Prophylaxis of early reproductive losses
Objective. To develop a complex program of preventative measures against early miscarriage after missed abortion based on the pathogenetic mechanisms of this pathology.Lipatov I.S., Tezikov Y.V., Tyutyunnik V.L., Kan N.E., Protasov A.D., Martynova N.V., Zhernakova E.V., Bukreeva A.A.
Subject and methods. A total of 170 women with spontaneous early (I trimester) miscarriage were examined and treated. The control group consisted of 30 healthy pregnant women. Immunoenzyme technique and luminescence immunoassay, hemostasis assessment tests, and histological techniques were used. Efficacy of the complex program of therapeutic measures to provide after non-developing pregnancy (NDP) was assessed using the criteria of evidence-based medicine.
Results. Over the past 25 years, the NDP rate has increased by a factor of 3.5. The following primary syndromes are distinguished in the NDP pathogenesis, i.e., systemic inflammatory response, endothelial-hemostasis dysfunction and functional endometrial insufficiency. A three-step complex program of prevention of early reproductive losses, including rehabilitation post-abortion treatment, prepregnancy care, and management of early-term pregnancy, developed basing on the pathogenetic mechanisms of NDP has demonstrated high efficacy, i.e., a 3.3-fold reduction of early reproductive losses and higher rate of favorable perinatal outcomes (by a factor of 2.3; NNT 1.6 [95% CI 1.1-2.2]; OR 9.8 [95% CI 6.4-12.5]).
Conclusion. The obtained data on missed abortions allowed to develop a pathogenetically valid complex program of pregnancy management in women with a history of NDP.
Keywords
non-developing pregnancy
abortion
preventative measures against early reproductive losses
systemic inflammatory response
endothelial-hemostasis dysfunction
functional endometrial insufficiency
Supplementary Materials
- Figure. The incidence of non-developing pregnancy and spontaneous abortion (1990-2015) (%).
- Table 1. The levels of inflammatory response, vascular endothelial dysfunction and endometrium dysfunction markers in blood of women depending on pregnancy outcome (Мe, LQ-HQ).
- Тable 2. Complications of pregnancy and pregnancy outcomes in women with previous history of missed abortion (% (absolute number))
- Тable 3. The efficiency of rehabilitation treatment comprehensive program
References
1. Sheshukova N.A., Borovkova E.I., Bol’shakova O.V. Etiopathogenic options of spontaneous miscarriage. Ginekologiya. 2014; 16(2): 84-8. (in Russian)
2. Strizhakov A.N., Lipatov I.S., Tezikov YU.V. Placental insufficiency. Samara: Ofort; 2014: 239 p. (in Russian)
3. Gazieva I.A., Chistyakova G.N., Remizova I.I. Predictive value of indicators of endothelial function and the regulation of angiogenesis in the I trimester of pregnancy in the development of placental insufficiency and early reproductive losses. Voprosy ginekologii, akusherstva i perinatologii. 2015; 14(2): 14-23. (in Russian)
4. Sementsova N.A., Zajratyants O.V., Ponomareva Yu.N., Barsanova T.G. Molecular biological mechanisms of nondeveloping pregnancy. Hirurg. 2013; 1: 4-9. (in Russian)
5. Agarkova I.A., Lipatov I.S., Tezikov Yu.V. Medical and social characteristics of women with diagnosed nondeveloping pregnancy observed in the women’s clinic. Spravochnik vracha obshchej praktiki. 2012; 1: 49-54. (in Russian)
6. Mor G., Gardenas I., Abrahams V., Guller S. Inflammation and pregnancy: the role of the immune system at the implantation site. Ann. N. Y. Acad. Sci. 2011; 1221(1): 80-7. doi: 10.1111/j.1749-6632.2010.05938.x.
7. Milovanov A.P., Ozhiganova I.N. Embryo-chorionic failure: anatomical and physiological background, rationale, definitions of pathogenetic mechanisms. Arhiv patologii. 2014; 76(3): 4-8. (in Russian)
8. Strizhakov A.N., Tezikov YU.V., Lipatov I.S., Agarkova I.A., Ivanova I.V. The clinical significance of immune cells apoptosis induced by trophoblast in complicated pregnancy. Voprosy ginekologii, akusherstva i perinatologii. 2011; 10(6): 26-31. (in Russian)
9. Kwak-Kim J., Park J.C., Ahn H.K., Kim J.W., Gilman-Sachs A. Immunological modes of pregnancy loss. Am. J. Reprod. Immunol. 2010; 63(6): 611-23. doi: 10.1111/j.1600-0897.2010.00847.x.
10. Strizhakov A.N., Tezikov Yu.V., Lipatov I.S., Agarkova I.A., SHarypova M.A. Pathogenetic substantiation of diagnosis and pre-gestational prevention dogestatsionnoy of embrioplatsentarnoy dysfunction. Voprosy ginekologii, akusherstva i perinatologii. 2012; 11(1): 5-11. (in Russian)
11. Kan N.E., Baranov I.I., Dikke G.B., Tyutyunnik V.L. Medically induced abortion at 12 to 22 weeks gestation: Indications, methods, and results. Akusherstvo i ginekologiya/Obstetrics and Gynecology. 2016; (4): 11-15. (in Russian) http://dx.doi.org/10.18565/aig.2016.4.11-15
12. Selihova M.S., Kuznecova O.A., Vdovin S.V., Dmitrienko G.V. Developing pregnancy: how to avoid losses in the future? Doktor. Ru; 2012; 75(7): 20-5. (in Russian)
13. Tyutyunnik V.L., Kan N.E., Mikhailova O.I. Use of folates in pregnancy. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2014; (8): 4-9. (in Russian)
14. Tezikov Yu.V., Lipatov I.S. The prediction and diagnosis of the severe forms of placental insufficiency. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2012; (1): 35-43. (in Russian)
15. Kotelnikov G.P., Shpigel A.S. Evidence-based medicine. Science-based medical practice. Moscow: GEHOTAR-Media. 2012; 222p. (in Russian)
16. Bushtyreva I.O., Kuznetsova N.B., Zamanskaya T.A., Dmitrieva M.P., Levchenko M.V., Shmakova K.P. Prognostic markers for early reproductive losses in patients with retrochorial hematoma. Akusherstvo i ginekologiya/Obstetrics and Gynecology. 2016; (1): 28-32. (in Russian) http://dx.doi.org/10.18565/aig.2016.1.28-32
17. Agarkova I.A., Lipatov I.S., Tezikov YU.V. Evaluation, forecasting and rehabilitation for missed abortion. Hirurg. 2012; 2: 46-53. (in Russian)
18. Chistyakova G.N., Gazieva I.A., Remizova I.I., Deryabina E.G., Trapeznikova Yu.M. On the search for laboratory predictors of early reproductive losses. Problemy reprodukcii. 2014; 4: 79-86. (in Russian)
19. Zenclussen A.C. Adaptive immune responses during pregnancy. Am. J. Reprod. Immunol. 2013; 69(4): 291-303. doi: 10.1111/aji.12097.
20. Voronina E.V., Perelygina I.O., Denisova N.V. An integrated approach to the rehabilitation of patients after developing pregnancy. Nauchno-medicinskij vestnik Central’nogo Chernozem’ya. 2016; 65: 183-186. (in Russian)
21. Stepanyan L.V., Sinchihin S.P. Features immunity mechanisms and the hemostatic system when developing pregnancy. Astrahanskij medicinskij zhurnal. 2013; 8(3): 86-89. (in Russian)
22. Prins J.R., Hylkema M.N., Erwich J.J., Huitema S., Dekkema G.J., Dijkstra F.E. et al. Smoking during pregnancy influences the maternal immune response in mice and humans. Am. J. Obstet. Gynecol. 2012; 207(1): 76. e1-14. doi: 10.1016/j.ajog.2012.04.017.
23. Brosens I., Pijnenborg R., Vercruysse L., Romero R. The «Great Obstetrical Syndromes» are associated with disorders of deep placentation. Am. J. Obstet. Gynecol. 2011; 204(3): 193-201. doi: 10.1016/j.ajog.2010.08.009.
Received 29.08.2016
Accepted 02.09.2016
About the Authors
Lipatov Igor S., PhD, MD, professor at the Department of Obstetrics and Gynecology № 1, Samara State Medical University, Ministry of Health of Russia.443099, Russia, Samara, Chapaevskaya str. 89. Tel.: +78469582418. E-mail: i.lipatoff2012@yandex.ru
Tezikov Yuriy V., PhD, MD, the head of the Department of Obstetrics and Gynecology № 1, Samara State Medical University, Ministry of Health of Russia.
443099, Russia, Samara, Chapaevskaya str. 89. Tel.: +78469582418. E-mail: yra.75@inbox.ru
Tyutyunnik Victor L., PhD, MD, the head of the obstetric physiological department, Research Center of Obstetrics, Gynecology and Perinatology Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954380988. E-mail: tioutiounnik@mail.ru
Kan Natalia E., PhD, MD, the head of the obstetric department, Research Center of Obstetrics, Gynecology and Perinatology Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79262208655. E-mail: kan-med@mail.ru
Protasov Andrey D., PhD, associate Professor at the Department of General and Clinical Microbiology, Immunology and Allergology, Samara State Medical University,
Ministry of Health of Russia. 443099, Russia, Samara, Chapaevskaya str. 89. Tel.: +78469582418. E-mail: crosss82@mail.ru
Martynova Nadezhda V., postgraduate student at the Department of Obstetrics and Gynecology № 1, Samara State Medical University, Ministry of Health of Russia.
443099, Russia, Samara, Chapaevskaya str. 89. Tel.: +78469582418
Zhernakova Elena V., senior laboratory technician at the Department of Obstetrics and Gynecology № 1, Samara State Medical University, Ministry of Health of Russia. 443099, Russia, Samara, Chapaevskaya str. 89. Tel.: +78469582418
Bukreeva Anna A., postgraduate student at the Department of Obstetrics and Gynecology № 1, Samara State Medical University, Ministry of Health of Russia.
443099, Russia, Samara, Chapaevskaya str. 89. Tel.: +78469582418
For citations: Lipatov I.S., Tezikov Y.V., Tyutyunnik V.L., Kan N.E., Protasov A.D., Martynova N.V., Zhernakova E.V., Bukreeva A.A. Prophylaxis of early reproductive losses.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (1): 24-32. (in Russian)
http://dx.doi.org/10.18565/aig.2017.1.24-32
Similar Articles
