Women with preterm labor, spontaneous miscarriages, missed pregnancies, as well as with threatened miscarriage and spotting during this pregnancy should be allocated to a high risk group for miscarriage for the timely administration of vaginal progesterone. Progesterone is prescribed from early pregnancy or from the moment of the threat of termination of pregnancy. The use of progesterone is also indicated to support the luteal phase after IVF. The route of administration of progesterone does not matter.
You can judge the favorable development of pregnancy by the indicators of hCG and progesterone. Until 6-7 weeks of pregnancy, the level of hCG should increase by 2 times every 1.5-2 days. If the hCG level is low or it goes down, then the pregnancy is not progressing.
With an ultrasound examination with a vaginal probe, the fetal egg should normally be visualized at a period of 4 weeks. The diameter of the ovum in this case is 3-5 mm, which corresponds to the hCG levels of 1500-2000 IU / l. In case of discrepancy with these criteria, the prognosis for the development of pregnancy is doubtful.
The level of progesterone can indirectly also be a predictor of pregnancy outcome:
• > 60 nmol/l - indicates the normal course of pregnancy;
• < 25 nmol / l - portends an unfavorable outcome of pregnancy.
Prevention of miscarriage includes:
• prevention of inflammatory diseases of the small pelvis, rehabilitation of foci of chronic inflammation;
• normalization of the biocenosis of the vagina;
• rejection of bad habits;
• healthy lifestyle;
• control of body weight;
• examination and treatment of general somatic pathology, correction of hormonal disorders;
• prevention of abortion;
• pregnancy planning;
• screening for sexually transmitted diseases and their timely treatment;
• diagnosis and treatment of TORCH infections, if any;
• avoidance of a large number of sexual partners.
Non-specific preconception preparation of the patient (preparation before pregnancy):
• psychological assistance to a patient who had an abortion;
• anti-stress therapy;
• normalization of the regime of work and rest, diet (it is recommended that 3 months before the intended conception, a woman should be given folic acid intake of 400 mcg per day);
• rejection of bad habits;
• medical genetic counseling for women with recurrent miscarriage.
If the cause of recurrent miscarriage is anatomical, surgical treatment is indicated: elimination of the intrauterine septum, synechia, myomatous nodes, endometrial polyps. After the elimination of the anatomical causes of miscarriage, the patient is prescribed a combined estrogen-gestagen preparation for a period of at least three months.
After the third miscarriage (recurrent miscarriage), with the exclusion of genetic and anatomical causes of miscarriage, a woman should be examined for possible coagulopathy (family history, determination of lupus anticoagulant and anticardiolipin antibodies, D-dimer, antithrombin 3, homocysteine, folic acid, antisperm antibodies).
Carrying out pathogenetically substantiated preconception preparation contributes to a significant reduction in gestational complications by 6-8 times, the overall frequency of adverse pregnancy outcomes by 4 times, spontaneous miscarriages by 4.5 times.