The effect of improved methods of management of women of late reproductive age with adenomyosis in the first half of pregnancy on the development of early gestation complications

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.