Risk assessment and prediction of reproductive outcomes in women with a comprehensive history

• Svetlana S. Karpova
• Nadezhda K. Ryzhova
• Ulyana A. Klokova
• Anna D. Maikova
• Tatyana S. Evdokimova
• Anna P. Bavrina

Abstract

The widespread prevalence of gynecological and somatic pathology among women of fertile age in recent years leads to an increase in the frequency of complications of pregnancy and childbirth, and reproductive health disorders. According to various estimates, the incidence of miscarriage is 10–25% and tends to increase. This is facilitated by early onset of sexual activity, an increase in the number of pregnancies among women of late reproductive age, the presence of bad habits, and widespread prevalence of sexually transmitted infections. The analysis showed a significant influence of a complicated medical history on miscarriage and proved the importance of timely identification of reproductive risk factors and elimination of symptoms of threatened miscarriage in reducing the incidence of premature birth. Introducing in the Nizhny Novgorod region mandatory consultation in antenatal fetal care rooms at a medical organization with an obstetric profile of the second or third group or a medical genetic center (consultation), (including the use of telemedicine technologies) for pregnant women with extragenital diseases, with a burdened obstetric history, with obstetric complications (early toxicosis with metabolic disorders), threat of miscarriage (with a complicated history of miscarriage), in the presence of a scar on the uterus after a cesarean section and surgical interventions on the uterus, with identified pathology of fetal development to determine obstetric tactics and further monitoring together with medical specialists in the profile of the disease will have a significant positive impact on the outcome of childbirth. The role of perinatal centers at the present stage of development of obstetric care in this matter cannot be overestimated.

Aim – assessment of risk factors for miscarriage and prognosis of perinatal outcomes in patients with an unfavorable gynecological and obstetric history using the example of a third-level perinatal center in the Nizhny Novgorod region.

Material and methods. A simple single-center retrospective randomized study was conducted. To conduct the study, data was copied from archival medical records on the basis of the State Budgetary Healthcare Institution of the Nizhny Novgorod Region “Dzerzhinsky Perinatal Center”. 60 cases of preterm birth (PB) (main group) were analyzed over a three-year period (2020–2022). The main group included women who experienced pregnancy loss between 22 and 37 weeks of gestation. The control group consisted of 60 women randomly selected with timely births. Statistical processing was carried out in Python in the Jupyter Notebook environment, using the following libraries: pandas, numpy, matplotlib.pyplot, seaborn, scipy.stats. The normality of distribution of quantitative data was determined using the Kolmogorov–Smirnov test. Contingency tables, Fisher’s exact test, and Chi-square test were used to analyze qualitative data. The presence of correlations was determined using the correlation coefficients Phi (for contingency tables 2×2) and Cramer (for contingency tables whose size exceeds 2×2); the strength of correlation was determined using the Chaddock scale. Differences were considered statistically significant at p<0.05.

Results. Reliable risk factors with a high positive correlation for the Nizhny Novgorod region have been identified. These include: the educational level of the pregnant woman, the serial number of pregnancy and childbirth, a history of premature birth, the threat of miscarriage at various stages, chronic placental insufficiency, acute respiratory viral infections during pregnancy and exacerbations of chronic pathology, iron deficiency anemia. The arrangement of risk factors in accordance with their significance for the development of early labor also reveals the main directions of preconception preparation. Medical volunteers who carry out health education work with women and girls play an important role in prevention of miscarriage.

Keywords: perinatal and obstetric risk factors; reproductive outcomes; miscarriage

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