The use of CFS in complex therapy for miscarriage

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

Relevance of the problem. Currently, the protection of the reproductive health of the population is a priority and defining task of the state policy in the field of health care. One of the most pressing and yet unresolved problems of reproductive health is miscarriage. The frequency of abortions is 10-20%, with 75-80% occurring in the first half of pregnancy - up to 12 weeks. Currently, up to 170,000 spontaneous abortions occur annually in Russia. This does not take into account a large number of subclinical abortions occurring in the very first weeks. Unfortunately, the current trend is that the frequency of miscarriage is steadily increasing.

The most common cause of reproductive health disorders in women is inflammatory diseases of the pelvic organs. In Russia, inflammatory diseases of the reproductive organs account for 28 to 34% in the structure of gynecological morbidity and do not tend to decrease.

Among the inflammatory diseases of the genital organs, chronic endometritis occupies an important place, 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, is the cause of infertility, unsuccessful attempts at in vitro fertilization when transferring the embryo to the uterus, miscarriage, complications during pregnancy and childbirth.

Chronic endometritis - an inevitable consequence of intrauterine death of the embryo - must be eliminated within the first three months after termination of pregnancy. This will save a subsequent pregnancy in 67% of women. In the absence of therapy, only 18% of patients expect a favorable outcome. However, the reality is that only 4% of women go through 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 the cyclic biotransformation and deficiency of the endometrial receptor field. Ultimately, this 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 has taken care of maintaining the health of the fruit-bearing place, creating an excellent anti-infective mechanism, which is 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 when exposed to negative factors, physiological protection is able to resist, but it should be remembered that its possibilities are not unlimited. The conditions of our life are becoming more and more complicated, and this affects all its aspects, including the state of the microbiome.

The factor of nutrition and infection, stress and insufficient sleep, the 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.

The purpose of the study. Evaluation of the effectiveness and safety of the use of CFS in the complex therapy of preconception preparation in women with miscarriage in terms of preventing reproductive losses.

Object and research methods. All women underwent clinical and special research methods according to medical standards.

The clinical examination included the analysis of anamnestic data, complaints, assessment of the objective status, gynecological examination.

The discharge from the reproductive organs was evaluated bacterioscopically and bacteriologically. STI verification was carried out using PCR.

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

The criterion for inclusion of patients in the study was clinical, instrumental and laboratory confirmation of miscarriage in the first trimester (spontaneous miscarriages in the 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 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 non-developing pregnancy (5 people) and a history of spontaneous abortion in the first trimester (14 people), who received preconception preparation according to the standard drug 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 detected in 45 women (80%): VVD - 14 (24.5%), kidney disease - 7 (12.2%), digestive tract diseases - 9 (15.7%), respiratory diseases - 8 (14%), thyroid diseases - 4 (7%) and others. One woman had from 2 to 3 gynecological diseases: chronic cervicitis, adnexitis, endometritis, uterine myoma, adenomyosis, bacterial vaginosis.

Monoinfection from the uterine cavity was found 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-viral. When comparing the incidence of STIs 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 during the observation process revealed endometrial dysfunction, characterized by the presence of atrophic endometrium that does not correspond to the days of the menstrual cycle. M-echo on the 6th-8th day of the menstrual cycle was no more than 3.8+-0.2 mm in both groups of patients.

A histological examination of the endometrium obtained by the pipel test showed 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, and a history of intrauterine manipulations.

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

• Relief of clinical symptoms
• 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)
• Endometrial immunohistochemistry data
• Pregnancy rate
• Tracking the course of pregnancy in case of its occurrence

Methods of treatment. We have developed guidelines for the use of CFS 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 noted 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 conditionally pathogenic microorganisms (facultative anaerobic, gram-positive, gram-negative, fungi) was suppressed, normocenosis was restored in all patients..
• In ultrasound examination of the M-echo on days 6-8 and on days 20-22 of the menstrual cycle, the average endometrial thickness was significantly less in patients of the comparison group. Comparative characteristics showed that the proliferation of the endometrium 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 patients of the comparison group was 8.9+-1.1 mm, and in patients of the main group - 13+-1.2 mm.
• The results of the morphological study 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 in the area of ​​sclerotic changes, and a full-fledged endometrium was noted, corresponding to the secretory phase of the cycle with the restoration of the endometrial receptor apparatus. In 8 patients (42%) of the comparison group, a lag in the development of the endometrial glands and a weak predecidual reaction around the spiral arterioles, 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 delivery was observed in all women of the main group (100%) and in 10 (52.6%) of the comparison group.

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