Акушерські та перинатальні наслідки розродження після ДРТ в жінок з інфекціями, що передаються статевим шляхом, в анамнезі

Abstract

Purpose - to analyze the clinical course of pregnancy, childbirth and the condition of newborns in women with sexually transmitted infections (STIs) in the anamnesis after pre-pregnancy training before assisted reproduction technology (ART) cycles. Materials and methods. A clinical analysis of pregnancy, childbirth and newborns in 100 pregnant women after ART, with a history of STIs. This women were randomly divided into two groups: Group I (main) - 50 pregnant women subject to pre-pregnancy training, obstetric and perinatal support and delivery according to our developed medical and organizational algorithms, prognostic methods and treatment and prevention schemes; Group II - 50 pregnant women who received conventional prognostic and treatment and prevention measures. The Group III (control) was included 50 practically healthy pregnant women with a successful reproductive history and uncomplicated course of this pregnancy. Statistical processing of research results was performed using standard programs Microsoft Excel 5.0 and Statistica 8.0. Results. The main complication in pregnant women of group I was placental dysfunction, which due to our proposed pre-pregnancy training and management of pregnancy, was reduced from 38.0% in the Group II to 22.0% in women of the Group I (p<0.05), the structure of which was dominated by compensated (72.7%) and subcompensated (27.3%) and no decompensated forms, recurrence of STIs (the Group I - 6.0% and the Group II - 16.0%, p<0.05) and colpitis (the Group I - 16.0% and the Group II - 26.0%, p<0.05). In addition, it is important to reduce the level of preeclampsia (the Group I - 6.0% and the Group II - 10%). In addition, gestational anemia (48.0%) was quite common in the Group II, the level of which we managed to reduce to 24.0% (p<0.05). The analysis of the clinical course of childbirth showed a significant reduction in all complications of childbirth: premature birth (the Group I - 12.0% and the Group II - 26.0%, p<0,05); premature rupture of fetal membranes (the Group I - 12.0% and the Group II - 36.0%, p<0.05); fetal distress (the Group I - 8.0% and the Group II - 20.0%, p<0.05) and obstetric bleeding (the Group I - 10.0% and the Group II - 18.0%), which is associated with severe decrease of the main complications of the gestational period). Condition of newborns after childbirth: in the Group I in 86.07% of cases the condition of children was satisfactory, 13.59% of children were born with signs of asphyxia (mild and moderate), and the overall level of children born with asphyxia decreased 2.5 times. The rate of fetal developmental delay decreased from 14.4% in the Group II to 3.03% in the Group I. Comprehensive dynamic monitoring and pathogenetic therapy were effective for the onset of pregnancy by ART and a favorable pregnancy outcome in 81.0% of women; reduction of reproductive losses by 4.4 times and perinatal mortality by 8.5 times. Conclusions. Early diagnosis, prevention and treatment of infectious diseases in women before pregnancy, pre-pregnancy preparation and planning of pregnancy in women with a history of STIs, effectively restores reproductive function, reduce the frequency of complications of gestation, severity (frequency and duration of relapses) infectious process during pregnancy, prevent severe forms of neonatal infection, reduce perinatal morbidity and mortality. The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of women was obtained for the study. No conflict of interests was declared by the author. Key words: sexually transmitted infections, pre-pregnancy training, pregnancy, obstetric and perinatal complications.