Differentiated approaches to prevention of perinatal complications in pregnant women with miscarriage in early gestation

Abstract

Purpose of the study was to develop differentiated approaches to prevention of perinatal complications in pregnant women with miscarriage in the early stages of gestation.Materials and methods. We examined 52 patients who had been diagnosed risk of abortion at an early pregnancy, both with and without bleeding. Criteria for exclusion from the study were multiple pregnancy, pregnancy as a result of assisted reproductive technologies, pregnancy in women with severe extragenital pathology, genital anomalies, and pregnancy with diagnosed fetal abnormalities. All pregnant women underwent a comprehensive clinical and laboratory examination. At the end of the first trimester during transvaginal ultrasound with a special three-dimensional VOCAL program we calculated the chorionic volume and evaluated its vascular system.Results of the study. Chorionic volume decrease by 10–15%, and a vascularization index by 20–25% at 12–13 weeks in 50% patients after treatment for early miscarriage (group I). Volume of chorion was reduced by 16–25%, and the vascularization index by 26–35% in 23.1% women (group II). Only in 26.9% pregnant women after treatment the volume of chorion and indicators of blood flow were within the physiological range (control group). Pregnant women with chorionic hypoplasia (group I and II) continued hormonal therapy in the II and III trimesters with the aim of effectively securing the second wave of cytotrophoblast invasion and adequate growth of uterine placental blood flow. They were prescribed micronized progesterone, venotonic drug Normoven, metabolite drug Artichol and Magnicum. Non-hormonal therapy was performed in cycles of 15–18 weeks, 25–28 weeks, and 32–35 weeks. Results of the study showed that the incidence of gestational period complications in pregnant women with chorionic hypoplasia and impaired vascularization in early gestation (group I and II) was higher than in the control group, but significantly lower than in literature.Conclusions. Determination of chorionic volume and evaluation of its vascular system at the end of the first trimester of gestation can serve as a criterion for patient selection for the group of perinatal complications risk. Chorionic hypoplasia and impaired vascularization in pregnant women with early miscarriage are indicative of further drug therapy in the II and III trimesters. The complex of medical drugs (micronized progesterone, Normoven, Artichol, Magnicum) has proven itself as an effective method for prevention of perinatal complications in pregnant women with miscarriage in the first trimester.