Treatment and rehabilitation issues of patients with inflammatory pelvic diseases stay essential due to frequent relapses and chronicity of the inflammatory process leading to worsen the realization of reproductive function, which might become a cause for important social and economic problem.
RESEARCH AIM
Comparative analysis of a pregnancy process, childbirth and newborns state after pregravid management of patients with pelvic inflammatory diseases.
MATERIALS AND METHODS
We analyzed the outcomes of pregnancy and childbirth (plus newborns states) in 171 patients with previous pelvic inflammatory diseases. Diagnosis verification for the examined group of patients consisted of coagulation tests, biochemical blood analysis, transvaginal pelvic ultrasound examination, dopplerometry, endometrial pipelle biopsy, hysteroscopy, endometrial biopsy, microbiological test of uterus aspirates, vaginal smears, microscopic examination and real-time polymerase chain reaction (RT-PCR) of uterine and cervical canal aspirates and vaginal discharge with an assessment of microbiocenosis and with an identification of pathogenic microflora. Pregravid management of 93 patients with pelvic inflammatory diseases was performed to 3 main stages. At the first stage, a preconception-prenatal assessment of the reproductive health of a married couple was carried out including genetic counseling (to exclude the likelihood of congenital fetal anomalies). The identification of chronic endometritis and TORCH infections justified the administration of antimicrobial therapy. Therapy of the 2nd stage was about of an administration of dipyridamole and hormone replacement therapy. At the 3rd stage, we used assisted reproductive technologies; early diagnostics of pregnancy was performed. We did not perform pregravid management to 78 patients with pelvic inflammatory disease.
RESULTS
In patients with inflammatory pelvic diseases after pregravid management the comparative analysis of the study showed the low rate of gestational period complications (spontaneous abortion, placental insufficiency, premature birth) compared to a statistical significance of the examined patients with no pregravid management. Similar outcomes were noted to the labor course (labor abnormalities, bleedings) and to the newborn pathological conditions (fetal growth restriction, hypoxia). The complication rate of childbirth and newborn pathological conditions was significantly higher in patients who did not carry out with pregravid management.
CONCLUSION
Nowadays we accept the suitability of pregravid management, which is a complex of diagnostic, preventive and therapeutic methods to prepare the female body for the full conception, bearing and giving birth to a healthy child. Pregravid management of patients with inflammatory pelvic diseases should be pointed not only to regulate hormonal balance (oocyte maturation), but also to regain the functional ability of endometrium as well as to the hemostatic system.
