Abstract:
The prevalence of adenomyosis among endometriosis patients ranges from 20 to 70%. In
recent years, several studies have reported a correlation between adenomyosis and major
obstetric adverse outcomes. The purpose of the study is to reduce the number and severity of
early gestational complications in women of late reproductive age with adenomyosis by
developing and implementing scientifically based preventive and therapeutic methods of
managing pregnant women in the first half of pregnancy. Material and methods. The influence of
different methods of management of 89 women of late reproductive age with a previously
radiologically established diagnosis of adenomyosis (group A) on the development of gestational
complications in the first half of pregnancy was analyzed. Group A was randomized into two
groups AI (n=45) with a developed management technique and AII (n=44) with traditional methods
of management. Control group K consisted of 30 conditionally somatically and gynecologically healthy pregnant women. Results. In pregnant women with adenomyosis, the placental processes
have been violated, which in 7-8 weeks of gestation is manifested by a statistically significant
decrease in the mean volume of chorion – (16.87 ± 0.24) cm3 versus (17.58 ± 0.30) cm3; an
increase in the spiral arteries of the mean resistance index 1.18 times and the pulsation index 1.55
times; reduction of serum concentrations of progesterone 1.22 times, placental lactogen 1.21
times, β-human chorionic gonadotropin (β- HCG) - 1.37 times, free estriol - 1.28 times, protein A
associated with pregnancy (PAPP-A) - 1.67 times, and endothelial dysfunction is manifested by a
decrease in free L -arginine - 1,18 times and NO2- - 1,32 times. The application of the proposed
pathogenetically sound prophylactic treatment of women with adenomyosis leads to a probable
improvement of morphofunctional indicators of placentation and allows to reduce the number of
complications in the first half of pregnancy, such as the threat of abortion by 2.56 times (OR 0.22;
95% CI 0.09-0.55), retrochorial hematomas - 2.13 times (OR 0.36; 95% CI 0.13-0.99), early
miscarriages - 3.07 times (OR 0.26; 95% CI 0.08-0.88), late miscarriages - 2.05 times (OR 0.47; 95%
CI 0.08-2.68 ), total miscarriages - 2.73 times (OR 0.27; 95% CI 0.09-0.77). Conclusions.
Pregnancies in women with adenomyosis have an increased risk of numerous obstetric
complications, especially early pregnancy loss, which requires more careful supervision of such
women than previously thought, and requires the development of treatment and prevention
methods of pregnancy management in the first half of pregnancy. Medical support during the
early stages of pregnancy in pregnant women with adenomyosis according to the developed
scheme led to a statistically significant decrease in complications in the first half of pregnancy.
