Research of the state of the stress-realizing systems in pregnant women with miscarriage

Abstract

Introduction. Miscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, within the time limit to 22 weeks. Unfortunately, the incidence of abortion in Ukraine remains quite high and ranges from 15 to 23% of all reported pregnancies, while over 92% of them occurred before 12 weeks (Ventskivskyy BM, 2004, Ginsburg V., 2003, Beetle C.I., 2000). The hypothesis of the development of spontaneous miscarriage as a result of the impact of mental stress factors C.T. Javert first proposed back in 1954. Later it was shown that biochemical substances (epinephrine, norepinephrine, oxytocin, prostaglandins) are involved in the processes of influence of stressfactors on pregnant women.

The aim of the work was to investigate some stress-realizing systems by adopting an integrated approach in women with threatened abortion for further development of the algorithm of the evaluation and prediction of risk of the miscarriage, which will contribute to the reduction of perinatal losses and improve the reproductive health of women.

Materials and methods. Study involved 34 pregnant women with diagnosis of "threatened abortion" gestational age from 7 to20 weeks with a singleton pregnancy. The control group consisted of 15 women with usual pregnancy. Was used an integrated approach, consisting of a set of methods for studying the autonomic nervous system using computer cardiointervalography, rheovasography, research levels of hormones such as cortisol, insulin, dehydroepiandrosteronesulfate, progesterone, estradiol, and clinical and laboratory parameters.

Results. According to the gynecological, obstetric and physical anamnesis any significant difference between the women of the 1^st and 2^nd groups were not found. In the study were found that in the main group cortisol levels were significantly (p ≤ 0,01) elevated and index ratio of cortisol and insulin was higher almost in 2 times relative to the control group. In the study of indicators humeral link as insulin and DHEA-S, significant differences were not found. As for estradiol, the main was characteristic of hiperestrohenemiya - estradiol level was 0,46 ± 0,04 vs 0,26 ± 0,04 in the control group(p ≤ 0,01). Analyzing of the level of progesterone was found that14.7% of women in the main group it was lower than the minimum rate for their gestational pregnancy. In the study of vegetative regulation was found significant difference according to such indicators as stressindex, HF, RMSSD. In the main group there were sympathotonia on the background the parasympathetic failure found. As for the level of low-frequency oscillation, any significant differences were not found. In the analysis of blood pressure, heart rate, cardiac output and total peripheral vascular resistance any significant difference was not found.

Conclusions. In the main group there were activation of sympathoadrenal system, leading to sympathicotonia on the background of parasympathetic failure, increased levels of cortisol, estradiol, cortisol, insulin index, systemic and local suppression of immunity and occurrence of symptoms of threatened abortion. In the analysis of indicators of central hemodynamics in pregnant women with miscarriage were not found any significant differences in comparison with the control group of women. The results of this work helps to develop algorithm for evaluation and prediction of the risk of miscarriage

Key words: miscarriage, stress, vegetative regulation, haemodynamics.