Abstract

Aim: to analyze the course of the first trimester of pregnancy in women with a history of antenatal fetal death against the background of the proposed preconceptional complex. Materials and methods. An analysis of 68 repeat pregnancies who were divided on the main and on the control group in the first trimester was conducted. The main group (MG) consisted of 31 pregnant women with a history of late-term pregnancy loss, in whom the main cause of previous reproductive losses was an infectious factor, and the control group (CG) included 37 pregnant women without a history of late-term reproductive losses. At the preconceptional stage, the MG group women obtained the complex which included psychological counseling in combination with immunomodulatory and antibacterial (if necessary) therapy and vaginal sanitation. In order to correct the psycho-emotional state, the vitamin-mineral complex included a drug with anxiolytic effect – temgikoluril 500 mg and a drug with an antidepressant effect on a plant basis, which included an extract of valerian roots, lemon balm leaves, and peppermint leaves. Results. Analyzing the course of the first trimester of pregnancy among the MG pregnant women, a significant majority of threatened miscarriage cases were noted – 9 (29.0%) (CG – 4 (10.8%), p<0.05) against the background of a significantly higher number of retrochorial hematomas – 6 (19.3%) (CG - 4 (10.8%), p>0.05) detection. In the dynamics of observation, 4 (12.9%) cases of spontaneous miscarriages were found among women in the MG and 7 (18.9%) cases of spontaneous miscarriages among women in the CG, p>0.05). When evaluating the results of the systolic-diastolic ratio in MG pregnant women, an increase in the indicator by an average of 1.5 times was noted in RUA (MG – 3.2±0.37 U, CG – 2.2±0.24 U, p<0.05) and LUA (MG – 3.4±0.47 U, CG – 2.3±0.23 U, p<0.05), which indicated an increase in vascular resistance due to diastolic incisura and indicated impaired trophoblast invasion into the spiral arteries with the possibility of further development of preeclampsia and fetal growth retardation. Conclusion. The results of the study demonstrate the effectiveness of the proposed preconceptional preparation for patients with a history of antenatal fetal death, which was implemented in a smaller number of spontaneous abortions (MG – 4 (12.9%), CG – 7 (18.9%), p>0.05) and the results of the first trimester biochemical screening, which were comparable to the results of patients in the control group (PAPP-A: MG – 1.8±0.2 mIU/ml, CG – 1.9±0.2 mIU/ml, p>0.05 and β-hCG: MG – 70.4±6.9 ng/ml, CG – 79.7±7.3 ng / ml, p>0.05). During ultrasound examination in patients with a history of antenatal fetal death, an increase in the systolic-diastolic ratio in the right and left uterine arteries was noted (RUA: MG – 3.2±0.37 U, CG – 2.2±0.24 U, p<0.05 and LUA: MG – 3.4±0.47 U, CG – 2.3±0.23 U, p<0.05), which with a high degree of probability may indicate impaired trophoblast invasion into the spiral arteries with the possibility of further development of preeclampsia and fetal growth retardation