Efficiency of using dienogest at the stage of pregravid preparation on the course of pregnancy and the outcome of childbirth in patients with endometriosis

Endometriosis is a common estrogen-dependent, chronic, inflammatory disease that has a negative impact on the getting pregnant, gestational process, and birth outcomes. Foci of endometriosis affect the processes of placentation and lead to its disruption, thereby increasing the risk of premature labour, fetal growth restriction (FGR), and low birth weight for gestational age. Prescribing of hormonal therapy at the stage of pregravid preparation can be considered as a pathogenetically justified direction for reducing the incidence of obstetric complications in patients with endometriosis. Objective. To analyze the effect of dienogest 2 mg, prescribed at the stage of pregravidar preparation for patients with endometriosis after surgical treatment, on the course of pregnancy and birth outcomes. Material and methods. The study was conducted in two stages. At the first stage, a retrospective analysis of the obstetric and gynecological anamnesis was performed in patients with diagnosis of endometriosis. In all patients, the diagnosis was established on the basis of laparoscopy and confirmed by the results of histological examination.The main group included 140 patients with different stages of endometriosis, the average age was 30.3±5.3 years, the control group (n=51) consisted of patients of reproductive age with regular ovulatory menstrual cycle, absence of pain syndrome, the average age was 29.2±4.95 years. At the second stage was assessed the impact of hormone-modulating therapy during the period of pregravid preparation on the course of pregnancy and the birth outcomes. The study included 67 patients with endometriosis. The first group included patients (n=42) who received micronized dienogest 2 mg (Zafrilla) at the stage of pregravidar preparation. The second group included patients (n=25) who did not receive hormone-modulating therapy at the stage of pre-gravidar preparation. Results. At the first stage of the study was revealed that patients with endometriosis had a high risk of preeclampsia (24%), premature labour (20%), FGR (19%), birth of children with a low Apgar score (19%), and the frequency of cesarean section (48%) compared to patients without endometriosis. The use of dienogest 2 mg at the stage of pregravid preparation reduces the risk of preeclampsia by 5 times (95% CI 1.82 13.94) and reduces the risk of moderate preeclampsia by 1.8 times (95% CI 0.51; 6.40) compared to patients who did not receive hormone-modulating therapy. It was also noted that the use of dienogest reduces the risk of preterm birth by 2.7 times (95% CI 0.86; 8.48), reduces the risk of developing FGR by 4.19 times (95% CI 1.22; 14.31), reduces the risk of birth of children with a low Apgar score by 2.4 times, and reduces the risk of delivery by cesarean section by 3.6 times (95% CI 1.84; 7.02) compared to patients who did not receive therapy. Conclusion. Patients with endometriosis belong to the risk group for the development of complications of the gestational process associated with the pathogenesis of the disease. Prescribing of dienogest 2 mg at the stage of pregravid preparation in patients with endometriosis significantly reduces the incidence of pregnancy complications and improves the outcome of childbirth: reduces the risk of fetal growth retardation, premature birth, preeclampsia, as well as the frequency of delivery by cesarean section.