FEATURES OF THE SECOND TRIMESTER OF PREGNANCY IN WOMEN WITH A HISTORY OF ANTENATAL FETAL DEATH UNDER A PROPOSED THERAPEUTIC COMPLEX
DOI:
https://doi.org/10.11603/24116-4944.2025.2.15361Keywords:
pregnancy, antenatal fetal death, perinatal outcomes, endothelial dysfunction, Doppler sonography, estradiol, progesterone, prolactinAbstract
The aim of the study – to determine the clinical course and outcomes of the second trimester in pregnancies with a history of antenatal fetal death (AFD) under an individualized therapeutic and preventive approach. The study also aimed to evaluate the effectiveness of differentiated interventions based on presumed etiological factors.
Materials and Methods. A prospective study was carried out between 2021 and 2024 involving 146 women, of whom 84 had a history of AFD. These were divided into three subgroups: A – coagulation disorders; B – infectious background; C – unknown etiology. A control group included 30 low-risk pregnancies. All participants received tailored preconception and gestational care, including progesterone support, vitamin supplementation, endocrine and immune corrections, anticoagulants in group A, antimicrobial therapy in group B, and phytotherapeutic agents in group C. Evaluations included hormonal profiles (estriol, progesterone, placental lactogen), glucose tolerance testing, uterine artery Doppler indices, and transvaginal measurement of cervical length at 18–22 weeks of gestation.
Results and Discussion. The individualized approach yielded reduced complication rates in all main subgroups. Group A showed improved outcomes despite existing hemostatic dysfunctions, with decreased rates of miscarriage threat (from 38.7 % in the first to 9.7 % in the second trimester, p<0.05). In group B, complications were dominated by infections, contributing to increased preterm labor risk. Group C showed combined endocrine, infectious, and immunologic abnormalities. Progesterone levels increased significantly across all subgroups (by 39.1 %, 43.9 %, and 49.5 %, respectively), confirming treatment effectiveness. However, estriol and placental lactogen remained statistically lower than in controls, indicating ongoing placental insufficiency and elevated preterm risk. Doppler indices showed moderate S/D ratio elevation in group C, while resistance index remained within normal limits, reflecting vascular compensation. Cervical shortening was observed in group C (mean (35.4±0.7) mm), suggesting the need to continue hormonal support into the third trimester. Glucose tolerance testing revealed gestational diabetes in 34.1 % of women in group C, compared to 16.1 % in group A and only 3.3 % in the control group. This underscores impaired carbohydrate metabolism as a critical contributor to adverse outcomes in unexplained AFD cases.
Conclusions. The proposed tailored approach proved effective in enhancing hormonal balance, optimizing placental function, and reducing pregnancy complications during the second trimester. Group A demonstrated the highest response to therapy. For subgroup C, where AFD etiology remains unclear, extended multidisciplinary follow-up and intensified surveillance are necessary. The findings support the relevance of a personalized pregnancy management strategy in high-risk obstetric populations.
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