Dynamics of mother–placenta–fetus system functioning in pregnant women with a history of sexually transmitted infections

Abstract

The objective: to analyze the dynamics of functional and laboratory indicators of the mother-placenta-fetus system in pregnant women with a history of sexually transmitted infections (STIs) after pregravid preparation before cycles of assisted reproductive technologies (ART). Materials and methods. An analysis of the mother–placenta–fetus system functioning was performed in 200 pregnant women with a history of STIs after the use of ART. The I (main) group included 100 pregnant women with pregravid preparation before the ART cycle, obstetric and perinatal support and childbirth in accordance with the medical and organizational algorithms, prognostic methods and treatment and prevention schemes developed by us; II group – 100 pregnant women who received generally accepted prognostic and treatment-prophylactic drugs. The control group included 100 practically healthy pregnant women with a normal reproductive history and uncomplicated course of this pregnancy. Statistical processing of research results was carried out using standard Microsoft Excel 5.0 and Statistica 8.0 programs. Results. In the I trimester of pregnancy, pregnant women in the I group were diagnosed hypoplasia of the chorion (23.0%) and thickening of the decidua basalis (32.0%) less often (p<0.05), compared to 39.0% and 51.0% persons, respectively, in the II group. The increased myometrium tone (especially in the location of the chorion) was found in 16.0% of women of the I group versus 26.0% – in the II group (p<0.05). During the II trimester, the moderate thickening of the placenta with increased diffuse hyperechogenicity was determined in 35.0% of pregnant women in the I group and in 48.0% – II group; hypertrophy of the placenta was accompanied by signs of polyhydramnio in 14.0% and 18.0% of cases, respectively. The probable decrease in the number of cases of placental hypoplasia was established among women of the I group (17.0%) versus 26.0% in the II group (p<0.05). In the III trimester of pregnancy, a significant decrease in the number of cases of hypoplasia and destructive changes in the placenta was found (by 3 times) among women of group I compared to pregnant women of group II (p<0.05).In 14.0% of the pregnant women in the I group oligohydramnios was detected, and in 15.0% – ultrasound signs of late fetal growth retardation (FGR) compared to 34.0% and 39.0% individuals, respectively, in the II group. The Ponderal index (ip) in the presence of late FGR in the I group was within the range of 1.9–2.0, and in the II group – 1.6–1.8. In the dynamics of the III trimester of pregnancy (33–34 weeks, 37–38 weeks) during the indirect cardiotocography, the fetal distress index in the It group of pregnant women was within the range of 0.98–1.02 and almost did not exceed the control standards (р>0.05), in the II group at the beginning of the III trimester it was 1.7 times higher, which indicated the presence of subcompensated fetal distress. At 37–38 weeks of pregnancy, the fetal distress index in the I group was 1.02 and it was 2.5 times lower than in women in the ІІ group (2.58; p<0.05). The hormonal activity of the fetoplacental complex during the III trimester of pregnancy in the II group indicates the changes which were typical for depletion of the placenta’s hormone synthetic and metabolic functions. Thus, the progesterone level in the II group was 501.6±51.6 nmol/l versus 596.4±56.4 nmol/l in the I group (p<0.05); cortisol and estriol levels – 546.8±24.3 nmol/l and 77.6±5.4 nmol/l versus 655.5±31.3 nmol/l and 98.5±6.9 nmol/l, respectively (p<0.05). Conclusions. According to the obtained data, in pregnant women who received our proposed complex pregravid training (I group), a state of unstable tension of hormonal regulation of the placenta was revealed until the end of pregnancy, and in the II group the exhaustion of placental and fetal hormones synthesis was observed. Our proposed pregravid preparation before ART cycles in women with a history of sexually transmitted infections leads to stabilization of the hormonal and metabolic functions of the placenta.