COMPLEX APPROACH TO TREATMENT OF SUBCHORIONIC HEMATOMA IN EARLY THREATENED ABORTION
Keywords:threatened miscarriage, subhorial hematoma, micronized progesterone, tranexamic acid.
Background. Currently, miscarriage is considered to be a multietiological disorder with trombofilic violations and hormone deficiency as the leading factors. Despite the achievements in treatment of miscarriage, the frequency of preterm termination of the wanted pregnancies is still high and the number of perinatal losses is significant. Therefore, pathogenetically based therapy, safe for the foetus, is very important in management of pregnancy interruption in the first trimester. A proper drugs administration provides optimal concentration of active ingredients and fast action. The aim is to improve effectiveness of the early threatened abortion treatment in cases of subchorionic hematoma (SCH) by combination of sublingual natural micronized progesterone and tranexamic acid
Objective. We examined 50 pregnant women with early threatened abortion with SCH. We studied system of haemostasis, basic hormonal markers and ultrasound criteria of threatened abortion. We compared efficacy of treatment between traditional (supportive) therapy (sedation, spasmolytic, haemostatic drug) and combination of supportive therapy in combination with tranexamic acid and natural micronized progesterone.
Results. The result of lab tests showed minimal signs of hypercoagulation, hyperfibrinogenemia and platelet hyperactivity, a significant β-hCG level decrease and approximate decrease in progesterone and free estriol production. Sonographic examination showed presents of local myometrial hypertonus, deformation of fertilized egg, hypoplasia of chorion, low location of fertilized ovum, retarded growth of CRL.The research proved that combined administration of sublingual micronized progesterone and tranexamic acid for the treatment of threatened abortion with SCH has more significant positive effect for pregnancy maintenance due to clinical, biochemical, hormonal and ultrasound results if compared with the group which underwent supportive therapy.
Conclusions. Complex application of natural micronized progesterone 100 mg three times a day sublingually and 500 mg of Tranexamic acid dissolved in 200 ml normal saline solution improves the dynamics of the main hormonal, haemostatic and ultrasound markers of abortion and significantly reduces reproductive losses. Tranexamic acid treatment proved a rapid and effective action on hematoma and absence of embryotoxical and сoagulopathyc influence. Tranexamic acid does not cause any significant disorders of hemostatic system. This is very important at the early gestation because of intravascular coagulation, physiological hypercoagulable condition during pregnancy that can cause microthrombosis and disrupt placentation. On the other hand, it is dangerous for the mother’s health because of the increased risk of thrombosis.
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