Maltsev S. Pre-conceptional medical care of women with miscarriage, caused by enterovirusinfection

This thesis is devoted to the problem of miscarriages in the setting of persistent en-teroviral infection, particularly decreasing the rate of subsequent miscarriages for cer-tain infections with the help of pregravid inracervical administration of Interferon Alfa and use of Wobenzym according to the described protocols. The study is based on clinical examination and management of 90 women with miscarriages who underwent inpa-tient treatment in the departments of gynecology in Kiev City Hospital № 18 and Kiev Maternity Hospital № 7 between 2005 and 2008. For the first time we describe 8.63 % incidence of enteroviral infections among women with miscarriages. Based on review of clinical histories and physical examinations, we discovered a correlation between certain somatic illnesses and enteroviral infections thus establishing a risk group for this infectious condition. While performing immunological and electron microscopy studies, we found specific changes in the immune status and microstructure of the endometrium among women with miscarriages that could be responsible for the spontaneous terminations of pregnancy. During subsequent research we investigated results of pregravid prophylaxis with medications. We compared immediate treatment results (viruria at 4 and 8 weeks post-treatment as well as immunologic status posttreatment) and long-term results (course of pregnancies that occurred 6 to 9 months after treatment and health of newborns) with the results of conventional treatment algorithms that are endorsed by the Healthcare Ministry of Ukraine. Consistent eradication of viruria, stabilization of immunologic characteristics, decrease in the rates of subsequent miscarriages and rates of intrauterine infections of newborns were achieved in patients with the history of miscarriages in the setting of persistent enteroviral infections who re-ceived described pregravid treatment protocol. This supports high clinical efficacy of this treatment which can thus be incorporated into clinical practice.