Modern view on the problem of optimization of therapy in pregnant women with functional cervical insufficiency

Keywords: pregnancy, functional cervical insufficiency, hormonal balance, treatment.

Abstract

A functional cervical insufficiency plays an important role in the etiology of miscarriage and premature birth. The aim of research was to estimate the hormonal balance indexes during the course of pregnancy in pregnant women with functional cervical insufficiency and to correct the revealed violations in order to prevent obstetric complications. 101 pregnant women with confirmed diagnosis of a functional cervical insufficiency in term of gestation 22–32 weeks of pregnancy (the main group) and 34 pregnant women and women in labor with physiological condition of the cervix (the control group) were examined. The content of estradiol, progesterone, cortisol and prolactin was examined in the blood serum. On the second stage of examination 63 pregnant women obtained general basic therapy (I main group) and 38 pregnant women (II main group) received a developed treatment complex which included progesterone support by the micronized progesterone 200–400 mg twice a day up to 34–35 weeks of pregnancy, magnesium support by the magnesium orotate dehydrate in the therapeutic dosage and arginine glutamate in the therapeutic dosage. The correction of cervical insufficiency was performed with the help of a cervical pessary (according to indications). The examination of hormonal balance revealed an accurate decease of progesterone concentration on the background of high concentration of estradiol and increased levels of stress-associated hormones. Propitious influence of the developed therapy is proved by increase of progesterone concentration in the blood serum, normalization in stress-associated hormones balance according to gestational age. All this provideded the decrease of specific weight of threatened preterm labors, placental dysfunction, vaginitis, bacterial vaginosis and delay the labors up to 38–39 weeks of gestation in 97,4% of pregnant women (82,5% in the I main group). Prescription of micronized progesterone, magnesium orotate dehydrate, arginine glutamate to pregnant women with a cervical insufficiency is reasonable and effective one comparing with general and traditional therapy.

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References

1. Babak, O. Ya. & Frolov, V. M. (2005). Glutargin – farmakologicheskoe dejstvie i klinicheskoe primenenie. [Glutargin-pharmacological action and clinical application]. Har'kov; Lugansk: izd-vo Ehlton. – Kharko- Lugansk: Elton publishing.
2. Beniuk, V. O., Dyndar, O. A. & Bala, O. O. (2011). Faktory perynatalnoho ryzyku pry nevynoshuvanni vahitnosti. [Factors of perinatal risk in miscarriage]. Neonatolohiia, khirurhiia ta perynatalna medytsyna - Neonatology, surgery and perinatal medicine, 1 (2), 75–77.
3. Hopchuk, O. M. (2016). Dyferentsiiovanyi pidkhid do zastosuvannia prohesteronu v akushersko-hinekolohichnii praktytsi. [Differentiated approach to the use of progesterone in obstetric and gynecological practice]. Zdorov'e zhenshchiny – Women's health, 2, 36–41.
4. Zhabchenko, I. A. (2015). Akusherskaya taktika pri istmiko-cervikalnoj nedostatochnosti: reshenie osnovnyh i soputstvuyushih problem. [Obstetrical tactics in case of Isthmiko-cervical insufficiency: the solution of the main and accompanying problems]. Ohrana materinstva i detstva – Protection of motherhood and childhood, 2, 58–65.
5. Zhuk, S. I. & Shchurevskaya, O. D. (2016). Osobennosti techeniya beremennosti i rodov u zhenshchin – vynuzhdennyh pereselenok. [Features of the course of pregnancy and childbirth in displaced women]. Zdorov'e zhenshchiny - Women's health, 2, 16–18.
6. Zarichanska, Kh. V. (2013). Vmist hlikoproteiniv ta vuhlevodnykh komponentiv slyzu tservikalnoho kanalu u zhinok iz istmiko-tservikalnoiu nedostatnistiu. [The content of glycoproteins and carbohydrate components of cervical mucus in women with isthmic-cervical insufficiency]. Aktualni pytannia pediatrii, akusherstva ta hinekolohii – Actually issues of Pediatrics, obstetrics and gynecology, 1, 155–157.
7. Ivaniuta, S. O. (2012). Peredchasni polohy (klinichna lektsiia). [Premature birth (clinical lecture)]. Neonatolohiia, khirurhiia ta perynatalna medytsyna – Neonatology, surgery and perinatal medicine, 2 (1), 71–75.
8. Kaminskyi, V. V. & Sehedii, L. I. (2011). Tsytokinovi provisnyky peredchasnykh polohiv pidchas vahitnosti pislia zaplidnennia in vitro ta perenesu embrioniv u porozhnynu matky. [Cytokine precursors of preterm birth during pregnancy after in vitro fertilization and embryo transfer into the uterine cavity]. Praktychna medytsyna – Practical medicine, 4 (XVII), 135–145.
9. Nakaz MOZ Ukrainy vid 03.11.2008 r. № 624 “Pro vnesennia zmin do nakazu MOZ Ukrainy vid 15 hrudnia 2003 roku”. Klinichnyi protokol “Nevynoshuvannia vahitnosti”. [Order of the Ministry of health of Ukraine dated 03.11.2008 № 624 “on amendments to the order of the Ministry of health of Ukraine dated 15 December 2003”. Clinical Protocol “Miscarriage”].
10. Nakaz MOZ Ukrainy vid 15.07.2011 r. № 417 “Metodychni rekomendatsii shchodo nadannia ambulatornoi akushersko-hinekolohichnoi dopomohy”. [Order of the Ministry of health of Ukraine dated 15.07.2011 № 417 “Guidelines for the provision of outpatient obstetric and gynecological care”].
11. Serova, O. F., Farin, D. & Topil'skaya, N. I. (2014). Novye podhody k profilaktike i vedeniyu prezhdevremennyh rodov. [New approaches to the prevention and management of preterm birth]. Reproduktivnaya endokrinologiya – Reproduction Endocrinology, 1, 70–76.
12. Alexander, Greg R. (2007). Prematurity at birth: determinants, consequences and geographic variation. Washington: National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK11386/.
13. Dodd, J. M. & Crowther, C. A. (2009). The role of progesterone in prevention of preterm birth. Int. J. Women’s Health, 1, 73–84. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971700/.
14. Norman, J. E., Marlow, N., Messow, C. M, Shennan, A. Bennett, P. R., Thornton, S. … Norrie, J. (2016). Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentre, randomized, double-blind trial. Lancet, 387 (10033), 2106–2116. doi: 10.1016/S0140-6736(16)00350-0.
15. Van Niekerk, E. C., Siebert, I. & Kruger, T.F. (2013). An evidence-based approach to recurrent pregnancy loss. African Journal of Obstetrics and Gynaecology, 19 (3), 61–65. http://www.sajog.org.za/index.php/SAJOG/article/view/670/405.
Published
2018-08-08
How to Cite
Oleshko, V. F. (2018). Modern view on the problem of optimization of therapy in pregnant women with functional cervical insufficiency. Reports of Vinnytsia National Medical University, 22(1), 173-177. https://doi.org/10.31393/reports-vnmedical-2018-22(1)-33