Прогнозування основних акушерських ускладнень у вагітних із поєднаною безплідністю в анамнезі

Abstract

The main gestational complications in pregnant women with a history of combined tubal-peritoneal and endocrine infertility are miscarriage, hypertensive and metabolic disorders. An adequate solution to the prevention of various obstetric complications became possible by developing methods of prognosis with using computer technology in clinics. Purpose - to develop an algorithm for predicting preterm birth, the development of isthmic and cervical insufficiency (ICI), gestational hypertension and gestational diabetes in pregnant women with a combined history of infertility. Materials and methods. The main groups: the Group 1 - 155 pregnant women who had a history of endocrine infertility; the Group 2 - 245 pregnant women who had a history of infertility of tubular-peritoneal genesis; the Group 3 - 83 pregnant women who had a history of combined infertility: tubular-peritoneal genesis with endocrine; the control Group 4 - 89 healthy pregnant women who did not have history of infertility. An algorithm for predicting the main gestational complications: hypertensive and metabolic disorders, miscarriage (ICI, preterm birth) was developed only in the most severe category of pregnant women (the Group 3). For the prediction of obstetric complications, the method of logistic regression was chosen, which allows to build a statistical model to predict the probability of occurrence of the event based on existing data. Results. With increasing age and in the presence of an obtuse cervical-uterine angle on ultrasound cervicometry, the risk of preterm birth dramatically increased. With increasing body mass index (BMI), increasing 17-OP, total testosterone, cortisol, the risk of preterm birth also increased. There was no significant increase in the risk of preterm birth with changes in dihydrotestosterone (DHT) and thyroid stimulating hormone (TSH). With increasing index of free testosterone (ІFТ), the risk of preterm birth, on the contrary, decreased. With increasing age and BMI, the risk of gestational hypertension dramatically increased. With the increase of 17-OP, total testosterone, cortisol, the risk of gestational hypertension also increased but the impact of these indicators was much less. There was no significant increase in the risk of gestational hypertension with changes in TSH, IFT. The presence of anemia and obtuse cervical angle of ultrasound cervicometry did not affect the risk of gestational hypertension. With increasing age, BMI and in the presence of an elevated glucose tolerance test (GTT), the risk of gestational diabetes dramatically increased. With increasing 17-OP, total testosterone, cortisol, TSH, the risk of gestational diabetes also increased. The risk of gestational diabetes, on the contrary, decreased with an increase in IFT. Conclusions. Our prediction algorithm (binary logistic regression model) allows to foresee the development of: preterm birth - in 73.43% (p=0.019938) pregnant women; ICI - in 91.30% (p=0.00004) pregnant women; gestational diabetes - in 80.43% (p=0.00004) pregnant women; gestational hypertension - in 82.61% (p=0.00322) pregnant women with combined infertility in history. The most informative clinical and laboratory predictive indicators (age, BMI, 17-OP, TSH, total testosterone, cortisol, GTT, cervical-uterine angle) were determined, which makes it possible to improve the management tactics of these pregnant women. 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.