Background: Missed miscarriage remains a highly prevalent form of early reproductive loss, representing a significant medical and social challenge. In the environmentally degraded Aral Sea region, specifically Karakalpakstan, this issue is exacerbated by severe ecological factors, endemic anemia, endocrine disruptions, and widespread micronutrient deficiencies. Standardized protocols for preconception care frequently fail to address the complex, multifactorial somatic and reproductive profiles of women residing in such regions. Objective: This study aims to develop, scientifically substantiate, and evaluate a personalized algorithm for pregravid preparation among women with a history of missed miscarriage in the Aral Sea region. Methods: A comprehensive clinical, laboratory, and anamnestic evaluation was conducted on 120 reproductive-aged women with a history of missed miscarriage. The cohort was divided into a control group receiving standard care and an intervention group receiving a region-specific, personalized pregravid preparation algorithm. Assessments included hormonal profiling, hemostasiograms, micronutrient status, and pelvic ultrasonography. Results: The regional patient profile revealed a profound incidence of extragenital pathologies, notably iron deficiency anemia, subclinical hypothyroidism, and sub-optimal vitamin D levels. The implementation of the personalized pregravid preparation algorithm led to a statistically significant improvement in somatic and reproductive health markers. Pregnancy outcomes in the intervention group demonstrated a substantial reduction in the recurrence of missed miscarriages and early pregnancy losses compared to the standard care group. Conclusion: Tailoring pregravid preparation to the specific environmental, somatic, and hemostasiological characteristics of women in ecologically unfavorable regions significantly optimizes reproductive outcomes and reduces the burden of recurrent pregnancy loss.

Missed miscarriage, pregravid preparation, Aral Sea region, reproductive health, personalized medicine, micronutrient deficiency, early pregnancy loss.

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