Annotation. The purpose of the work is to analyze the gynecological, somatic, reproductive history, as well as to determine the risk factors and etiopathogenetic factors of miscarriage on the background of endometritis. We examined 98 women of childbearing age who applied to the Innomed Clinic in Vinnytsia during 2019–2020. Patients were divided into two groups: the main group – 68 women (the average age was 27.25±0.29) with habitual miscarriage and chronic endometritis; control group – 30 re-pregnant women (the average age was 26.74±0.18) without previous pregnancy loss. Statistical processing, as well as analysis of the obtained data was performed using the program “Microsoft Excel” using the methods of mathematical statistics. Statistical evaluation was performed using the Student’s test. The obtained results were considered reliable at a reliability factor p <0.05 (95% significance level). Distribution of patients of the main group by number of reproductive losses was as follows: twice – 45 women, three times – 15 women, 4 and more – 8 women. Structural distribution of pregnancy losses in women of the main group (n=68) was next: miscarriage – 41, missed abortion – 21, anembryonic pregnancy – 6. The number of reproductive losses in the first trimester was 71.7%. Reproductive losses detected during 13–22 weeks reached 28.3%. Concomitant impressions of extragenital organs and systems were found in 46 (67.6%) women of the main group and 7 (23.3%) women of the control group. The leader of somatic morbidity was endocrine pathology. Among gynecological pathology, chronic endometritis was observed in 100% (n = 68) of the examined women of the main group. In addition, 55 patients (80.9%) of this group in the structure of gynecological pathology had other lesions, among which a significant indicator belongs to chronic salpingo-oophoritis (22 (32.4%)) and various menstrual disorders (18 (26.5%)). The vast majority of women in the main group had a history of instrumental revision of the walls of the uterine cavity for various pregnancy losses in the anamnesis (28 (41.2%)). That is why the qualitative analysis of clinical data of women with habitual miscarriage and chronic endometritis is an important area of research, as it allows to carry out adequate treatment and prevention measures at the stage of pre-pregnancy training.
Chronic endometritis is a clinical and morphological syndrome, which under the influence of an infectious agent contributes to the violation of cyclic biotransformation and reciprocity of the endometrium. In the diagnosis of gynecological pathology, in particular chronic endometritis, or habitual miscarriage on the background of chronic endometritis, ultrasonography is a mandatory, non-invasive and highly specific method of research. The aim of the study was to assess the anatomical and functional condition of the pelvic organs in women with habitual miscarriage and chronic endometritis using ultrasound (ultrasound and Doppler) criteria. We examined 98 women of childbearing age who applied to the Inomed clinic in the city of Vinnytsia during 2019-2020. Patients were divided into two groups: the main group – 68 women with habitual miscarriage and chronic endometritis; control group – 30 re-pregnant women without previous pregnancy loss. Initially, ultrasound examination (ultrasound) of the pelvic organs was performed on day 5-7 of the menstrual cycle, and to monitor folliculogenesis, the study was repeated on day 13-17 of the cycle. One of the main signs of chronic endometritis is the heterogeneity of the structure of the endometrium, which was found in the vast majority of examined patients of the main group (80.88% at n=68). When determining the thickness of the endometrium, two diametrically opposite processes were established, namely: atrophy (39.71% at n=68) and atypical glandular hyperplasia (22.05% at n=68). In the second half of the menstrual cycle there was a significant thinning of the endometrial layer <0.6 cm. In the control group during the ultrasound examination revealed the following disorders: increased uterine peristalsis, dilation of the arcuate plexus, the heterogeneity of the subendometrial layer, and when re-ultrasound took into account the data of folliculogenesis. Follicular cysts were detected in 10.3% of cases in the main group and 3.3% in the control group of women. At the time of re-ultrasound in each ovary was observed 5-8 antral follicles (the size of which ranged from 6.8 mm to 11.5 mm) with the presence of one dominant, the size of which ranged from 18.2 to 23.4 mm. In order to increase the informativeness of ultrasound, Doppler was additionally performed. Thus, ultrasonography is a highly specific method for determining the anatomical and functional characteristics of the pelvic organs, in particular the pathology of the endometrium in women with habitual miscarriage. The main ultrasound characteristics of chronic endometritis, as one of the causes of reproductive losses, are changes in endometrium structure, thickness, the presence of additional structures (polyps) and fluid component. Informativeness of ultrasound examination of structural changes in the endometrium in chronic endometritis is complemented by Doppler characteristics of blood flow in the basal and spiral arteries of the uterus.
ТАКТИКА ВЕДЕННЯ ТА РОЗРОДЖЕННЯ ЖІНОК ІЗ РЕЗУС-КОНФЛІКТНОЮ ВАГІТНІСТЮМета дослідження -знизити перинатальну захворюваність і смертність у жінок із резус-конфліктною вагітністю шляхом оптимізації підходів до її ведення та тактики розродження.Матеріали та методи. Проведено ретроспективний аналіз 68 історій пологів та індивідуальних карток жінок із резус-конфліктною вагітністю та проспективне обстеження 43 жінок із резус-конфліктною вагітністю, які склали основну групу. Контрольну групу склали 34 жінки із резус-негативною групою крові без титру антитіл. Дослідження проводили на базі міської лікарні «Центр матері та дитини» м. Вінниці.Результати дослідження та їх обговорення. У роботі проведена оцінка діагностичної цінності пікової систолічної швидкості кровотоку в середній мозковій артерії плода в поєднанні з показниками біофізичного профілю та STV-тесту як діагностичного критерію стану плода при резус-конфліктній вагітності. В результаті проведеного дослідження визначений та апробований новий підхід до пренатальної діагностики важкості стану плода при резус-конфліктній вагітності, розроблений алгоритм її комплексного ведення та показань до розродження.Висновок. Запропонований ефективний та патогенетично обумовлений алгоритм ведення резус-конфліктної вагітності з визначенням пікової систолічної швидкості кровотоку в середній мозковій артерії як діагностичного критерію стану плода дозволяє зменшити кількість інвазивних процедур, частина яких супроводжується втратою вагітності, і значно поліпшити перинатальні наслідки.Ключові слова: вагітність; резус-конфлікт; гемолітична хвороба новонародженого; швидкість кровотоку в середній мозковій артерії плода. ТАКТИКА ВЕДЕнИЯ И РОДОРАЗРЕшЕнИЯ жЕнЩИн С РЕЗУС-КОнФЛИКТнОЙ БЕРЕМЕннОСТЬЮЦель исследования -снизить перинатальную заболеваемость и смертность у женщин с резус-конфликтной беремен-ностью путем оптимизации подходов к ее ведению и тактики родоразрешения.Материалы и методы. Проведено ретроспективный анализ 68 историй родов и индивидуальных карточек женщин с резус-конфликтной беременностью и проспективное обследование 43 женщин с резус-конфликтной беременностью, ко-торые составили основную группу. Контрольную группу составили 34 женщины с резус-отрицательной группой крови без титра антител. Исследование проводили на базе городской больницы «Центр матери и ребенка» г. Винницы.Результаты исследования и их обсуждение. В работе проведена оценка диагностической ценности пиковой систо-лической скорости кровотока в средней мозговой артерии плода в сочетании с показателями биофизического профиля и STV-теста как диагностического критерия состояния плода при резус-конфликтной беременности. В результате про-веденного исследования определен и апробирован новый подход к пренатальной диагностике тяжести состояния плода при резус-конфликтной беременности, разработанный алгоритм ее комплексного ведения и показаний к родоразрешению.Вывод. Предложенный эффективный и патогенетически обусловленный алгоритм ведения резус-конфликтной беремен-ности с определением пиковой систолической скорости крово...
Purpose of the study: to determine the effectiveness of micronized progesterone with antibacterial therapy in the complex of pregravid training and during pregnancy in women with recurrent pregnancy loss on the background of chronic endometritis.Materials and methods. It was assessed the course of pregnancy and childbirth on clinical and instrumental grounds with a prospective analysis of reproductive losses in women with recurrent miscarriage and chronic endometritis. 45 pregnant women with recurrent miscarriage on the background of chronic endometritis formed the main group and were prospectively examined. Main group were divided into subgroups: I subgroup – 24 patients who were included in the study at the stage of perconception training; subgroup II – 21 patients who were included in the study with a diagnosed pregnancy for up to 12 weeks. The control group consisted of 32 pregnant women with a normal course of previous pregnancies without a history of reproductive loss.Results. Patients with recurrent miscarriage and chronic endometritis who received a complex of preconception training with support of the luteal phase with micronized progesterone showed a statistically significantly lower percentage of clinical symptoms of threatened abortion, with no significant difference in control group. Thus, only 2 (8.3%) patients lost pregnancy in the I subgroup who received the proposed preconception therapy, and 6 (28,5%) women lost pregnancy in the II subgroup who started taking micronized progesterone only from the moment of pregnancy diagnosed.Conclusions. Obtained results prove the effectiveness of the micronized progesterone (Utrogestan®) at the stage of pre-pregnancy training in women with recurrent pregnancy loss and chronic endometritis, as evidenced by the percentage of reproductive losses. The universality of routes of administration for micronized progesterone and possibility of its use throughout pregnancy contributes to individualize of treatment regimens
Background. Premature rupture of the amniotic membranes (PRAM) is a spontaneous rupture before the onset of labor at 22-37 weeks. The main complications of PRAM for mother and fetus include infection, premature birth, asphyxia of the fetus during labor, and the increased frequency of cesarean sections. Deformations of extremities, face and lungs are observed in case of a long oligohydramnion (>3 weeks). Objective. To describe the features of the management of pregnant women with PRAM. Materials and methods. Analysis of literature sources on this topic. Results and discussion. Gynecological and extragenital pathology of mother, genetic predisposition, adverse environmental factors and infections are risk factors for PRAM. Prevention of PRAM includes detection and treatment of urogenital infections, quitting of smoking and alcohol intake, screening for bacteriuria and bacteriological culture for β-hemolytic streptococcus (BHS) at 35-37 weeks of pregnancy. From 22 to 34 weeks of pregnancy, pregnant women with PRAM are hospitalized to the tertiary level hospitals, since 35 weeks care can be provided in secondary level hospitals. The management algorithm is the following: 1) history taking; 2) establishment of gestational age; 3) establishment of the approximate time of PRAM; 4) general physical examination; 5) external obstetric examination; 6) cardiotocogram (CTG), tests of fetal movements (TFM), ultrasonography (US); 7) blood test with leukocyte formula, determination of C-reactive protein; 8) bacterioscopic examination of vaginal discharge; 9) collection of amniotic fluid for microbiological examination, study of rectogenital smear for BHS; 10) sanitation of the vagina with a solution of antiseptic decamethoxine after collection of vaginal secretions and amniotic fluid. PRAM management involves active or waiting tactics. Waiting tactic includes monitoring of the fetus and mother (thermometry and pulsometry, the number of leukocytes and C-reactive protein, bacterioscopy of vaginal discharge, CTG, TFM, US). Antibiotic prophylaxis (semi-synthetic penicillins + macrolides, reserve – second-generation cephalosporins) in PRAM significantly prolongs the latent phase of delivery, reduces the incidence of infections in both mother and newborn, reduces the need for surfactant and oxygen therapy. In the presence of chorioamnionitis, delivery should be performed within <12 hours. In case of PRAM in the term of 24-34 weeks the course of corticosteroids is administered. Delivery delay for 48 h for steroid prophylaxis is the main indication for tocolysis in PRAM. In general, the tactics of pregnancy management in PRAM at 24-34 weeks include monitoring of the mother and fetus, steroid prophylaxis, tocolytic therapy and the use of magnesium sulfate. Waiting tactic should be followed until 34 weeks. In women with PRAM without contraindications to prolonging pregnancy, the waiting tactic is accompanied by better results for both mother and fetus. Signs of infection or other complications of pregnancy indicate the need for termination of the waiting tactic and delivery management according to the clinical situation. Within 34-37 weeks, the waiting tactic is followed for 24 hours. Antibiotic prophylaxis is prescribed after 18 hours of anhydrous interval, and in case of BHS – immediately after PRAM. In the absence of active labor process, an internal obstetric examination is performed to decide the tactics of delivery. Other procedures include cervix preparation, induction of labor and washing of the vagina with decamethoxine solution. Cesarean section is indicated for PRAM at 26-32 weeks and immaturity of the birth canal. Conclusions. 1. Hospitalization and delivery in women with PRAM is carried out in hospitals of secondary and tertiary level. 2. Routine use of antibiotics in PRAM prolongs the latent phase of delivery and reduces the incidence of neonatal sepsis. 3. Waiting tactic in pregnant women with PRAM in the period of 24-34 weeks is accompanied by good outcomes for both mother and child. 4. Pregnant women with PRAM in 24-34 weeks should be treated with corticosteroids to prevent acute respiratory distress syndrome in neonates.
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