Pregravid prognostic criteria of deciduitis

Abstract

Background. Lack of adequate management of female patients with non-developing pregnancy often contributes to persistence of infectious agents in the uterine cavity. The developed clinical protocol for pregravid preparation includes a detailed examination of a woman who is planning a pregnancy, while a comprehensive examination of a married couple can improve perinatal outcomes. This protocol states: "differentiated approach based on determining high-risk groups allows to avoid pregravid excessive preparation". For this reason it is advisable to determine the risk group for miscarriage due to infections given patient medical history and clinical laboratory pregravid prognostic criteria. Aim. To determine patient medical history and pregravid clinical and laboratory prognostic criteria for a disorder of decidualization of inflammatory genesis during the first trimester of pregnancy. Outcomes and methods. A retrospective analysis of medical history data of 30 pregnant women with non-developing pregnancies in terms of 8–10 weeks (group 1) and with histologically confirmed deciduitis was carried out. Comparison group included 50 pregnant women with a favorable course of pregnancy (group 2). Results. Patient history risk factors for non-developing pregnancy with decidual membrane infectious-inflammatory disorders are a history of acute or chronic endometritis (RR=15.83 and OR=41.45); a history of miscarriages (RR=13.33 and OR=17.82); recurrent colpitis of various etiologies (specific, non-specific) in the pregravid period (RR=6.67 and OR=8.73); a history of postpartum endometritis (RR=6.11 and OR=9.07); an increment of the placenta in a previous pregnancy (RR=5.83 and OR=7.30); a history of frozen pregnancies (RR=4.67 and OR=4.37). Pregravid risk factors for a non-developing pregnancy are a lack of both increased echogenicity and coiled arteries visualization in a middle secretory phase of menstrual cycle in a pregravidary period (RR=15,00 and OR=36.00) and endometrium thickness <10 mm at 24th day of menstrual cycle in a pregravidary period (RR=7.22 and OR=11.98). There is no association of deciduitis with late miscarriages, antenatal fetal death and early neonatal death in previous pregnancies. Conclusions. Screening patient history risk factors for infectious complications of pregnancy, including a non-developing pregnancy with deciduitis has to be implicated into a practice of obstetrician-gynecologist when giving pregravidary training. Disorder of decidualization of the endometrium is a prognostically unfavorable background for the chorion, the amnion and the embryo itself pathology formation.