ОТКРЫТЫЙ УНИВЕРСИТЕТ
ДОБРОЖЕЛАТЕЛЬНОГО АКУШЕРСТВА И
ПРАКТИЧЕСКОЙ ПСИХОТЕРАПИИ
ПРОФЕССОРА Н.В. СТАРЦЕВОЙ

Among infertile women the incidence of genital endometriosis is as high as 50%. Besides tubal factor endometriosis contributes to the problem of infertility, it being an autoimmune process increasing the concentration of autoantibodies to their antigens.

The development of endometriosis lesions associated with immune depression is accompanied with rejection response, manifesting itself with inflammation and delayed-type hypersensitivity (DTH). Persistency of immune rejection with autoaggression against proper body tissues of a woman promotes high autoimmunity against elements of a follicle, ovum, endometrium and trophoblast and in case of conceiving causes failure of immunologic tolerance and interruption of pregnancy in its early stage.

The advance of pregnancy and labor in 41 women with extensive genital endometriosis (uterus, pelvic peritoneum, posterior vault, sacrouterine ligaments and ovaries ) has been studied. The mean age of pregnant women was 31,1+0,7 years. The duration of the disease ranged from 5 to 20 years (8,47+0,76). The onset of the disease in most patients was associated with menarche, in 30% - it was due to genital infection, in 30% - to abortions, and in 30% of patients it occurred in conjunction with stress. The main symptoms were noted to be: algodysmenorrhea (78%), dyspareunia, chronic pelvic pains, hypermenorrhea. The period of infertility appeared to be 5,61+0,49 years. Primary infertility was determined in 37% and secondary infertility - in 54% of cases. 32 women were primaparae, 16 were gravida I. This group of women was found to have low fertility rate; each of them had the history of 1,45 pregnancies, of this number there were : 9 labors, 3 cases of extrauterine pregnancy, 16 spontaneous abortions, and 19 artificial abortions performed 5 - 10 years before. Previous therapy included periodic administration of hormone preparations (gestagens), 14 patients had been operated on for a chocolate cyst. The pregnancy under study started during releasing-hormone treatment (ZOLADEX) in 3 women, the course of immunocorrecting preparation (LEVAMISOL) in 20 women and hirudotherapy –in 8 women within the period from 6 months to 2 years. High prenatal risk (10-20 points) was observed in all pregnant women, The advance of pregnancy was complicated with the threat of miscarriage in the first trimester - in 90% of cases, in the second trimester – in 65,7% and in the third trimester – in 25,7%. In 14,6% of cases pregnancy was interrupted at 7 to 16 weeks of gestation. Retarded fetal growth was observed in 6%. Premature delivery occurred in 10,3% (vs. 7% in the population). All the pregnant women had been repeatedly hospitalized because of risk of miscarriage, early (58%) and gestosis (38,5%), pyelonephritis and fetoplacental incompetence (30,8%). A long period of misfortunes, unfavorable end of a previous pregnancy influence the advance of the desired pregnancy.

Women were very anxious about the fate of their children and their own lives, they felt fear of doctors and delivery, so they required continuous psychotherapeutic support during pregnancy. Labor was also unfavorable: early rupture of amniotic fluid sac in 17,9%, powerless labor and stimulation of delivery with OXYTOCIN – in 28,2%, fetal hypoxia – in 15,4%, operative delivery – in 33,3%, perinatal nervous system impairment in newborns was noted in 28,2% of cases, hypotrophy – in 14,4 %. The weight of neonates was 3258+75,31 gr. All deliveries took place in high-level perinatal centers where the women and their children were provided with all types of highly qualified obstetric and resuscitation care.

Both women and neonates had been carefully observed for a one year period. 4 of them had secondary deliveries after 2 years, 5 - interrupted their pregnancy, after 3-5 years 3 women had consecutive pregnancy with retarded fetal growth at the early stage. All of them had hypogalactia, breast feeding lasted for 2-3 months, the resumption of menstruation was reported to take place within 6 months, 39 patients had the recurrence of the disease in a year.

Conclusions:

- secondary infertility prevails among patients with endometriosis;

- interruption of the first pregnancy in adolescent and early reproductive age is one of the factors, contributing to the extension and development of endometriosis and infertility;

- in case of a severe extensive endometriosis pregnancy is a rare event, which advances with serious complications and does not bring to postpartum remission.

* Abstracts/ Siena, Italy. 2005/29/.P.95. Стендоывй доклад. 1-st SGI International Summit Preterm Birth