The features of the first trimester of pregnancy course in first-time mothers over 40 years old

Abstract

The purpose of the work is the pregnancy miscarriage frequency reduction in primiparous women over 40 years old on the basis of the clinical-echographic, endocrinological, biochemical and microbiological changes study. Materials and Methods. A clinical-functional and laboratory studies were performed on 40 primiparous women over 40 years old, divided into two groups (the first group was divided into two subgroups). Results. In the current conditions the frequency of premature abortion varies within 10-25%. Despite the fact that many scientific groups in Ukraine and abroad work to solve this problem, the level of miscarriage is from 5.0 to 10.0%. Among the various risk factors for miscarriage a greater importance is put on the women’s reproductive history, especially in terms of age for women and men who are planning a pregnancy. The progress of modern reproductive medicine has created the prerequisites for origin of reproductive system disorders understanding in women and provided an opportunity for mechanisms of miscarriage better understanding in women who are naturally pregnant and with assistive reproductive technologies (ART). The special group of risk consists of primiparous women over 40 years old. Apart from that the miscarriage pathogenesis in these women, including after the ART, is underinvestigated. There are no clear data on the peculiarities of the fetoplacental complex formation and functional state and of a fetus and a newborn state depending on the endocrinological and immunological features. Additionally, there are no data on the possibility of miscarriage prevention and early diagnosis, taking into account the option of pregnancy. Conclusions. As the results from the first trimester of pregnancy have shown, primiparous women over 40 years old represent a high-risk group of miscarriage with a frequency of 15.0%. This complication develops against the background of pronounced echographic changes (amniotic hypoplasia, premature obliteration of exocelom, accelerated growth or early hydramnion and chorionic hypoplasia); dyshormonal disorders (decrease in the content of E and GHG); immunological (reduction in the number of CD3+ and CD4+ with increasing number of CD8+); biochemical (increase in the content of β-lipoproteins, triglycerides and LF) and microbiological (decrease in the number of lactobacilli and bifidobacteria against the background of staphylococci various strains growth) disorders. These findings should be taken into account in algorithm of management plan development for primiparous women over 40 years old in the first trimester of pregnancy.