Prognosis of pregnancy and perinatal outcomes in the presence of polycystic ovary syndrome

Abstract

Aim. To determine prognostic criteria for pregnancy complications and perinatal pathology in women with polycystic ovary syndrome.Materials and methods. A prospective study of 100 pregnant women with polycystic ovary syndrome at the St. Joasaph Belgorod Regional Clinical Hospital. Depending on the type of ART method, 2 groups were formed. The first group (n=50) of women – pregnancy occurred by induction of ovulation with chlorthyanisene clomiphene citrate (CC). The second group (n=50) – with the help of In vitro fertilisation (IVF). Research methods – clinical, laboratory, instrumental.Result. It was revealed that the main conditions for the probability of the formation of polycystic ovary syndrome and infertility are: the presence of childhood infections in the anamnesis, low birth weight of mothers. Disorders of the reproductive system in polycystic ovary syndrome (PCOS) are detected by menstrual cycle disorders, late menarche, inflammatory diseases of the genitals, primary and secondary infertility. Extragenital pathology is diagnosed in 100 % of women with PCOS and appears in the form of obesity, infectious and inflammatory diseases, infectious and inflammatory pathologies. With PCOS, miscarriage, preeclampsia, isthmic-cervical insufficiency, gestational diabetes mellitus, fetal growth retardation, chronic placental insufficiency are noted. The onset of pregnancy by stimulating ovulation of CC has an unfavorable course relative to IVF: the risk of miscarriage and isthmic-cervical insufficiency is higher. The average weight of full-term babies, the method of their birth turned out to be IVF, is greater than ovulation stimulation. The probability of perinatal damage against the background of ovulation stimulation exceeds IVF by about 1.5 times. In the early period of gestation and in conditions of PCOS, there is a hormonal imbalance: a fascination with TBG and a decrease in the secretion of PAMG in peripheral blood at 7–8 and 10–12 weeks. In women with polycystic ovary syndrome, the probability of termination of pregnancy in the first trimester is characterized by the presence of chorionitis, a decrease in the volume of the amniotic cavity, tachycardia of the embryo. Signs of placental insufficiency were detected in the II and III trimesters. In pregnant women with PCOS, hemostatic disorders are observed – a shortening of the activated recalcification time and blood clotting time and an increase in fibrinogen and prothrombin index. Pregnancy on the background of PCOS is accompanied by activation of free radical oxidation and the development of oxidative stress.Conclusion. To predict placental insufficiency, the risk of miscarriage, perinatal pathology of the nervous system in pregnant women with PCOS, it is necessary to assess the level of glycodelin, TBG, PAMG‑1, β-HCG.