Несмотря на все профилактические и образовательные кампании, частота незапланированных беременностей составляет 40% из более чем 200 млн беременностей, возникающих в мире. При этом примерно половина из них заканчивается абортом. Женщины в возрастной группе 20–30 лет, на которых приходится пик абортов, еще не выполнили свои репродуктивные планы. Отсутствие грамотной постабортной реабилитации женщины, включающей в том числе консультирование по вопросам контрацепции, приводит к тому, что каждая третья выбирает менее эффективный метод, а каждая четвертая и вовсе не использует методы контрацепции. Согласно Руководству Всемирной организации здравоохранения по безопасному аборту, всем женщинам после спонтанного или индуцированного аборта следует использовать гормональную контрацепцию. Комбинированные оральные контрацептивы (КОК) с дозой этинилэстрадиола 30 мкг в комбинации с дроспиреноном, обладающим выраженной антигонадотропной активностью, способны эффективно подавлять возбудимость гипоталамо-
гипофизарно-яичниковой оси после аборта. КОК могут использоваться для профилактики дефектов нервной трубки плода в случае наступления беременности после отмены КОК. Применение фолатсодержащих КОК – разумное средство доставки фолатных добавок у женщин репродуктивного возраста, которое может гарантировать будущую здоровую беременность и сохранить здоровье в целом.
Ключевые слова: аборт, контрацепция, дроспиренон, фолаты, здоровье женщины
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Despite all prevention and education campaigns, the rate of unintended pregnancies is 40% of the more than 200 million pregnancies occurring worldwide. About half of them end in abortion. Women in the 20–30 age group, where abortions peak, have not yet fulfilled their reproductive plans. The lack of competent post-abortion rehabilitation for women, including contraception counselling, results in one in three choosing a less effective method, and one in four not using any contraceptive methods at all. According to the The World Health Organization Guidelines for Safe Abortion, all women should use hormonal contraception after spontaneous or induced abortion. Combined oral contraceptives (OCs) with 30 mcg ethinyl estradiol in combination with drospirenone, which has strong antigonadotropic activity, can effectively suppress hypothalamic-pituitary-ovarian axis excitability after abortion. OCs can be used to prevent neural tube defects in the case of pregnancy after withdrawal of OCs. The use of folate-containing OCs is a sensible means of folate supplementation in women of reproductive age that may guarantee a future healthy pregnancy and overall health.
Keywords: abortion, contraception, drospirenone, folate, women's health
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1. Guttmacher Institute. Adding it up: Investing in Contraception and Maternal and Newborn Health 2017. Available at: https://www.guttmacher.org/fact-sheet/adding-it-up-contraception-mnh-2017 Accessed: 20.02.2022.
2. Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plann. 2014;45(3):301-14.
3. Sakevich VI, Denisov BP. The latest trends in reproductive health and the problem of abortion in Russia. Sotsiologicheskie issledovaniia. 2019;11:140-51 (in Russian). DOI:10.31857/S013216250007457-5
4. Statistika abortov v Rossii po dannym Rosstat. Rosstat, 2019. Available at: https://rosinfostat.ru/statistika-abortov-v-rossii-po-dannym-rosstat/ Accessed: 13.11.2020 (in Russian).
5. Nauchnye issledovaniia v oblasti preduprezhdeniia nebezopasnogo aborta. VOZ. Available at: https://www.who.int/reproductivehealth/topics/unsafe_abortion/med_abortion/ru/ Accessed: 10.02.2021 (in Russian).
6. Kontratseptsiia posle aborta. Pentkroft Farma. Available at: http://www.ru486.ru/doctor_contr.htm Accessed: 13.11.2020 (in Russian).
7. Henshaw R, Naji S, Russell I, Templeton A. Psychological responses following medical abortion (using mifeprictone and gemeprost) and surgical vacuum aspiration. A patientcentered, partially randomized prospective study. Acta Obstet Gynecol Scand. 1994;73(10):812-8.
8. The World Health Organization’s Safe Abortion Guidance Document. Am J Public Health. 2013;103(4)593-6. DOI:10.2105/AJPH.2012.301204
9. Unanyan AL, Arakelov SE, Polonskaya LS, et al. Postabortal rehabilitation: theoretical and practical aspects. Medical Council. 2014;(9):26-9 (in Russian).
DOI:10.21518/2079-701X-2014-9-26-29
10. Dikke GB. Medikamentoznyi abort v ambulatornoi praktike. Moscow: GEOTAR-Media, 2018 (in Russian).
11. Che Y, Liu X, Zhang B, Cheng L. Oral contraception following abortion. A systematic review and meta-analysis. Medicine (Baltimore). 2016;95(27):e3825. DOI:10.1097/MD.0000000000003825
12. Krattenmacher R. Drospirenone: Pharmacology and pharmacokinetics of a unique progestogen. Contraception. 2000;62(1):29-38.
DOI:10.1016/s0010-7824(00)00133-5
13. Keam SJ, Wagstaff AJ. Ethinylestradiol/drospirenone: a review of its use as an oral contraceptive. Treat Endocrinol. 2003;2(1):49-70.
14. Endrikat JS, Milchev NP, Kapamadzija A, et al. Bleeding pattern, tolerance and patient satisfaction with a drospirenone containing oral contraceptive evaluated in 3488 women in Europe, the Middle East and Canada. Contraception. 2009;79:428-32.
15. Foidart JM, Wuttke W, Bouw GM, et al. A comparative investigation of contraceptive reliability, cycle control and tolerance of two monophasic oral contraceptives containing either drospirenone or desogestrel. Eur J Contracept Reprod Health Care. 2000;5:124-34.
16. Landersoe SK, Petersen KB, Sørensen AL, et al. Ovarian reserve markers after discontinuinglong-term use of combined oral contraceptives. Reprod Biomed Online. 2020;40(1):176-86. DOI:10.1016/j.rbmo.2019.10.004
17. Landersoe SK, Larsen EC, Forman JL, et al. Ovarian reserve markers and endocrine profile during oral contraception: Is there a link between the degree of ovarian suppression and AMH? Gynecol Endocrinol. 2020;36(12):1090-5. DOI:10.1080/09513590.2020.1756250
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Авторы
Л.И. Мальцева1, Ю.В. Гарифуллова*2
1 Казанская государственная медицинская академия – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Казань, Россия;
2 ФГБОУ ВО «Казанский государственный медицинский университет» Минздрава России, Казань, Россия
*gamil.garifullov@yandex.ru
________________________________________________
Larisa I. Maltseva1 , Julia V. Garifullova*2
1 Kazan State Medical Academy – branch of Russian Medical Academy of Continuous Professional Education, Kazan, Russia;
2 Kazan State Medical University, Kazan, Russia
*gamil.garifullov@yandex.ru