Assessment of the hormonal levels in different management strategies for women with cervical insufficiency and a history of anovulatory infertility
Keywords:cervical insufficiency, treatment, cervical cerclage, cervical pessary, progesterone
Cervical insufficiency (CI) is one of the causes of preterm birth. The rate of CI is higher in women after in vitro fertilization treatment for infertility compared to the general population.
The aim. To assess the hormonal level in women with CI and a history of anovulatory infertility in the second and third trimesters of pregnancy in different management strategies for CI.
Materials and methods. 60 pregnant women with CI who conceived through in vitro fertilization treatment for anovulatory infertility were divided into two groups: in the I group (30 women), CI was corrected only with cervical cerclage / pessary in the II trimester of pregnancy, in the II group (30 persons), cervical cerclage / pessary was combined with vaginal progesterone 200 mg ones a day until 34 full weeks of gestation. 30 pregnant women without СІ or infertility with the physiological course of pregnancy were controls. The concentrations of estradiol, progesterone, placental lactogen, prolactin and cortisol were determined in the terms of 19–22 and 30–32 weeks of gestation in the maternal blood serum.
Results. In the patients with CI at 19–22 gestational weeks, the estradiol and placental lactogen concentrations were slightly lower in the I and II groups than those in the control women, the level of progesterone was less in the I group by 13.44 %, in the II group – by 17.30 % (P < 0.05) compared to the controls; the levels of prolactin and cortisol in the I and II groups were increased significantly (P < 0.001). At 30–32 gestational weeks, the levels of estradiol (P < 0.05), progesterone (a decrease of 23.10 %, P < 0.001) and placental lactogen (a decrease of 10.74 %, P < 0.05) were significantly less as compared to the physiological ranges, while these parameters in the II group patients were on the lower limit of normal. In the I group, the concentrations of prolactin and cortisol were higher by 41.70 % (P < 0.001) and 27.36 % (P < 0.001), respectively, than the controls, in the II group – only by 24.10 % (P < 0.05) and 13.70 % (P < 0.05), respectively.
Conclusions. In the women with cervical insufficiency after in vitro fertilization treatment for anovulatory infertility, the levels of estradiol, progesterone and placental lactogen are not significantly different from physiological indices, but the prolactin and cortisol concentrations are much higher. Adjunctive vaginal progesterone treatment to cervical cerclage/pessary in the third trimester of pregnancy promotes the normalization of progesterone, estradiol and placental lactogen levels, the decrease in prolactin and cortisol indices at 30–32 gestational weeks compared to the women with cervical cerclage/pessary alone.
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