Application of FSC in complex therapy of preconception preparation

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

Relevance of the problem. Currently, protecting the reproductive health of the population is a priority and determining task of state policy in the field of health care. One of the most pressing and yet unresolved problems of reproductive health remains miscarriage. The incidence of abortion is 10-20%, with 75-80% occurring in the first half of pregnancy - up to 12 weeks. Currently, up to 170 thousand spontaneous abortions occur annually in Russia. This does not take into account the large number of subclinical abortions in the very first weeks. Unfortunately, the current trend is that the rate of miscarriage is steadily increasing.

The most common cause of reproductive health problems in women is inflammatory diseases of the pelvic organs. In Russia, inflammatory diseases of the reproductive organs make up from 28 to 34% in the structure of gynecological morbidity and do not have a tendency to decrease.

Chronic endometritis occupies an important place among inflammatory diseases of the genital organs, the maximum frequency of which is observed in women of reproductive age. The presence of chronic endometritis leads to disruption of the menstrual cycle, reproductive function, causes infertility, unsuccessful attempts at in vitro fertilization when transferring an embryo to the uterus, miscarriage, complications during pregnancy and childbirth.

Chronic endometritis - an inevitable consequence of intrauterine embryo death - must be eliminated within the first three months after termination of pregnancy. This will allow 67% of women to maintain subsequent pregnancies. In the absence of therapy, only 18% of patients expect a favorable outcome. 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 endometrial receptor field. This ultimately leads to termination of pregnancy. 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 the persistence of viruses.

Nature itself took care of preserving the health of the fruit receptacle, creating an excellent anti-infective mechanism, which is represented by the normal topography of the female genital organs, the physiological biocenosis of the vagina and the components of local immunity. Even when exposed to negative factors, physiological defense is able to withstand, but it should be remembered that its possibilities are not limitless. The conditions of our life are becoming more and more complex, and this affects all aspects of it, including the state of the microbiome.

Factors of nutrition and infection, stress and insufficient sleep, free availability of pharmaceuticals and self-medication, electromagnetic radiation - all these influences seem to test the strength of the “safety lock” of the reproductive system.

Purpose of the study: To evaluate the effectiveness and safety of the use of FSC in complex therapy of preconception preparation in women with miscarriage in terms of preventing reproductive losses.

Object and methods of research. 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, and gynecological examination.

Discharge from reproductive organs was assessed bacterioscopically and bacteriologically. Verification of STIs was carried out using PCR.

Using ultrasound diagnostics, the size of the uterus, ovaries, and changes in the structure of the endometrium were determined according to the phase of the menstrual cycle. To analyze the condition of the endometrium, the following diagnostic measures were carried out: control aspirate - endometrial biopsy on days 20-24 of the cycle, followed by immunohistochemical study.

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

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

The main group - 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 preconception preparation according to the method we proposed (complex therapy using FSC).

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 preconception preparation according to a standard medication regimen.

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

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

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

Histological examination of the endometrium obtained by pipell test revealed focal stromal fibrosis and sclerotic changes in the walls of the spiral arteries, which indicated the presence of chronic endometritis with damage to the endometrial receptor apparatus in women suffering from miscarriage.

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

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

• Relief of clinical symptoms of the disease
• Restoration of the ultrasound picture of the endometrium (the size of the thickness of the endometrium in the dynamics of the cycle initially and after treatment)
• Data from immunohistochemical study of the endometrium
• Pregnancy rate
• Tracking the progress of pregnancy if it occurs

Methods of treatment. We have developed guidelines for the use of FSC in patients with miscarriage, taking into account the two-phase menstrual cycle and, accordingly, the time of day.

Tab. 1. The use of FSC taking into account the two-phase menstrual cycle and, accordingly, the time of day in women with miscarriage.

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Results:

• Restoration of the normal menstrual cycle was observed in all patients of the main group and in 10 (52.6%) of the comparison group.
• Pain relief was observed in all patients.
• According to a bacteriological study after treatment, the growth of opportunistic microorganisms (facultative anaerobic, gram-positive, gram-negative, fungi) was suppressed, and normocenosis was restored in all patients.
• In an M-echo ultrasound examination on days 6-8 and days 20-22 of the menstrual cycle, the average endometrial thickness was significantly lower in patients in the comparison group. Comparative characteristics showed that endometrial proliferation in the first phase of the cycle in patients in the comparison group was 4.1+-0.1 mm, and in patients in the main group – 6.4+-1.1 mm. In the second phase of the cycle, the secretory endometrium in patients in the comparison group was 8.9+-1.1 mm, and in patients in the main group – 13+-1.2 mm.
• The results of a morphological study of an endometrial biopsy revealed restoration of the morphological structure of the endometrium in all women of the main group, including the absence of inflammatory infiltrates and a reduction in the area of sclerotic changes, and a full-fledged endometrium was noted, corresponding to the secretory phase of the cycle with restoration of the endometrial receptor apparatus. In 8 patients (42%) of the comparison group, a lag in the development of endometrial glands and a weak predecidual reaction around the spiral arterioles were revealed, 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 completion of pregnancy with timely birth was observed in all women of the main group (100%) and in 10 (52.6%) of the comparison group.

Conclusion. Management of patients with recurrent miscarriage and chronic endometritis is a complex process and, of course, a favorable outcome of treatment of chronic endometritis is the onset and gestation of pregnancy. Preconception preparation, including adequate treatment in combination with FSC, can really prevent reproductive losses.