PREVENTION OF PREECLAMPSIA IN WOMEN WITH MULTIPLE PREGNANCY AFTER ASSISTED REPRODUCTION

Abstract

The aim: To reduce the frequency and severity of preeclampsia, to improve obstetrical and perinatal outcomes in women with multiple pregnancy after assisted reproduction by the development and implementation of the preventive algorithm with biochemical markers of endothelial dysfunction prospective analysis. Materials and methods: Clinical and laboratory prospective analysis of 54 cases of twins in women, treated from infertility with assisted reproductive technologies (ART), using the method of intracytoplasmic sperm injection (ICSI) and frozen embryos transfer, have been made. It was proven, that women with multiple pregnancy are always in a high risk group of placental dysfunction (PD) and preeclampsia (PE). Depending on the treatment algorithm and preventive measures, 2 groups of patients were formed. Group I included 29 pregnant women with twins, managed in accordance with developed recommendations. We didn’t find evidence-based European guidelines, that would recommend routine prescription of progesterone to improve chorion invasion and further placentation in such group of patients, but in order to prevent endothelial dysfunction and to decrease the incidence and severity of preeclampsia, placental abnormalities and intrauterine growth restriction (IUGR), we proposed the following algorithm: – micronized progesterone 200 mg vaginally (PV), as soon as pregnancy was diagnosed by positive hCG-test, till 16 weeks of pregnancy, angioprotector diosmin 600 mg once daily orally (PO), 2 courses: from 8 till 12 and from 16 till 20 weeks of gestation, antiaggregant – acetylsalicylic acid 150 mg from 12 till 36 weeks of gestation. Group II included 25 pregnant women with twins after the same ART procedures, who have not received above mentioned treatment. Plasma concentrations of PlGF, sFlt-1 and the ratio of sFlt-1/PlGF in the second trimester were investigated in both groups of women in order to assess the effectiveness of proposed preventive measures. Results: Usage of preventive algorithm has shown the reduction of PE incidences in 26%, PD in 28.1%, IUGR in 35%, prematurity by 23% and fetal distress in 18%, that led to improvement of obstetrical and perinatal outcomes in I group of women with multiple pregnancies after ART-treated infertility, compared with group II (p<0.05). The evaluation of PlGF, sFlt-1 plasma concentrations and the ratio of sFlt-1/PlGF in the second trimester of pregnancy reflected the effectiveness of our method in women with twins after ART. The level of PlGF in the study group was higher (186.5 ± 12 vs 154.2 ± 10.7; p<0.05), and the level of sFlt-1 was lower (1523.1 ± 40.3 vs 1835.3 ± 33.6; p <0.05). Results of sFlt-1/PlGF ratio analysis in the I group also showed effectiveness of the method proposed (20.3 ± 3.1 vs 28.1 ± 2.2; p<0.05). Conclusions: The observed results suggest, that pregnant women with twins after ART-treated infertility are in a high-risk group of PE, PD and IUGR of one or both fetuses. Implementation of the proposed preventive algorithm allows to reduce the incidence of PE, obstetrical and perinatal complications in this group of patients, and can be widely used in clinical practice. Evaluation and prospective assessment of biochemical markers, such as PlGF, sFlt-1 and sFlt-1/PIGF ratio, in the second trimester of pregnancy in the target groups may likely predict the development of PE and its severity.