Features of the course of pregnancy in women with menstrual dysfunction in puberty
Objective: is a complex analysis of the course of pregnancy in women with menstrual dysfunction in puberty for an individual approach to periconceptional supplementation when planning the pregnancy and prevention of complications. Methods: We performed a prospective examination of 160 pregnant women: 120 of them had menstrual dysfunction in puberty, 40 of them had a regular menstrual cycle. We determined level of estriol, progesterone, placental grows factor (PlGF) и vascular endothelial growth factor receptor 1 in blood serum. Women was run ultrasound and doppler examination of the blood flow in uteroplacental and fetal placental vessels on the 30th-34th and on the 36th-40th weeks of pregnancy. Results: Threatened miscarriage on the 11th-14th week of gestation was diagnosed in 41 women of the main group, and in 3 women of the control group. Swellings, proteinuria and hypertensive disorders occurred more often in the main groups by 2.8 times. Concentration of PlGF in blood serum of pregnant women of the main group was significantly lower than in the control group. The lowest concentration of PlGF was detected in women who had pre-existing pubertal uterine bleedings. Chronic placental insufficiency was more often diagnosed in women of the main group as well. Relative risk of placental insufficiency development was 1.53 in women with menstrual dysfunction in puberty. Conclusions: Placental insufficiency in women with late age at menarche is caused by reduction of estriol and progesterone level in periconceptional period, in women with pubertal bleedings is caused by decrease of PlGF expression and disorders of chorion angiogenesis with advanced maturation of its vessels.