NON-DEVELOPING PREGNANCY IN THE EARLY STAGE: NEW APPROACH TO PATHOGENIC MECHANISM AND DIAGNOSTIC PRINCIPLES
Kagramanova Janna
FSAEI of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
Abstract
Background: Percentage of non-developing pregnancy (NDP) in reproductive loss structure is 10-20%, the frequency rate of NDP in spontaneous abortion in the first trimester being 45-88%.
Aim: Early pathogenetic prediction of NDP of different types using ultrasonography for prevention of fertility complications.
Materials and Methods: 64 women aged 18-40 with NDP diagnosis in gestational period up to 12 weeks underwent clinical laboratory investigations. We determined the role of risk factors for various types of NDP, development terms of gestational sac and its time duration in uterine cavity after embryo death, dimensional ratio of mean inner diameter (MID) and parietal-coccygeal length (PCL) of embryo visualized by ultrasound imaging, and the value of β-HCG. Besides, the statistical analysis was performed.
Results: 56% women were primigravidas and 44% were multigravidas, 32% of the total amount of patients had recurrent miscarriage. Admission to hospital of all pregnant women with NDP was within gestational period of 5-11 weeks. 42% had NDP of embryo death type (ED), 47% patients had anembryonic gestation I (AG I) and 11% had anembryonic gestation II (AG II). Ovum development arrest in the majority of AG I and II patients occurred within 4-7 gestational weeks. On average, the stop of development of the fetal egg occurred at the time of 5.4 weeks of pregnancy.Time duration in uterine cavity after stop of development of the fetal egg was from several days to 5 weeks (mean value being 3 weeks). AG I and II patients’ admission to hospital had two peaks: gestational age of 6-7 weeks and of 9-10 weeks. Average gestational age for NDP of ED type diagnosis was 8.4 weeks. β-HCG value range in AG I patients was 122-1825 iU/ml (averagely 3.8 times less than lower limit of normal) and depended neither on MID value nor on MID undersize. Mean MID value in AG I and II patients was 18.3 mm. In case of ED mean hospital refer period was 8-9 weeks. Estimated mean ED period was 6.5-7 gestational weeks. Average PCL value was 7.6 mm. Mean MID size was 25.5 mm. Average period of gestational sac persistence in uterine cavity after embryo death was 2.5 weeks. β-HCG level in ED patients’ blood was averagely 1.6 times less than lower limit of normal (value range: 3232-33603 iU/ml) but more than in case of AG I.
33% participants were assigned progesterone by prenatal clinic doctor to prolong pregnancy. There were no statistically significant difference between women taking progesterone and not taking progesterone in terms of NDP diagnosis period and MID and PCL value range. Duration of ovum stay in uterine cavity was shorter in women taking progesterone. After the vacuum aspiration of gestational sac anti-inflammatory therapy consisting of fluoroquinolone- ciprofloxacin and antiviral immune response modifier Viferon 1000000 IU- rectal suppositories were applied. HDP diagnosis of all patients was confirmed morphologically.
Conclusion: Two periods were determined in pathogenesis of different types NDP (ED and AG) according to hospital admission terms, gestational sac development duration, its persistence in uterine cavity after embryo death, MID and PCL undersize and their connection with β-HCG level. If no heartbeating embryo is visualized by ultrasonography, prescription of progesterone is unjustified due to high frequency of anembyonic gestations. Predicting NDP in prenatal clinic enables early hospital admission for minimally invasive vacuum aspiration of gestational sac contributing to prevention of further complications.