Оптимізація тактики ведення вагітності та ранніх передчасних пологів у жінок після застосування допоміжних репродуктивних технологій

Abstract

The objective: reduction of the frequency of perinatal complications in women with early preterm labor after the ART, based on the improvement and implementation of the algorithm for diagnostic and therapeutic and prophylactic measures. Materials and methods.We analyzed the course of 130 single-pregnancy pregnancy women with restored fertility after the use of therapeutic assisted reproductive technologies programs that ended with early premature births. The study of the subpopulation composition of lymphocytes and the content of activation markers of peripheral blood lymphocytes was performed using the method of quadratic color laser flow cytometry and a set of monoclonal antibodies. The concentration of cytokines IFN- γ, IL-4, IL-17A, IL-17F, IL-21 and IL-22 in serum of pregnant women was determined by solid-phase immunoassay analysis. The material for studying and analyzing the morpho-functional state of the fetoplacental complex was the results of pathomorphological study of the litter in all cases of early premature birth. By our own research, we established the frequency, structure and leading causes of early premature birth after assisted reproductive technologies, optimized the tactics of conducting induced pregnancies of high obstetric risk, formulated practical recommendations for implementation in practical medicine of Ukraine. Results. For introduction into practical medicine of Ukraine with the purpose of decreasing the frequency of perinatal complications and effective provision of obstetric and gynecological care, we recommend that the following provisions be included in the clinical protocol for the management of pregnancy of high obstetric risk in women after assisted reproductive technologies: 1. To predict the risk of early premature birth in women after ancillary reproductive technologies, the diagnostic algorithm should additionally include the definition of the main indicators of the serum cytokine profile: proinflammatory serum cytokines IFN- γ, IL-2, IL-12, IL-18; anti-inflammatory regulatory cytokine IL-10; quantitative indicators of NK cells with the phenotype CD3-CD16+CD56+, CD94+ lymphocytes and peripheral blood CD71 transferrin. 2. Use of medication correction – Micronized progesterone (200 mg/day). 3. At the gestational age of 28–33 weeks, with the premature rupture of the membranes optimal and effective is the expectant management of pregnancy for 5 days with subsequent delivery of women through the natural birth canal, which makes it possible to achieve the maximum possible degree of maturity of the fetus with a minimum risk of ascending infection in newborns. Conclusions. The effectiveness of our improved algorithm is a significant reduction in women after assisted reproductive technologies, early preterm labor (2.8 times), placental dysfunction (2.3 times), premature rupture of the membranes (in 2, 1 time), fetal distress (3,6 times), abdominal degeneration (2.9 times) and implementation of intraaminal infections (2.6 times; p<0.05). The total morbidity of newborns in the early neonatal period decreased 2.4 times, and perinatal losses were absent. Key words: assisted reproductive technologies, RPP, PRPO, markers of activation of lymphocytes, cytokines.