Complex Approach to Treatment of Subchorionic Hematoma in Early Threatened Abortion

Abstract

<p>Background. Currently, miscarriage is considered to be a multietiological disorder with trombofilic violations<br />and hormone deficiency as the leading factors. Despite the achievements in treatment of miscarriage, the<br />frequency of preterm termination of the wanted pregnancies is still high and the number of perinatal losses is<br />significant. Therefore, pathogenetically based therapy, safe for the foetus, is very important in management of<br />pregnancy interruption in the first trimester. A proper drugs administration provides optimal concentration of<br />active ingredients and fast action. The aim is to improve effectiveness of the early threatened abortion treatment<br />in cases of subchorionic hematoma (SCH) by combination of sublingual natural micronized progesterone and<br />tranexamic acid<br />Objective. We examined 50 pregnant women with early threatened abortion with SCH. We studied system<br />of haemostasis, basic hormonal markers and ultrasound criteria of threatened abortion. We compared efficacy<br />of treatment between traditional (supportive) therapy (sedation, spasmolytic, haemostatic drug) and combination<br />of supportive therapy in combination with tranexamic acid and natural micronized progesterone.<br />Results. The result of lab tests showed minimal signs of hypercoagulation, hyperfibrinogenemia and platelet<br />hyperactivity, a significant β-hCG level decrease and approximate decrease in progesterone and free estriol<br />production.<br />Sonographic examination showed presents of local myometrial hypertonus, deformation of fertilized egg,<br />hypoplasia of chorion, low location of fertilized ovum, retarded growth of CRL.<br />The research proved that combined administration of sublingual micronized progesterone and tranexamic<br />acid for the treatment of threatened abortion with SCH has more significant positive effect for pregnancy<br />maintenance due to clinical, biochemical, hormonal and ultrasound results if compared with the group which<br />underwent supportive therapy.<br />Conclusions. Complex application of natural micronized progesterone 100 mg three times a day sublingually<br />and 500 mg of Tranexamic acid dissolved in 200 ml normal saline solution improves the dynamics of the<br />main hormonal, haemostatic and ultrasound markers of abortion and significantly reduces reproductive losses.<br />Tranexamic acid treatment proved a rapid and effective action on hematoma and absence of embryotoxical and<br />сoagulopathyc influence. Tranexamic acid does not cause any significant disorders of hemostatic system. This is<br />very important at the early gestation because of intravascular coagulation, physiological hypercoagulable condition<br />during pregnancy that can cause microthrombosis and disrupt placentation. On the other hand, it is<br />dangerous for the mother’s health because of the increased risk of thrombosis.<br />KEY WORDS: threatened miscarriage, subhorial hematoma, micronized progesterone, tranexamic<br />acid.</p>