of eclampsia and complications, improvement of blood perfusion and reduction of hypoxia in the organism are necessary. Heparin-mediated in vitro LMWH coagulation may be used as a therapeutic route for preeclampsia. clinical study by Sergio et al. concluded that prevention of recurrent severe preeclampsia with LMWH and low-dose aspirin may improve pregnancy outcome. In China, it has also been reported that LMWH helps to improve the treatment outcome of pregnant women with severe pre-eclampsia and is safe for mother and child. 3. Cholestasis in pregnancy syndrome Cholestasis in pregnancy syndrome is a unique complication in the middle and late stages of pregnancy. Clinically, the treatment of cholestasis of pregnancy syndrome aims to relieve pruritus, restore liver function, reduce blood bile acid levels, and improve pregnancy outcome. In recent years, some studies have reported significant decreases in alanine aminotransferase, aspartate aminotransferase, and clear glycolic acid and gradual recovery of liver function with higher doses of regular heparin and LMWH in the treatment of cholestasis in pregnancy syndrome. The mechanism of action of heparin in the treatment of cholestasis in pregnancy syndrome may be that heparin can combine with many hormones and cytokines and act as a heparin pool. 4, pregnancy combined with heart disease Pregnancy combined with heart disease can increase the burden on the heart during pregnancy, delivery and puerperium and induce heart failure, combined with the formation of thrombosis threatens the life of pregnant women, need to carry out anticoagulation therapy. Acute myocardial infarction during pregnancy is rare, but it is often caused by atherosclerosis or anatomical reasons (embolism, arterial spasm), etc. Aspirin and heparin are safe and effective in treating acute myocardial infarction during pregnancy. 5. Pregnancy combined with systemic lupus erythematosus In patients with systemic lupus erythematosus, there is a large amount of immune complex deposition in the meconium villi of the placenta of pregnancy, intravascular embolus formation, reduced placental perfusion, and uteroplacental ischemia and hypoxia. This results in a high incidence of intrauterine growth restriction, miscarriage, preterm delivery and stillbirth. To address the pathological changes of the placenta in SLE pregnancies, anticoagulation with LMWH is used to improve mid- to late-stage umbilical artery blood flow, improve microcirculation, increase uteroplacental blood flow, and reduce perinatal morbidity. Heparin is effective in treating SLE pregnancy combined with fetal growth restriction with few adverse effects. 6.Fetal intrauterine growth retardation Abnormally high end-systolic/end-diastolic blood flow ratio of umbilical artery blood flow in mid to late pregnancy may lead to intrauterine growth retardation. LMWH combined with aspirin to unblock microcirculation can improve fetal energy supply and reduce the birth of low body mass children due to intrauterine growth restriction. If the stillbirth is not expelled from the uterus after 3 weeks, the degenerated placental tissue will release thrombin into the maternal blood circulation and activate intravascular coagulation factors, consuming fibrinogen and platelets and other coagulation factors in the blood, resulting in a much higher chance of disseminated intravascular coagulation. If the fibrinogen content and platelets are significantly reduced, heparin can be used as treatment. To restore fibrinogen and platelets to the effective level of hemostasis, and then induce labor, can avoid the occurrence of disseminated intravascular coagulation. 8, early puerperium The blood of the mother is still in a hypercoagulable state, and the possibility of thrombosis in the circulatory system leading to vascular embolism is also increased, and the prophylactic application of heparin can reduce the incidence of thromboembolism in the puerperium. The treatment and prevention of puerperal thrombosis and thromboembolism are best treated with low-molecular heparin, which has a weaker anticoagulant and stronger antithrombotic effect, avoids bleeding, and does not require frequent coagulation testing. Precautions: Although heparin has been widely used in clinical practice, due to its powerful anticoagulant function, improper application can cause coagulation disorders, so the coagulation function should be closely monitored during application to prevent unimaginable consequences. In addition, the application of heparin for 3-6 months can cause allergic reactions such as osteoporosis, rash, drug fever, etc. Patients with hepatic or renal insufficiency, bleeding constitution, peptic ulcer, etc. are prohibited without special circumstances. The use of LMWH during pregnancy is relatively safe for the mother. Heparin does not pass through the placenta and is safe for the fetus without teratogenic effect, so it can be used from early pregnancy. The chance of adverse drug reactions is small, but care should still be taken to discontinue the drug promptly in case of drug allergy, severe bleeding events and heparin-induced thrombocytopenia. For osteoporosis, calcium and VitD can usually be applied for prevention. In terms of fetal safety, there are no reports of fetal malformations caused by LMWH; LMWH does not cross the placental barrier and does not increase the incidence of fetal bleeding events. Therefore, it can be used safely during pregnancy. In addition, LMWH is not secreted in breast milk, so it is also safe to use during lactation. In conclusion, when applying heparin, the principles of small dose, short course and interval should be followed to minimize its side effects and maximize its positive effects.