Management of pregnancy, delivery, and postpartum in patients of advanced maternal age with pregnancies obtained by assisted reproductive technologies

Abstract

The objective: to reduce the frequency of obstetrical and perinatal complications in women of late reproductive age, whose pregnancy occurred with the help of assisted reproductive technologies (ART).Materials and methods. 150 nulliparous women of late reproductive age with a singleton pregnancy and fetal head presentation without severe somatic and gynecological pathology and fetal malformations, were examined. All patients were randomly divided into three groups: the main group (50 pregnant women after the ART program (n1), who received the developed algorithm – diagnosis, prevention and therapy of gestational anemia, diagnosis and prevention of intranatal complications, prevention of prolonged pregnancy, prevention of hemorrhagic complications, screening, prevention and therapy of perinatal psychological disorders; comparison group (50 patients with ART pregnancy, n2), and control group (50 patients with spontaneous pregnancy, n3). Pregnancy, childbirth and the postpartum period in the patients of the comparison group and the control group were conducted in accordance with the orders of the Ministry of Health of Ukraine. All women had a complete clinical and laboratory examination during pregnancy, childbirth and in the postpartum period, as well as a study of the level of anxiety, sleep quality, and assessment of the development of postpartum depression. Results. During the pregnancy course the percentage of patients with gestational anemia significantly decreased in the main group and was 2.0% versus 30.0% in the comparison group and 18.0% in the control group (р1.2;р1.3<0.05). In the postpartum period, the rate of anemia was also significantly lower in the main group than in the comparison and control groups.26% of patients in the comparison group and 14% – in the control group had labor induction in the term of 40–41 weeks, in the same gestational term 20% of patients in the main group were delivered by the plan caesarean section because of the absence of spontaneous onset of regular labor activity. There was no significant difference in the frequency of normal delivery and cesarean section between the main and comparison groups, but the extensive frequency of urgent cesarean section was significantly lower in the main group and it was 52% versus 83.3% in the comparison group and 86.7% – in the control group (р1.2;р1.3<0.05). The mean volume of blood loss in the main group was significantly less than in the comparison group – 300.0 (250.0; 642.5) ml versus 690.0 (300.0; 800.0) ml (р1.2<0.001) and did not significantly differ from this indicator in the control group - 300.0 (250.0; 600.0) ml. Mean volumes of blood loss separately during vaginal delivery and caesarean section in the main group were also significantly lower than in the comparison group, and were 250.0 (200.0; 280.0) ml versus 300.0 (255.0; 350.0) ml (р1.2=0.004) and 650.0 (610.0; 740.0) ml versus 750.0 (700.0; 800.0) ml (р1.2=0.01), respectively . As pregnancy progressed, the patients in the comparison and control groups were more prone to high anxiety and sleep disturbances. For the patients of the comparison group, in contrast to the women of the main group, there was a significant increase in the time required to fall asleep, the frequency of awakenings during the night, women more often needed to use sleeping pills and complained of excessive sleepiness during the day and, accordingly, had significantly lower indicators of subjective evaluation sleep quality. At 35–37 weeks of pregnancy, the rate of patients with high levels of state and trait anxiety was significantly lower in the main group than in the comparison group (28.0% vs. 66.0% and 14.0% vs. 52.0% , respectively; p1,2<0.05). Immediately after delivery, levels of both state and trait anxiety decreased slightly in all study groups, but the validity of the differences remained constant. The frequency of patients with a moderate risk of the postnatal depression development was 16% in the main group, 36% – in the comparison group (p1.2<0.05) and 20% – the control one. In 6-8 weeks after childbirth, on the background of gaining the necessary experience, there is a moderate improvement in the quality of sleep and a significant decrease in anxiety levels in all groups. The rate of patients with a moderate risk of depression development in this term remained lower in the main group than in the comparison group (12% vs. 38% ; p1.2<0.05), in the control group this indicator was 18% . Conclusions. The study proved the feasibility, efficacy, and safety of the treatment and diagnostic algorithm for prevention the obstetrical and perinatal complications in patients in late reproductive age who became pregnant after the use of ART.