L. Markin, H. Kunynets

Danylo Halytsky Lviv National Medical University

Introduction. The presence in the history of two spontaneous miscarriages and more in the first trimester is treated as the usual miscarriage of pregnancy. Endocrine factors, genital infections, extragenital diseases play a significant role in the etiology of habitual miscarriage of pregnancy. It is noteworthy that the frequency of idiopathic (unclear etiology) of the usual miscarriage of pregnancy reaches 50.0-75.0%.

Aim. To evaluate the effectiveness of preventive measures with the use of “Pregnaca” by people with idiopathic habitual miscarriage of pregnancy.

Materials and methods. The group of observation was 50 women with idiopathic habitual miscarriage of pregnancy, who had been prevented from involuntary miscarriage from a 7-8 week pregnancy. The pregnant first subgroup (25 women) prescribed dydrogesteron (10.0 mg twice daily), the second (25 women) diddgesterone and “Pregnachea” (1 capsule a day).

The peculiarities of the course of the gestation process were judged on the basis of the results of ultrasound biometrics, the determination of the internal diameter of the fetal egg and the caudal-parietal size of the fetus. The results of the measurements were compared with the indicators of T. V. Khodareva, A. M. Stigar (1989), obtained during the dynamic monitoring of pregnancy with normal course.

With the help of silicicular echography, the degree of myometrium hypertonum, the ratio of the length of the uterus cavity to its anterior posterior size, and the ratio of the length of the cervix to its diameter at the level of the inner eye were determined.

Results and discussion. All women in the surveillance group during the previous abortion failed to demonstrate the role of endocrine and immunologic factors, genital infections, chromosomal disorders, extragenital diseases, isthmic-cervical insufficiency.

In the 7-8-week period of pregnancy signs of hypertonic myometrium were absent. Local thickening of myometrium during ultrasound examination was not detected. The ratio of the length of the uterine cavity to its forebrain size was 1.32 ± 0.03, and the ratio of the length of the cervix to its diameter at the inner eye level was 1.56 ± 0.04. Clinical signs of the threat of involuntary abortion were not observed. The dimensions of the uterus and the biometric indices of the fetal egg and fetus corresponded to the period of gestation. In the course of the uncomplicated pregnancy, the growth rate of the fetal egg was an average of 0.63 cm, and an increase in the caudal-parietal size of the fetus – 0.84 cm per week.

Preventive measures were ineffective in 32.0% of the first subgroup of pregnant women and in 24.0% of women from the second subgroup.

In the case of an involuntary miscarriage, the study of fetal heart rate revealed bradycardia (103.7 ± 5.8 beats/min). There was a lag behind the size of the internal diameter of the fetal egg and the coccyx-parietal fetal size for 7-9 days from the date of gestation. The hypertonic myometrium of II-III degree was characterized predominantly. The ultrasound examination then showed several thickening of the myometrium, including in the placental area, which caused a decrease in the anterior-posterior size of the uterus. The ratio of the length of the uterus to its anterior posterior size was 1.70 ± 0.05 (p <0.05). Increasing the activity of the uterus led to a shortening and opening of the cervix. The ratio of the length of the cervix to its diameter at the internal eye level was reduced to 1.20 ± 0.04 (p<0.05).

Сonclusions. It was proved that using Pregnacare increases the effectiveness of the preventive measures in case of the idiopathic habitual miscarriage to 25.0 %.

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