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Therapy in pregnancy in women with NFP
Last reviewed: 08.07.2025
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Despite preparation for pregnancy, most women with NLF in previous cycles experience problems during pregnancy. The greatest problems exist in the first trimester during the formation of the placenta, but they often arise in the second and third trimesters due to the formation of primary placental insufficiency, underdevelopment of the myometrium with hypoplasia, and infantilism of the uterus.
Therefore, from the first weeks it is necessary to control the development of the placenta and all formations of the fertilized egg. In this category of patients, the uterus often lags behind the gestational age in size, according to hormonal research, a low and slow rise in hCG and TBG is noted. According to ultrasound, a ring-shaped chorion is noted for a longer time than normal, there is an early disappearance of the yolk sac.
To maintain normal pregnancy development, it is advisable to administer maintenance doses of hCG at a dose of 5000 IU 2 times a week under the control of the hCG level. Currently, data have been obtained that hCG not only affects the ovaries, stimulating the production of steroids, but also has a direct effect on the endometrium, increasing its receptivity and promoting decidualization. Currently, there is a cautious attitude to the use of hormonal agents during pregnancy after the sad experience of using diethylstilbestrol. Estrogens are not used during pregnancy. In the first 5-6 weeks of pregnancy, there is no need for hormonal treatment, since with a physiological course of pregnancy, the level of estrogens and progesterone is within the levels of phase II of the cycle. If it is necessary to maintain pregnancy in case of insufficient effect of hCG or if ovulation stimulation was performed, from the 6th week it is advisable to prescribe Duphaston at a dose of 10 mg 2 times a day, or Utrozhestan 100 mg, 1 capsule 2-3 times per os or vaginally. Hormonal therapy can be continued up to 16 weeks of pregnancy, until the placenta is fully formed.
To reduce the dose of medications, hormonal therapy can be combined with physiotherapy - endonasal galvanization, acupuncture, etc.
In recent years, the attention of researchers has been attracted by methods of therapy carried out by immunization with lymphocytes of the husband or donors, depending on compatibility according to the HLA system.