INFLUENCE OF HYPERPROLIFERATIVE UTERINE DISEASES ON THE COURSE OF THE FIRST TRIMESTER OF PREGNANCY

The impact of hyperproliferative uterine diseases (HPD), including uterine leiomyoma (LM), uterine endometriosis (adenomyosis) (A), and endometrial hyperplastic processes (such as polyps and/or endometrial hyperplasia (PE and/or GE)) present prior to pregnancy, particularly their combination, on pregnancy outcomes remains a pressing issue in modern medicine. Over the past decade, there has been a significant increase in the number of pregnant women with endometriosis, LM, and a history of PE and/or GE. Aim of the study: To investigate the characteristics of pregnancy course in women with hyperproliferative uterine diseases. Materials and methods. A prospective cohort randomized study was conducted among 680 women treated at the Department of Purulent-Inflammatory Diseases in Obstetrics and the Department of Rehabilitation of Women's Reproductive Function at the State Institution "All-Ukrainian Center for Motherhood and Childhood of the National Academy of Medical Sciences of Ukraine" from January 2018 to December 2024. Group 1 included 517 pregnant women with HPD and their combinations (LM, A, PE and/or GE). Group 2 (comparison group) consisted of 82 pregnant women without HPD but with pregnancy complications. Group 3 (control group) included 81 pregnant women without HPD and without pregnancy complications. Results. Early pregnancy loss was observed in 68.2% of pregnant women with HPD, while 36.6% of patients had a history of induced or medical abortions, and 27.2% exhibited a combination of complications from previous pregnancies. A high frequency of uterine wall curettage was also noted in the medical history of pregnant women with HPD (88.6%). During the first trimester, the threat of early miscarriage was present in 90% of pregnant women with HPD (OR = 3.922; 95% CI: 2.261–6.802). Retrochorial hematoma was detected twice as often in Group 1 compared to the comparison group (OR = 2.519; 95% CI: 1.418–4.473), and low placentation was observed in 18.9% of women in Group 1 (OR = 2.163; 95% CI: 1.010–4.635). These complications were more prevalent in pregnant women with a combination of adenomyosis and other uterine fibroids. Conclusions. Pregnancy in women with hyperproliferative uterine diseases (LM, A, PE and/or GE present prior to pregnancy) is frequently complicated during the first trimester by the threat of early miscarriage, retrochorial hematoma, and low placentation.