Application of CFS in complex therapy of pre-gravid preparation

Danielyan T. Yu., gynecologist of the highest category, Doctor of Medicine, chief physician of LLC "Medical Studio", Perm
N. A. Danielyan, dermatovenerologist, LLC "Medical Studio", Perm

The urgency of the problem. Currently, the protection of the reproductive health of the population is a priority and determining task of the state policy in the field of health care. One of the most urgent and still unresolved problems of reproductive health remains miscarriage. The frequency of abortions is 10-20%, and 75-80% occur in the first half of pregnancy - up to 12 weeks. Currently, up to 170,000 involuntary abortions occur annually in Russia. This does not take into account the large number of subclinical abortions in the first weeks. Unfortunately, the modern trend is such that the frequency of miscarriage is constantly increasing.

Inflammatory diseases of the pelvic organs are the most common cause of impaired reproductive health in women. In Russia, inflammatory diseases of the reproductive organs account for 28 to 34% of gynecological morbidity and do not show a downward trend.

Among the inflammatory diseases of the genital organs, an important place is occupied by chronic endometritis, the maximum frequency of which is observed in women of reproductive age. The presence of chronic endometritis leads to a violation of the menstrual cycle, reproductive function, is the cause of infertility, unsuccessful attempts at in vitro fertilization when the embryo is transferred to the uterus, miscarriage, complications of the course of pregnancy and childbirth.

Chronic endometritis - an inevitable consequence of the intrauterine death of the embryo - must be eliminated during the first three months after the termination of pregnancy. This will save the next pregnancy in 67% of women. In the absence of therapy, only 18% of patients expect a favorable result. However, the reality is that only 4% of women undergo rehabilitation.

The frequency of chronic endometritis in women with miscarriage ranges from 33 to 70%. Chronic endometritis is a clinical and morphological syndrome, as a result of persistent damage to the endometrium by an infectious agent, multiple secondary morphofunctional changes occur that disrupt cyclic biotransformation and deficiency of the receptor field of the endometrium. Ultimately, this leads to abortion. A clinically asymptomatic inflammatory process in the endometrium is the presence of associations of obligate anaerobic microorganisms, as well as the persistence of opportunistic flora and persistence of viruses.

Nature itself has taken care of preserving the health of the fruiting body by creating an excellent anti-infection mechanism, represented by the normal topography of the organs of the female genital area, the physiological biocenosis of the vagina and the components of local immunity. Even under the influence of negative factors, physiological protection is able to withstand, but it should be remembered that its possibilities are not limitless. The conditions of our lives are becoming more and more complicated, and this affects all aspects, including the state of the microbiome.

The factor of nutrition and infections, stress and insufficient sleep, free availability of pharmaceuticals and self-medication, electromagnetic radiation - all these influences seem to test the strength of the "protective lock" of the reproductive system.

Aim of the study. Evaluation of the effectiveness and safety of the use of CFS in the complex therapy of pre-gravid preparation in women with miscarriage in order to prevent reproductive losses.

Object and research methods. All women underwent clinical and special research methods in accordance with medical standards.

Clinical examination included analysis of anamnestic data, complaints, assessment of objective status, gynecological examination.

Separated from reproductive organs was assessed bacterioscopically and bacteriologically. Verification of STDs was carried out using PCR.

With the help of ultrasound diagnostics, the size of the uterus, ovaries, changes in the structure of the endometrium according to the phase of the menstrual cycle were determined. To analyze the condition of the endometrium, the following diagnostic measures were performed: control aspirate - biopsy of the endometrium on day 20-24 of the cycle followed by immunohistochemical examination.

Criteria for the inclusion of patients in the study was clinical, instrumental and laboratory confirmation of miscarriage in the first trimester (spontaneous miscarriages at short term and non-developing pregnancies).

According to the goals and objectives of the study, all examined women (57 people) were divided into two groups.

The main group is 38 women with a non-developing pregnancy (11 people) and a history of spontaneous abortion in the first trimester (27 people), who received treatment in terms of pre-gravid preparation according to our proposed method (complex therapy using CFC).

The comparison group - 19 women with a non-developing pregnancy (5 people) and a history of spontaneous abortion in the first trimester (14 people), who received pre-gravid training according to a standard drug regimen.

The average age of the patients was 26.5 years, ranging from 19 to 40 years. 30 women (52%) started sexual life before the age of 17, bad habits were observed in 9 (15%). Various extragenital diseases were detected in 45 women (80%): VSD - 14 (24.5%), kidney diseases - 7 (12.2%), diseases of the digestive tract - 9 (15.7%), respiratory organs - 8 (14%), thyroid diseases - 4 (7%) and others. One woman had 2 to 3 gynecological diseases: chronic cervicitis, adnexitis, endometritis, uterine myoma, adenomyosis, bacterial vaginosis.

Mono-infection from the uterine cavity was detected only in 11 women (19.25%), and in 48 (84.2%) examined pathogenic microorganisms were found in associations. The most common combinations of infectious agents were bacterial and viral. When comparing the frequency of STDs in the group of patients compared with miscarriage and in the main group of patients, no significant differences were found.

Dynamic ultrasound monitoring of the endometrium in the course of observation revealed endometrial dysfunction characterized by the presence of atrophic endometrium that does not correspond to the days of the menstrual cycle. M-echo on day 6-8 of the menstrual cycle was no more than 3.8+-0.2 mm in both groups of patients.

During the histological examination of the endometrium obtained by the Paipel test, focal fibrosis of the stroma and sclerotic changes in the walls of the spiral arteries were noted, which indicated the presence of chronic endometritis with damage to the receptor apparatus of the endometrium in women suffering from miscarriage.

In general, the patients we observed had a low index of somatic health, early sexual debut, gynecological diseases against the background of STIs, artificial and spontaneous abortions, as well as a history of intrauterine manipulations.

Evaluation of the effectiveness of the treatment courses was carried out according to the following parameters:

• Buying clinical symptoms of the disease
• Restoration of the ultrasound picture of the endometrium (measurement of the thickness of the endometrium in the dynamics of the cycle initially and after treatment)
• Data of an immunohistochemical study of the endometrium
• Frequency of pregnancy
• Tracking the course of pregnancy in case of its occurrence

Methods of treatment. We have developed methodological recommendations for the use of CFS in patients with miscarriage, taking into account the biphasic menstrual cycle and, accordingly, the day.

Tab. 1. The use of CFS taking into account the biphasic menstrual cycle and, accordingly, the day in women with miscarriage.

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Results:

• Restoration of the normal menstrual cycle was noted in all patients of the main group and in 10 (52.6%) of the comparison group.
• Buying pain sensations was observed in all patients.
• According to bacteriological research, after treatment, the growth of conditionally pathogenic microorganisms (facultatively anaerobic, gram-positive, gram-negative, fungi) was suppressed, and normocenosis was restored in all patients.
• In the ultrasound examination of M-luna on day 6-8 and on day 20-22 of the menstrual cycle, the average indicators of endometrial thickness were significantly lower in patients of the comparison group. Comparative characteristics showed that endometrial proliferation in the first phase of the cycle in patients of the comparison group was 4.1+-0.1 mm, and in patients of the main group - 6.4+-1.1 mm. In the second phase of the cycle, the secretory endometrium in the patients of the comparison group was 8.9+-1.1 mm, and in the patients of the main group - 13+-1.2 mm.
• The results of the morphological examination of the endometrial biopsy revealed the restoration of the morphological structure of the endometrium in all women of the main group, including the absence of inflammatory infiltrates and the reduction of the area of sclerotic changes, and a full-fledged endometrium corresponding to the secretory phase of the cycle with the restoration of the receptor apparatus of the endometrium was noted. In 8 patients (42%) of the comparison group, a delay in the development of the endometrial glands and a weak predecidual reaction around the spiral arterioles were found, i.e. insufficiently expressed receptor apparatus of endometrial cells.
• Tracking the course of pregnancy in women with miscarriage showed the following results. Biochemical pregnancy was recorded in all patients. Successful continuation and termination of pregnancy with timely delivery was observed in all women of the main group (100%) and in 10 (52.6%) of the comparison group.

Conclusion. Management of patients with habitual miscarriage and chronic endometritis is a complex process and, of course, the favorable outcome of the treatment of chronic endometritis is the onset and carrying of pregnancy. Pre-pregnancy preparation, which includes adequate treatment in combination with CFS, is really able to prevent reproductive losses.