Modern view on the problem of optimization of therapy in pregnant women with functional cervical insufficiency

Abstract

A functional cervical insufficiency plays an important role in the etiology of miscarriage and premature birth. The aim of research was to estimate the hormonal balance indexes during the course of pregnancy in pregnant women with functional cervical insufficiency and to correct the revealed violations in order to prevent obstetric complications. 101 pregnant women with confirmed diagnosis of a functional cervical insufficiency in term of gestation 22–32 weeks of pregnancy (the main group) and 34 pregnant women and women in labor with physiological condition of the cervix (the control group) were examined. The content of estradiol, progesterone, cortisol and prolactin was examined in the blood serum. On the second stage of examination 63 pregnant women obtained general basic therapy (I main group) and 38 pregnant women (II main group) received a developed treatment complex which included progesterone support by the micronized progesterone 200–400 mg twice a day up to 34–35 weeks of pregnancy, magnesium support by the magnesium orotate dehydrate in the therapeutic dosage and arginine glutamate in the therapeutic dosage. The correction of cervical insufficiency was performed with the help of a cervical pessary (according to indications). The examination of hormonal balance revealed an accurate decease of progesterone concentration on the background of high concentration of estradiol and increased levels of stress-associated hormones. Propitious influence of the developed therapy is proved by increase of progesterone concentration in the blood serum, normalization in stress-associated hormones balance according to gestational age. All this provideded the decrease of specific weight of threatened preterm labors, placental dysfunction, vaginitis, bacterial vaginosis and delay the labors up to 38–39 weeks of gestation in 97,4% of pregnant women (82,5% in the I main group). Prescription of micronized progesterone, magnesium orotate dehydrate, arginine glutamate to pregnant women with a cervical insufficiency is reasonable and effective one comparing with general and traditional therapy.