HEALTH OF WOMAN. 2019.2(138): 70–73; doi 10.15574/HW.2019.138.70

Skripchenko N. Ya. , Pavlova O. M., Mazur T. M.
SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova NAMS of Ukraine», Kiev

The objective: to evaluate the effectiveness of the proposed method of lifestyle correction as an auxiliary pregravid preparation and prevention of obstetric complications in women with adenomyosis.

Patients and methods. 65 patients of reproductive age (29–32 years) with adenomyosis in 1–2 stage. Control group – 38 healthy women. Differences between the groups: pregravid preparation (group 1 received dietary recommendations and metered physical exercises, group 2 – combined oral contraceptives) and pregnancy (group І received progesterone therapy and diet therapy, group ІІ received exclusively progesterne therapy). Levels of progesterone, placental lactogen, tumor necrosis factor, interleukin-6, percentage of pregnancy, early miscarriage risks and reproductive loss were studied.

Results. In 87% of women with adenomyosis there were manifestations of inflammation of different localization in pelvis, infertility – in 94% of women. The level of IL-6 in women with adenomyosis before treatment was increased by almost 2.6 times. The increase in tumor necrosis factor- is associated with dysfunction of the inner organs, as possible development factor of septic complications. The reduction of progesterone in patients with adenomyosis confirms the pathogenetic mechanism of the disease. In group I, 80% (28) had pregnancy, 42.8% (12) had risk of miscarriage, 14.3% (4) cases of reproductive loss. Pregnancy in group II was detected in 80% (24) cases, of which 50% (12) had a risk of miscarriage and 6 (25%) reproductive losses.

Conclusions. Pregravidal preparation, which includes physical activity and dietary nutrition, contributed to improve reproductive function, normalized of the cytokine and hormonal profile in the progression of pregnancy, and contributed to the reduction in obstetric and perinatal losses in women with adenomyosis.

Key words: adenomyosis, pregravidder training, lifestyle correction, pregnancy, obstetric complications.

REFERENCES

1. Adamyan LV, Yarotskaya EL. 2002. Genitalnyiy endometrioz: diskussionnyie voprosyi i alternativnyie podhodyi k diagnostike i lecheniyu. Zhurnal akusherstva i zhenskih bolezney 3: 103-111.

2. Damirov MM. 2010. Genitalnyiy endometrioz – bolezn aktivnyih i delovyih zhenschin. M: 191.

3. Ischenko AI, Kudrina EA. 2008. Endometrioz: sovremennyie aspekty:176. M.

4. Unanyan AL, Sidorova IS, Kogan EA. 2012;. Aktivnyiy i neaktivnyiy adenomioz: kliniko-morfologicheskie varianty razvitiya, differentsirovannyiy podhod k terapii. Akusherstvo, ginekologiya i reproduktsiya 2: 25-30.

5. Ascher SM, Jha RC, Reinhold C. 2003. Benign myometrial conditions: leiomyomas and adenomyosis. Top Magn. Reson. Imaging 14: 281-304. https://doi.org/10.1097/00002142-200308000-00003; PMid:14578775

6. Bazot M, Darai E, Hourani R et al. 2004. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 232:379-389. https://doi.org/10.1148/radiol.2322030762; PMid:15205479

7. Barrier BF, Malinowski MJ, Dick EJ Jr, Hubbard GB, Bates GW. 2004. Adenomyosis in the baboon is associated with primary infertility. Fertil Steril. 82:1091-1094. https://doi.org/10.1016/j.fertnstert.2003.11.065; PMid:15474079

8. Benagiano G, Brosens I, Carrara S. 2009. Adenomyosis: new knowledge is generating new treatment strategies. Women’s Health 5(3): 297-311. https://doi.org/10.2217/WHE.09.7; PMid:19392615

9. Dong X, Yang Z. 2010. High-intensity focused ultrasound ablation of uterine localized adenomyosis. Curr. Opin. Obstet. Gynecol. 22(4): 326-30. https://doi.org/10.1097/GCO.0b013e32833bea2e; PMid:20610999

10. Devlieger R, D’Hooghe T, Timmerman D. 2003. Uterine adenomyosis in the infertility clinic. Hum Reprod Update. 9: 139-147. https://doi.org/10.1093/humupd/dmg010; PMid:12751776

11. Jason A. 2017. Abbott, Adenomyosis and Abnormal Uterine Bleeding (AUB-A) – Pathogenesis, diagnosis, and management, Best Practice & Research Clinical Obstetrics & Gynaecology 40:68. CrossRef. https://doi.org/10.1016/j.bpobgyn.2016.09.006; PMid:27810281

12. Parazzini F, Viganò P, Candiani M, Fedele L. 2013. Diet and endometriosis risk: a literature review. Reprod Biomed Online. 26 (4): 323–336. https://doi.org/10.1016/j.rbmo.2012.12.011; PMid:23419794

13. Romero R, Espinoza J, Goncalves LF et al. 2014. The Role of Inflammation and Infection in Preterm Birth. W. Semin. Reprod. Med. 25 (l): 21–39.

14. Tseng JF, Ryan IP, Milam TD. 2016. Interleukin-6 secretion in vitro is up-regulated in ectopic and eutopic endometrial stromal cells from women with endometriosis. J. Clin. Endocrinol. Metab. 81;3: 1118–1122. https://doi.org/10.1210/jc.81.3.1118

15. Sharma A, Satyam A, Sharma J. 2014. Leptin, IL-10 and inflammatory markers (TNF-alpha, IL-6 and IL-8) in pre-eclamptic, normotensive pregnant and healthy non-pregnant women. Am. J. Reprod. Immunol. 58;1: 21–30. https://doi.org/10.1111/j.1600-0897.2007.00486.x; PMid:17565544