Pregravid preparation and pregnancy management in women with a history of antenatal fetal death

Objective: to stratify the risk of recurrent reproductive losses and to elaborate a differentiated approach to pregnancy management tactics on the basis of complex clinical, echographic, and laboratory examinations of the fetoplacental system in order to reduce perinatal morbidity and mortality in women with antenatal losses during previous pregnancy. Subjects and methods. The investigation included 340 women, which was conducted in 2 steps: 1) complex pregravid laboratory and instrumental examination of 90 women with a history of antenatal losses (a prospective group) and 60 women without an obstetric/gynecological history (a control group) to identify risk factors for recurrent antenatal losses; 2) analysis of the course of pregnancy, labor, delivery, and perinatal outcomes in 190 women from 3 groups. A study group of 70 women from the prospective group, whose pregnancy occurred during the investigation, underwent complex laboratory and instrumental examination and careful follow-up during pregnancy. A comparison group of 60 pregnant women with a history of antenatal fetal death (AFD) underwent standard follow-up and examination in the women’s health clinic. A control group consisted of 60 women with physiological monocyesis who had been examined at the first stage. Results. The differentiated approach to managing the next pregnancy in the women with a history of AFD versus the comparison group could lower the frequency of gestation complications: threatened miscarriage by 1.63 times, placental insufficiency (PI) by 1.33 times (40% versus 53.3%); preeclampsia was detected 1.2 times more infrequently and manifested as a mild form twice more commonly (mild preeclampsia in 85.7 and 43% in the study and comparison groups, respectively); there were no cases of chronic fetal hypoxia. Drug prevention of PI during early pregnancy could prevent the progression and development of severe PI. The study group was found to have only compensated PI (40%) that presented as grade 1 isolated hemodynamic disorders in 57% of cases and as that concurrent with grade 1 fetal growth restriction syndrome, oligohydramnios, and early placental maturation in 43%. Conclusion. Pregravid preparation, laboratory and instrumental examination, drug prevention of PI during early pregnancy, and elaboration of individual obstetric tactics in women with a history of AFD contributes to a reduction in the frequency and severity of gestational complications, to improvement of perinatal outcomes, and to a decrease in perinatal morbidity.

perinatal mortality, antenatal fetal death, placental insufficiency, pregravid examination, intrauterine infection, risk factors, pregnancy management