Лікувально-профілактичні заходи, спрямовані на зниження частоти гестаційних ускладнень у жінок із поєднаною безплідністю в анамнезі

Abstract

The purpose - to substantiate the principles of prevention and treatment of major gestational complications in women with a history of combined infertility. Materials and methods. The patients were divided into the groups, depending on the prescribed treatment regimen: the group 1 - 52 pregnant women with a history of combined infertility who received basic therapy with a positive urinary test for pregnancy (dydrogesterone 10 mg 2 times a day for up to 12 weeks, folic acid - 400 mcg per day up to 14 weeks of pregnancy). The group 2 - 50 pregnant women with combined infertility who received our improved regimen (5-methyltetrahydrofolate - 600 mg, iodine - 200 mcg, micronized progesterone - 200 mg, cardioaspirin - 150 mg, calcium with vitamin D3, omega-3, -6, -9 polyunsaturated fatty acids - 1000 mg, magnesium with vitamin В6). Statistical processing of data was performed by the methods of variation statistics. Results. More often, gestational complications in the trimester II were in pregnant women of the group 1, who took the basic treatment regimen, than in patients of the group 2, who used the therapeutic complex improved by us. Thus, polyhydramnios was detected almost 2.5 times more often in patients of the group 1 (11.5%) versus 4% of pregnant women of the group 2; and oligohydramnios was confirmed 3 times more often in women of the group 1 (7.7%), while in pregnant women of the group 2 only in 2%. Isthmic-cervical insufficiency developed in every 5 women (21.2%) in the group 1 and almost three times less often - in 8% of women in the group 2. Anomalies of placental attachment, namely: placenta previa and its low location occurred 2.5 times more often in women of the group 1 (15.4%) compared with pregnant women of the group 2 (in 6%). Premature maturation of the placenta, which was manifested by structural changes in it on ultrasound, was manifested almost three times more often in women of the group 1 - in 17.3% versus 6% of pregnant women in the group 2. Gestational anemia was found in women of the group 1 (19.2%), which is half as often as in the group 2 (12%). Gestational diabetes was also half as common in women of the group 1 (30.8%) compared to the group 2 (20%). Exacerbation of chronic pyelonephritis was almost twice as common in women of the group 1 (7.7%) compared with the group 2 (4%). But pregnant women of the group 1 (23.1%) had vaginitis 4 times more often than the group 2 (6%). Conclusions. The use of the monitoring algorithm developed by us and a set of therapeutic and preventive measures in women with a history of infertility has significantly improved the results of their pregnancies. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.