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Therapy in pregnancy in women with NLF
Last reviewed: 19.10.2021
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Despite the preparation for pregnancy in most women with NLF in previous cycles, pregnancy is problematic. The greatest problems exist in the I trimester in the formation of the placenta, but they often occur in the II and III trimesters due to the formation of primary placental insufficiency, underdevelopment of the myometrium in hypoplasia, infantilism of the uterus.
Therefore, from the first weeks, the control of the development of the placenta and all the formations of the fetal egg is necessary. In this category of patients, the uterus lags far behind the gestational age, according to the hormonal study, there is a low and slow rise in HG, TBG. According to ultrasound, a ring-shaped chorion is noted for a longer time than in norm, there is an early disappearance of the yolk sac.
To maintain the normal development of pregnancy, it is advisable to administer maintenance doses of HG at a dose of 5000 units 2 times a week under the control of the HG level. At present, data have been obtained that HC not only affects the ovaries, stimulating the production of steroids, but also has a direct effect on the endometrium, increasing its receptivity and contributing to decidualization. At present, there is a cautious attitude towards the use of hormones during pregnancy after the sad experience of using diethylstilbestrol. Estrogens during pregnancy do not apply. In the first 5-6 weeks of pregnancy, there is no need for hormonal treatment, since in the physiological course of pregnancy the level of estrogen and progesterone is within the levels of phase II of the cycle. If it is necessary to maintain pregnancy in case of insufficient HG effect or if stimulation of ovulation has been carried out, from 6 weeks it is advisable to prescribe Dufaston in a dose of 10 mg 2 times a day, or 100 mg once daily for 1 capsule 2-3 times per os or vaginally. Hormonal therapy can be continued until 16 weeks of pregnancy, until the end of placenta formation.
To reduce the dose of drugs hormone therapy can be combined with physiotherapy - endonasal galvanization, acupuncture, etc.
In recent years, researchers are attracted to the methods of therapy, carried out by immunization with lymphocytes of the husband or donors, depending on the compatibility of the HLA system.