Tactics of preparation for pregnancy of patients with malformations of the uterus

Preparation of women with malformations of the uterus for pregnancy should be carried out taking into account anamnesis and the type of malformation of the uterus. Very often a woman has a normal reproductive function and does not suspect that she has an underdevelopment of the uterus. According to Simon S. Et al. (1991), uterine malformations were detected during sterilization in 3.2% of women with normal reproduction function. According to Stampe Sorensen S. (1988), uncovered bicornic uterus was found in laparoscopy for sterilization in 1.2% of patients, intrauterine partition in H, 2% of fertile women and saddle-uterus - in 15.3% of patients.

In addition to the development of the uterus in patients with a habitual loss of pregnancy, there is NLF, isthmico-cervical insufficiency, chronically endometritis.

When preparing for pregnancy, it is necessary to exclude the presence of a bacterial and / or viral infection, hormonal disorders. If there are inconsistencies in the tests of functional diagnostics hormonal parameters exclude damage to the endometrial receptor apparatus.

Preparation for pregnancy is made up of the results of the survey. It can be carrying out antibacterial, antiviral, immunomolyating therapy. Normalization of the II phase of the cycle through the use of cyclic hormone therapy in combination with physiotherapy (electrophoresis Ca), maufflexotherapy.

In the event that conservative methods of preparing for pregnancy and managing pregnancy can not complete the pregnancy safely, then it is possible to recommend surgical treatment of malformation of the uterus. Especially good results are observed with the removal of the intrauterine partition in hysteroscopy. Most researchers recommend after insertion of the septum to insert a spiral or Folievsky catheter and to schedule cyclic hormonal therapy for 2-3 cycles, then remove the spiral and use 2-3 cycles of cyclic hormone therapy.

In developmental malformations in the form of the two-horned uterus, metroplasty is recommended by the Strassmann method. The operation consists of dissection of the uterine horns, excision of the upper part of uterine horns, and the formation of the uterus. After the operation on the uterus, a spiral is inserted into the cavity for a period of 3 months to prevent the formation of synechia and conduct cyclic hormonal therapy. If the postoperative period is favorable, the spiral is removed after 3 months, and a control hysterosalpingography is performed. After 6-7 months, hormone levels are assessed, and functional diagnostic tests are performed. If all parameters are within the normal range, then after 5-9 months, pregnancy is allowed.

In assessing the significance of surgical treatment and conservative, many researchers have received data that surgical treatment of large pre-dominance gives. So, according to the research, in the groups of women with the two-horned uterus and with the uterine septum the outcome of pregnancy was favorable in 52% and 53% of women before surgical treatment and 58% and 65% after surgical treatment in the same patients.

In the absence of the effect of conservative methods of preparation and management of pregnancy in women with malformations of the uterus, it is necessary to clarify the form of the defect and the accompanying changes in the architectonics of vice and the condition of neighboring organs. For these purposes, magnetic resonance imaging (MRI) can be performed, during which the form of uterine malformation and, possibly, concomitant pathology is specified. After clarifying the clinical situation in each case, a reconstructive-plastic surgery can be proposed. The use of endoscopic access allows performing these operations in full, as well as a one-time correction of concomitant gynecological pathology (adhesions, endometriotic foci, myoma, etc.). The effectiveness of reconstructive and plastic surgeries is enhanced by the use of modern methods, in particular, the use of a harmonic scalpel, which causes less tissue trauma, complete organ repair and a reduction in adhesion.

Reconstructive plastic surgery with the intrauterine partition is carried out by the method of hysteroscopy.

Surgical intervention in the two-legged uterus by the Strassmann method, but laparoscopic access with simultaneous hysteroscopy, ultrasonic scalpel provides minimal tissue trauma. In this regard, further pregnancy outcome was favorable in 84% of women.

With malformations of the uterus, interruption of pregnancy in the first trimester is also observed quite often due to unfavorable implantation, reduction of vascularization, in case of the inferior phase II of the cycle. In these terms, pregnancy is rarely interrupted due to the developmental defect of the uterus, more often due to concomitant disorders - NLF, chronic endometritis.

When preparing for pregnancy, patients with intrauterine synechiae are recommended to destroy synechia in hysteroscopy. A modern method of destruction of synechia is laser surgery. After the operation, as well as with the removal of the uterine septum, it is advisable to insert a spiral, conduct cyclic hormone therapy, and physiotherapy.

At the onset of pregnancy, these patients are also administered as patients with NLF, ischemic-cervical insufficiency.

Thus, after examination and preparation for pregnancy, pregnancy can be resolved if:

1. normal parameters of hemostasis;
2. normal indicators of a general blood test;
3. 2-phase cycle;
4. there are no antibodies of IgM class to herpes simplex virus, cytomegalovirus;
5. there are no viruses in the "C" PCR method;
6. normal levels of proinflammatory cytokines;
7. normal indices of interferon status;
8. normocinosis of the vagina;
9. indicators spermogrammy husband within the norm.