MANAGEMENT OF PREGNANCY IN WOMEN WITH CURED INFERTILITY AGAINST THE BACKGROUND OF HYPERPROLACTINEMIA SYNDROME
DOI:
https://doi.org/10.11603/24116-4944.2024.1.14750Keywords:
infertility, idiopathic hyperprolactinemia, microprolactinoma, cabergoline, pregnancy complications, miscarriage, premature birth, dydrogesteroneAbstract
The aim of the study - to determine the characteristics of the course of pregnancy and childbirth in women with cured infertility due to hyperprolactinemia syndrome (HPRLS) against the background of idiopathic hyperprolactinemia (IH) or microprolactinoma (MP) and the effectiveness of hormonal support of such a pregnancy with dydrogesterone.
Materials and Methods. The follow-up included 78 infertile women with HPRLS due to MP or IH who became pregnant as a result of cabergoline treatment. After the onset of pregnancy, women of the main group O (n=32) received dydrogesterone until 20 weeks of pregnancy, vitamin-mineral complexes, with high levels of serum prolactin (PRL) - cabergoline until the normalization of PRL levels; women of the comparison group P (n=30) were managed in accordance with the existing standards of pregnancy management. Control group K consisted of 30 conditionally healthy fertile women of control group K without neuroendocrine disorders. The hormonal profile of peripheral blood serum in the dynamics of infertility treatment, serum levels of PRL at 11-12, 18-20, 30-31 and 36-37 weeks of pregnancy, the results of the course of pregnancy and childbirth were studied.
Results and Discussion. Before the start of treatment, the hormonal status of infertile women with HPRLS was characterized by increased levels of PRL and free testosterone, decreased serum concentrations of follicle-stimulating and luteinizing hormone, estradiol and progesterone. Continuous treatment with cabergoline took an average of 6.21±0.16 months. Ovulation resumed after 5.27±0.13 months. Pregnancy was achieved with SGPRL after 8.04±0.19 months. The proposed treatment led to a 3.47-fold decrease in the frequency of threatened miscarriage in group O (OR 0.1868 [0.0610-0.5723]), placental dysfunction by 5.07 times (OR 0.0827 [0.0266- 0.2567]), miscarriages 12.92 times (OR 0.0585 [0.0069-0.4971]), premature rupture of membranes 3.60 times (OR 0.2121 [0.0585-0.7686 ]). Premature births in group P occurred in 36.36% of cases, in group O all births were urgent (p<0.01).
Conclusions. Long-term treatment with cabergoline in women with infertility on the background of IH and MP restores fertility, and the use of dydrogesterone in the first half of pregnancy leads to a probable decrease in gestational and obstetric complications.
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