PREGNANCY LOSS

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DETERMINING THE CAUSES AND THE PROGNOSIS

Definition: pregnancy (fetal) losses – spontaneous abortion, or spontaneous termination of pregnancy before 22 weeks of gestation, premature delivery of non-viable fetus, still-birth (including fetal development pathologies).

15-20% of clinically established (ultrasound and hystomorphologically confirmed) pregnancies end with spontaneous abortions (before 22 week of gestation).

Most frequent causes of spontaneous abortions on early stages of gestation (before 12 week – I trimester) are fetal chromosomal abnormalities incompatible with life. Among other causes should be mentioned amniotic sac without fetal ovary (anembrionia), endocrine disorders (lutein failure, thyroid gland dysfunctions, diabetes mellitus, etc.); Spontaneous abortions in I and II trimesters of pregnancy are conditioned by uterine organ damages (congenital uterine pathologies – septum, double-horned (bicornuate) or single-horned (unicornuate) uterus, uterine adhesions,  myoma of the uterus, cervical insufficiency, etc.), infections in women (ureaplasma, mycoplasma, chlamydia, cytomegalovirus, herpes, toxoplasmosis, etc.).

If the pregnancy was spontaneously terminated 2 times or more – such a condition is considered as a recurrent pregnancy losses. The term “habitual abortions” was also used to refer to the spontaneous termination of the pregnancy several times in the early stages of gestation.

According to modern international data, the frequency of recurrent pregnancy losses are between 1-2% of the population. Their causes are diverse, including the organic damages of the uterus and cervix (uterus development failures, fibromyoma, cervical insufficiency, etc.), endocrine disorders (thyroid gland dysfunctions, diabetes mellitus, insulin resistance, prolactin level increase, progesterone deficiency, male hormones increase, etc.), autoimmune disorders (antiphospholipid syndrome, autoimmune thyroiditis, presence of antiembrional and antiendometrial antibodies), Rhesus conflict, balanced (compensated) chromosomal structural disorders in women and/or men, genetically-determined disorders of the woman’s blood coagulation system (thrombophilia genes mutations). In some cases, there may be several causes, and in all such cases it is necessary to perform complete, complex examination (Appendix 7).

The role of men’s sperm in development of pregnancy losses is of major importance.   Accordingly, when managing these conditions, it is necessary that the couple (women and men) equally participate in investigations and treatment.

In about 50% of recurrent pregnancy losses exact cause can’t be determined. In such cases presumably so called “alloimmunity” is observed, which means the following – in normal pregnancy, mother’s immune system has the ability to recognize semi-alien (transferred from father 50% of “not-own”) fetus antigens and form blocking factors to protect the fetus. Violation of this process can play a significant role in termination of pregnancy. Immunotherapy can ensure sustainability towards the father’s antigens.

Importance of correct and timely determination of the causes of pregnancy losses in their prevention is indicated by the fact that the possibility of completing the pregnancy term without physician’s intervention after pregnancy losses makes up: after 3 losses – 30%; after 4 losses – 25%; after 5 and more – 5%, while timely and adequate treatment increases this chance to 70-85%. 

SELECTION OF MANAGEMENT TACTICS AND TREATMENT

Importance of correct and timely determination of the causes of pregnancy losses in their prevention is indicated by the fact that the possibility of completing the pregnancy term without physician’s intervention after pregnancy losses makes up: after 3 losses – 30%; after 4 losses – 25%; after 5 and more – 5%, when timely and adequate treatment increases this chance to 70-85%.

In case of determining the cause of recurrent pregnancy losses, treatment can be performed through appropriate conservative and/or surgical methods, but in all cases it is necessary to identify and treat the causes before new pregnancy occurs and then follow-up the pregnant woman during the whole pregnancy term till timely delivery.

Effectiveness of such complex approach is proved by the results achieved at the CRM “Universe” – hundreds of couples, who passed complete examinations and treatment at the “Scientific-Practical Center of Management of Recurrent Pregnancy Losses” of the CRM Universe and as a result became parents of long-awaited children.

In order to contribute to the improvement of demographic situation in the country CRM Universe has been implementing a Pregnancy (fetal) Losses Management Project for more than 2 years, which offers to the couples with pregnancy losses the opportunity to undergo high quality, comprehensive examinations and treatment on the most concessional terms.