DOI: https://doi.org/10.18370/2309-4117.2020.51.51-54

Differentiated approaches to prevention of perinatal complications in pregnant women with miscarriage in early gestation

О. В. Кравченко

Abstract


Purpose of the study was to develop differentiated approaches to prevention of perinatal complications in pregnant women with miscarriage in the early stages of gestation.

Materials and methods. We examined 52 patients who had been diagnosed risk of abortion at an early pregnancy, both with and without bleeding. Criteria for exclusion from the study were multiple pregnancy, pregnancy as a result of assisted reproductive technologies, pregnancy in women with severe extragenital pathology, genital anomalies, and pregnancy with diagnosed fetal abnormalities. All pregnant women underwent a comprehensive clinical and laboratory examination. At the end of the first trimester during transvaginal ultrasound with a special three-dimensional VOCAL program we calculated the chorionic volume and evaluated its vascular system.

Results of the study. Chorionic volume decrease by 10–15%, and a vascularization index by 20–25% at 12–13 weeks in 50% patients after treatment for early miscarriage (group I). Volume of chorion was reduced by 16–25%, and the vascularization index by 26–35% in 23.1% women (group II). Only in 26.9% pregnant women after treatment the volume of chorion and indicators of blood flow were within the physiological range (control group). Pregnant women with chorionic hypoplasia (group I and II) continued hormonal therapy in the II and III trimesters with the aim of effectively securing the second wave of cytotrophoblast invasion and adequate growth of uterine placental blood flow. They were prescribed micronized progesterone, venotonic drug Normoven, metabolite drug Artichol and Magnicum. Non-hormonal therapy was performed in cycles of 15–18 weeks, 25–28 weeks, and 32–35 weeks. Results of the study showed that the incidence of gestational period complications in pregnant women with chorionic hypoplasia and impaired vascularization in early gestation (group I and II) was higher than in the control group, but significantly lower than in literature.

Conclusions. Determination of chorionic volume and evaluation of its vascular system at the end of the first trimester of gestation can serve as a criterion for patient selection for the group of perinatal complications risk. Chorionic hypoplasia and impaired vascularization in pregnant women with early miscarriage are indicative of further drug therapy in the II and III trimesters. The complex of medical drugs (micronized progesterone, Normoven, Artichol, Magnicum) has proven itself as an effective method for prevention of perinatal complications in pregnant women with miscarriage in the first trimester.


Keywords


prevention; perinatal complications; miscarriage; I trimester of gestation

References


Alexandrova, N.V., Bayev, O.R. “The early stages of the formation of the mother-placenta-fetus system.” Obstetrics and gynecology 8 (2011): 4–10.

The threat of abortion of various lines of gestation. Tactics and strategy of modern therapy. Moscow. RNIMU named after N.I. Pirogov (2013).

Kiryushchenkov, P.A., Belousov, D.M., Alexandrina, O.S., Alekseeva, M.S. “Clinical, laboratory and ultrasound evaluation, pregnancy management tactics for various forms of chorion pathology in the first trimester.” Obstetrics and gynecology 1 (2010): 19–23.

Dobrokhotova, Y.E., Zubarev, A.R., Zalesskaya, S.A., et al. “Evaluation of the forming utero-placental blood flow in patients with the threat of interruption due to progesterone deficiency in the first trimester of pregnancy.” Obstetrics and gynecology 6 (2016): 54–60.

Savelyeva, G.M., Panina, O.B., Kurtser, M.A., et al. “Prenatal period: physiology and pathology.” Rossiyskiy vestnik akushera-ginekologa 10.2 (2010): 61–5.

Sidelnikova, V.M., Sukhikh, G.T. Miscarriage. Management. Moscow. MIA (2011): 536 p.

Van, A.V., Kulikova, A.S., Zalesskaya, S.A., Dobrokhotova, Y.E. “Modern tocolytic therapy in the complex treatment of threatening preterm birth (literature review).” Gynecology 16.4 (2014): 68–71.

Tetruashvili, N.K., Agadzhanova, A.A., Ionanidze, T.B. “Bleeding up to 22 weeks of pregnancy: clinic, diagnosis, hemostatic therapy.” Meditsynskiy sovet 9 (2014): 60–3.

Titchenko, L.I., Chechnev, M.A., Zhukova, N.V. “Three-dimensional ultrasound reconstruction in the first trimester of pregnancy.” Medical journal “SonoAce-Ultrasound” 15 (2006): 78–8.

Ferri, F.F. “Vaginal bleeding uring pregnancy.” In: Ferri's clinical advisor. Mosby (2014): 1143 p.

Scifres, C.M., Nelson, D.M. “Intrauterine growth restriction, human placental development and trophoblast cell death.” J Physiol 587.14 (2009): 3453–8.

Tamura, H., Miwa, I., Taniguchi, K., et al. “Different changes in resistance index between uterine artery and uterine radial artery during early pregnancy.” Hum Reprod 23.2 (2008): 285–9.

Whitley, G.S., et al. “Trophoblast-mediated spiral artery remodelling: a role for apoptosis.” J Anat 215.1 (2009): 21–6.

Yoshinaga, K. “Research on blastocyst implantation essential factors (BIEFs).” Am J Reprod Immunol 63.6 (2010): 413–24.


GOST Style Citations


1.            Александрова, Н.В. Ранние этапы становления системы мать-плацента-плод / Н.В. Александрова, О.Р. Баев // Акушерство и гинекология. – 2011. – № 8. – С. 4–10.

2.            Доброхотова, Ю.Э. Угроза прерывания беременности различных строков гестации. Тактика и стратегия современной терапии / Ю.Э. Доброхотова. – М.: РНИМУ им Н.И. Пирогова, 2013. Dobrokhotova, Y.E.

3.            Кирющенков, П.А. Клинико-лабораторная и ультразвуковая оценка, тактика ведения беременности при различных формах патологии хориона в I триместре / П.А. Кирющенков, Д.М. Белоусов, О.С. Александрина, М.С. Алексеева // Акушерство и гинекология. – 2010. – № 1. – С. 19–23.

4.            Доброхотова, Ю.Э. Оценка формирующего маточно-плацентарного кровотока у пациенток с угрозой прерывания на фоне дефицита прогестерона в I триместре беременности / Ю.Э. Доброхотова, А.Р. Зубарев, С.А. Залесская и др. // Акушерство и гинекология. – 2016. – № 6. – С. 54–60.

5.            Савельева, Г.М. Пренатальный период: физиология и патология / Г.М. Савельева, О.Б. Панина, М.А. Курцер и др. // Российский вестник акушера-гинеколога. – 2010. – № 10(2). – С. 61–65.

6.            Сидельникова, В.М. Невынашивание беременности. Руководство / В.М. Сидельникова, Г.Т. Сухих. – М.: МИА, 2011. – 536 с.

7.            Ван, А.В. Современная токолитическая терапия в комплексном лечении угрожающих преждевременных родов (обзор литературы) / А.В. Ван, А.С. Куликова, С.А. Залесская, Ю.Э. Доброхотова // Гинекология. – 2014. – № 16(4). – С. 68–71.

8.            Тетруашвили, Н.К. Кровотечения до 22 недель беременности: клиника, диагностика, гемостатическая терапия / Н.К. Тетруашвили, А.А. Агаджанова, Т.Б. Ионанидзе // Медицинский совет. – 2014. – № 9. – С. 60–63.

9.            Титченко, Л.И. Трехмерная ультразвуковая реконструкция в І триместре беременности / Л.И. Титченко, М.А. Чечнева, Н.В. Жукова // Медицинский журнал «SonoAce-Ultrasound». – 2006. – № 15. – С. 78–88.

10.          Ferri, F.F. “Vaginal bleeding uring pregnancy.” In: Ferri's clinical advisor. Mosby (2014): 1143 p.

11.          Scifres, C.M., Nelson, D.M. “Intrauterine growth restriction, human placental development and trophoblast cell death.” J Physiol 587.14 (2009): 3453–8.

12.          Tamura, H., Miwa, I., Taniguchi, K., et al. “Different changes in resistance index between uterine artery and uterine radial artery during early pregnancy.” Hum Reprod 23.2 (2008): 285–9.

13.          Whitley, G.S., et al. “Trophoblast-mediated spiral artery remodelling: a role for apoptosis.” J Anat 215.1 (2009): 21–6.

14.          Yoshinaga, K. “Research on blastocyst implantation essential factors (BIEFs).” Am J Reprod Immunol 63.6 (2010): 413–24.





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