Прогнозування і профілактика прееклампсії при багатоплідній вагітності після допоміжних репродуктивних технологій

Abstract

Purpose - to assess the effectiveness of the implemented algorithm of treatment and preventive measures by analyzing the course of pregnancy, childbirth and the condition of newborns in multiple pregnancies after assisted reproductive technologies to assess of changes in biochemical markers of endothelial dysfunction in the detection of pre-clinical manifestations of preeclampsia in pregnant women with multiple pregnancies after the use of assisted reproductive technologies. Materials and methods. A prospective study of pregnant women with dichorionic diamniotic twins after assisted reproductive technologies was conducted: the Group І (main) - 35 pregnant women with twins who were offered a developed monitoring algorithm; the Group ІІ (control) 27 pregnant women who were monitored according to generally accepted methods of managing multiple pregnancies. Statistical processing of the research results was carried out using standard programs “Microsoft Excel 5.0” and “Statistica 6.0”. Results. In the Group І 2 cases of moderate preeclampsia were found in 32 and 33 weeks of pregnancy (PLGF results - 63.2 pg/ml and 58.7 pg/ml, sFlt-1/PLGF ratio - 51.7 and 66.3). In the Group II 4 cases of preeclampsia were identified: 2 cases of moderate preeclampsia (PLGF - 74.1 pg/ml and 69.3 pg/ml, sFlt-1/PLGF ratio - 98.6 and 104.5); 2 cases of severe preeclampsia at 33 and 34 weeks (PLGF data - 44.1 pg/ml and 47.3 pg/ml, sFlt-1/ PLGF ratio 122.4 and 130.1) against the background of signs of gestational hypertension. Fetal growth retardation in the Group І was noted in 3 (8.6%) women (І stage - in 2 (5.7%) cases, II stage - in 1 (2.9%) case, III stage was not diagnosed), in the Group II - in 7 (25.9%) women (I stage - in 2 (7.4%) cases, II stage - in 4 (14.8%) cases, III stage - in 1 (3.7%) case). Fetal distress in the Group І was detected in 4 (11.4%) pregnant women (during pregnancy - in 1 (2.9%) case, during deliveries - in 3 (8.6%) cases); in the Group II - in 7 (25.9%) women (during pregnancy - in 5 (18.5%) cases, during deliveries - in 2 (7.4%) cases). Premature deliveries in the Group I was noted in 5 (14.3%) women (before 34 weeks of gestation - in 2 (5.7%) cases, after 34 weeks of gestation - in 3 (8.6%) cases); in the Group II - in 8 (29.6%) women (before 34 weeks of gestation - in 5 (18.5%) cases, after 34 weeks of gestation - in 3 (11.1%) cases). Premature detachment of a normally located placenta was detected in 2 (7.4%) women in the Group II, and in the Group I such cases were not recorded. Vaginal delivery was observed in 14 (40%) women in the Group I and 7 (25.9%) patients in the Group II; cesarean section - in 21 (60%) and 19 (70.4%) women, respectively. Combined delivery was performed in 1 (3.7%) woman of the Group II, and in the Group I - not recorded. Hypoxic-ischemic lesions were detected in 2 (5.7%) children from women of the Group I and in 4 (14.8%) children from mothers of the Group II. Adaptation disorders were noted in 5 (14.3%) cases in the Group I and in 8 (29.6%) cases in the Group II. Transfer to the second stage of treatment required 3 (8.6%) children from mothers of the Group I and 6 (22.2%) children from mothers of the Group II. Conclusions. The proposed algorithm of modern diagnostic and treatment-prophylactic measures made it possible to reliably reduce the frequency of development of preeclampsia, obstetric and perinatal complications and can be recommended for use in practical health care. The study of the anti-angiogenic factor sFlt-1 and the pro-angiogenic factor PLGF and their ratio is promising in the prediction and early diagnosis of preeclampsia in multiple pregnancies after assisted reproductive technologies. The use of Triage PLGF and sFlt-1/PLGF ratio should be widely implemented in the practice of obstetrician-gynecologists as a prognostic marker for early recognition of preeclampsia in order to reduce perinatal complications, both from the mother and the fetus. Based on monitoring the growth dynamics of the sFlt-1/PLGF ratio, it is possible to predict the early development of preeclampsia even without clinical symptoms, and to make a decision about the possibility of extending the pregnancy or the need for urgent delivery. 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 author.