Microbiological and hormonal characteristics of the formation of an undeveloped pregnancy

Non-developing pregnancy is a complex of pathological symptoms, including intrauterine fetal death (embrio), pathological inertia of myometrium and disturbances of the hemostasis system [2, 4, 5]. Noninvasive pregnancy in 21% - 32% is due to hyperandrogenism to a greater or lesser extent and 27% of thyroid function disorders in the form of hyperand hypothyroidism, which leads to a disruption of the metabolism of androgens and estrogens, contributes to inadequate preparation of the endometrium for pregnancy and inadequate implantation of the fetal egg [ 1, 5, 6].

Purpose of the study: To study the microbiological and hormonal characteristics of an undeveloped pregnancy.

Materials and methods: We examined 75 pregnant women with a history of antenatal fetal death (group I) and 50 pregnant women with a physiological pregnancy course control group (group II). All patients underwent a full clinical examination in a maternity hospital. All observed patients underwent a complete clinical and laboratory examination, including: General clinical, hematological, biochemical, hormonal laboratory tests performed in the department of clinical laboratory diagnostics of the city maternity hospital.

Results and discussion. In the control group, in spite of the negative results of bacteriological and PCR analyzes, a bacterial conditionally pathogenic microflora of 103 colony forming units (CFU) and / or Candida fungi was detected in 10% of patients. In the main group, in 36% of cases, a microflora was revealed, which is a possible etiological significance in the case of an undeveloped pregnancy. It included strains considered pathogenic to any degree of presence and conditionally pathogenic microorganisms sown in an amount of> 104KOE, as well as pathogens of TORCH infection.

The results of bacteriological analysis indicated the presence of epidermal staphylococcus in 26% of women, enterobacteria - in 8%, TORCH - in 52% of patients, and 22% of them had no similar microorganisms in the cervical canal (Table 1). The most frequent representatives of TORCH infection in the main group were ureaplasma 42%, chlamydia in 34%, mycoplasma 16%, HSV2 in 34%, CMV in 26% of women.

In the second subgroup of patients, the main etiological factor was hormonal changes: insufficiency of the luteal phase of the cycle against a background of progesterone deficiency. Progesterone deficiency was indicated by the absence of a yellow ovarian body in ultrasound in 62.0% of women or a sharp decrease in its size to 0.9 ± 1.3 cm in the remaining 38% of patients. To confirm hormonal disorders, hormonal studies have been carried out. An individual analysis of hormonal disorders in this subgroup of women with undeveloped pregnancy showed that 30.0% of women had worn out forms of PCOS that were characterized, in addition to low levels of progesterone, by an increase in LH to 12.8 ± 2.3 IU / L (at a rate of 7 , 6 ± 1.8 IU / l) in combination with a normal or decreased FSH value of 4.1 ± 1.3 IU / L (at a rate of 5.3 ± 1.5 IU / L), with 12% of them increased the ratio of LH / FSH more than 2.5 times.

A high testosterone level (4.9 ± 1.4 nmol / L at a norm of 3.0 ± 0.5 nmol / L) was determined in 52% of patients. Hyperprolactinemia (763 ± 24.5 mIU / L at a norm of 323.5 ± 17.7 mIU / L) was observed in 12.0% of women, 2 of them with PCOS, and one with hyperandrogenia. Isolated decrease in the level of progesterone was observed in 7.1% of women. These data indicate that the undeveloped pregnancy was most often observed in patients with erased forms of PCOS, hyperandrogenia and hyperprolactinaemia, and the severity of hormonal disorders is not the same in the selected subgroups.

 

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Year: 2018
City: Shymkent
Category: Medicine