Особливості перебігу вагітності у жінок з пролонгованою та переношеною вагітністю (Дані ретроспективного аналізу)

Abstract

The problem of post-term pregnancy and late birth is extremely relevant in modern obstetrics and perinatology due to the fact that the incidence of this pathology is high, remains in the range of 3,5–16,0% and has no tendency to decrease. Also, the importance of this problem is due to the significant number of complications during late delivery, as well as the high neonatal morbidity and perinatal mortality of post-term babies. The objective: to determine the features of the course of pregnancy in women with prolonged pregnancies and form risk groups for prolonged pregnancy. Materials and methods. In order to determine the risk groups of pregnant women to prolonged pregnancy we conducted a retrospective clinical and statistical analysis of 197 histories of pregnancy and childbirth of women who were treated and given delivery in the department of pathology of pregnancy and childbirth of «Тhe Institute of Pediatrics, Obstetrics and Gynecology named after academician A.M. Lukyanova NAMS of Ukraine» for the years 2011–2015. The social situation, gynecological and obstetric history, the course of pregnancy and the extent of infection of women with prolonged and post-term pregnancy were studied. The main group consisted of 156 women, giving birth after 41 weeks of pregnancy: 2011 – 26 (16.8%), 2012 – 26 (8%), 2013 – 57 (36.5%), 2014 – 34 (21.9%), 2015 – 26 (16.8%). Of these, childbirth in 41 weeks – 110 (70%), 41–42 weeks – 33 (21%), in 42 weeks – 13 (9%). The control group consisted of 41 pregnant women who gave birth in a timely manner. Results. The average age of the main group of pregnant women was 28.7±1 year, and in the control group it was 27±1 year. Pregnant women over 35 years of age (12.8%) prevailed significantly among them, in the control group – 9.7%; p<0.05). With obesity I – 29 women (18.6%) of the main group and only 3 pregnant women (7.3%; p<0.05) of the control group were respectively identified. It was reliably established that women with prolongation pregnancy more often had ARVI during their lifetimes than pregnant women of the control group 47 (21.4%) and 5 (12.2%; p<0.05), respectively. After analyzing the features of somatic history in women of the main and control groups, we found a high incidence rate. An irregular menstrual cycle was noted by every fifth pregnant woman (20.5%) of the main group and only 3 pregnant women (7.3%; p<0.05) of the control group. Late onset of menstruation was significantly more common in pregnant women of the main group – 16 women (10.3%) compared with the control group. The proportion of non-pregnant women in the group of patients with prolonged and post-term pregnancies was 73.7% (control group – 48.7%; p<0.01). Every 2nd woman in the main group was first pregnant. Only 26.3% of patients in the main group had a birth history. For the women of the main group, the intergenetic interval is increased, namely from 4 to 10 years or more (78.8%, control – 52.3%; p<0.01). Most often, during this pregnancy, placental dysfunction occurred in women of the main group, which was diagnosed by ultrasound and Doppler examination (34.0%, control – 17.1%; p<0.05) and ARVI (22.4%, control – 9.7%; p<0.05). Also, every third pregnant woman from the main group treated the threat of early spontaneous abortion (30.8%) and anemia of varying severity (28.2%). Complicated during this pregnancy and vaginitis in 17.9% of cases (control group, 7.3%; p<0.05). It was revealed that in the overwhelming majority of pregnant women with post-term pregnancies the cause of inflammatory diseases of the female genital organs and background diseases of the BV is precisely the association of pathogens. Thus, in 68.0% of pregnant women of the main group, associations of STI pathogens were detected (control group – 34.1%; p<0.05), namely, epidermal streptococcus with conditionally pathogenic flora of the intestinal group. The presence of the association of TORCH pathogens was noted by 75.6% of the pregnant women of the main group (the control group – 29.3%; p<0.05). Conclusions. In women with prolonged pregnancies, complications of gestation were often found, namely: recurrent miscarriage threat (30.8%), placental dysfunction (34.0%) and vaginitis (17.9%). Taking into account the data of our study, it is necessary to include first-pregnant, women of early and late reproductive age, pregnant women who had a late birth, pregnant women with metabolic disorders detected before pregnancy, pregnant women with frequent acute respiratory viral infections, women with chronic heart diseases vascular system and gastrointestinal tract, pregnant with inflammatory diseases of the female genital organs and background diseases of the cervix. Key words: pregnancy, post-term pregnancy, prolongation, prolonged pregnancy, complications of pregnancy, risk groups, obesity, placental dysfunction.