MISSED ABORTION: CLINICAL AND MORPHOLOGICAL PARALLELS AND PREVENTION OF INFECTIOUS AND INFLAMMATORY COMPLICATIONS AFTER UTERINE CAVITY CURETTAGE

Over many years, the problems of miscarriage have been the focus of attention of obstetricians/gynecologists and investigators in related areas of science. The fact that there is a rise in the number of missed abortions with increases in the incidence and severity of chronic infectious and inflammatory diseases of the female reproductive system arouses particular interest among investigators. Objective. To optimize treatment policy in patients after uterine cavity curettage for missed abortion in the first trimester of pregnancy. Subject and methods. The investigation included 96 patients aged 18 to 45 years after uterine cavity curettage for missed abortion in the first trimester of pregnancy. To evaluate the efficiency of different procedures for antibiotic use, the patients with missed abortion were divided into 3 groups according to the variant of drug administration for preventive purposes. The laboratory efficiency of ways to prevent infectious and inflammatory complications from uterine cavity curettage was evaluated using a noninvasive method for calculating the integrated peripheral hemogram readings. Results. The pathomorphological evaluation of uterine cavity curettage specimens identified conventionally 4 types of changes: 1) no inflammatory changes in oval and endometrial tissue; 2) an inflammatory reaction mainly in the endometrium and decidua; 3) predominantly inflammatory changes in the oval tissue; 4) equivalent inflammatory changes in the ovum and endometrium. The rates of changes in nonspecific immunological resistance indices in patients after instrumental emptying the uterine cavity for missed abortion in the first trimester indicated unidirectional changes in all the study groups: a decrease in leukocyte intoxication index and increases in the indices of the body’s allergy alertness, specific immune lymphocyte and monocyte potential, and cellular phagocytic defense. No statistically significant group differences were found in the leukocyte intoxication index and allergy alertness during the investigation while calculation of the specific immune lymphocyte and monocyte potential showed a statistically significant rise in this indicator by 33.8% of the baseline value in patients having oral antibiotic prophylaxis with safocid. The similar pattern was seen when estimating the cellular phagocytic defense index: a statistically significant increase by 36.45% of the baseline value in the group of patients using the study combined drug. Conclusion. Assessment of clinical and history data and the results of pathomorphological studies of uterine cavity curettage specimens demonstrated the expediency and high efficiency of preoperative antibiotic prophylaxis with the combined drug safocid in patients with missed abortion.

missed abortion, pathomorphology of uterine cavity curettage specimens, perioperative oral antibiotic prophylaxis, safocid