Pathogenetic approaches to prevention and therapy of the different forms of hormonal miscarriage in early pregnancy period
This article is devoted to modern clinical approaches for pregravidic prepare, prevention and therapy of hormonal miscarriage during early pregnancy. There is observed the pathogenesis of preplacental stage pregnancy and role of pituitary and ovary hormones in its preservation. The estimation of a role and sequence of a clinical, instrumental, hormonal and cytological monitoring at this stage pregnancy is given. Authors allocate 3 stages (types) of hormonal miscarriage: initial or gradually forming of yellow body insufficiency with progressing pregnancy until 7 weeks; failure of progesterone ovarial-placental transmission (7-11 weeks); elongation the latent period of the starting of progesterone production by placenta (since 12 weeks). Importance of correct pregravidic preparing of the woman for pregnancy is underlined. It should include sanation of infection, creation of full value menstrual cycle, compensation of extragenital pathologies. Preventive hormonal therapy of miscarriage must be used throughout of all first trimester until to full inclusion of placenta (and finishing of a yellow body function) in 15 weeks of pregnancy. The character of supporting hormonal therapy should be constructed under proceeding of cytological picture of miscarriage - hyper- or hypoestrogen types. The first type demands only of progesterone preparations, the second - combination of progesterone with estrogen. The comparative estimation of various introduction manners of hormonal medicaments is given. The approaches to supporting of pregnancy under thyroid insufficiency, hyperprolactinemia, hyperandrogenism and myoma uteri are considered.