Ahmad K. A role of connective tissue elements of fetal covers in occurrence of their premature rupture at immature pregnancy.

Object of the study: pregnant women with a premature rupture of the foetal membranes (PRFM) in immature pregnancy (IP). Purpose of the study: to reveal the part played by connective tissue elements in the genesis of PRFM in IP and develop a method for prognosticating a risk of this complication of pregnancy. Methods of the study: clinical, bacteriological, biochemical, immunohistochemical, pathomorphological, instrumental and statistical ones. Practical significance: the necessity of assessing the phenotypical markers of connective-tissue dysplasia in pregnant women for the prognosis of a spontaneous PRFM was proved. An insufficient amount of N-Acetylglucosamine in pregnant women with PRFM during IP was found out. The necessity was revealed to examine pregnant women for their blood levels of N-Acetylglucosamine and glycosaminoglycanes (GAG), as well as to study the excretion of connective tissue metabolites for assessing the risk of PRFM in IP. The part of the connective-tissue metabolic stress with the necrosis of collagen and GAG imbalance in the genesis of PRFM was proved, thereby requiring a prophylactic administration of the matrix-protective therapy. Novelty of the obtained results: a diagnostic value of the phenotypical markers of connective-tissue dysplasia for prognosticating PRFM was found out. For the first time, biochemical peculiarities of the metabolism of collagen, GAG and their precursors in pregnant women with PRFM during IP were revealed. A relationship was established between the levels of N-Acetylglucosamine and sulphated GAG, the state of the lipid peroxidation system and that of antioxidant protection. The part played by an insufficiency of the connective tissue matrix, manifested by a deficit of the structural components and imbalance of GAG in the genesis of PRFM in IP, was detected. A theory of PRFM as a systemic and local disorganization of the connective tissue in conditions of the depletion of regeneration mechanisms was formulated. A method for assessing the risk of PRFM in IP was suggested. Degree of introduction: results of the conducted studies were introduced in the work of obstetrical departments and consultative polyclinic of the Kharkiv City Clinical Maternity Home with the Neonatological Inpatient Department, Kharkiv City Maternity Home No. 1, Kharkiv City Clinical Maternity Home No. 2 and Maternity Home No. 6. The fundamental propositions of the thesis are used in the educational process at the Department of Perinatology and Gynaecology of Kharkiv Medical Academy of Postgraduate Education, the Department of Obstetrics and Gynaecology of the Medical Faculty of V. N. Karazin Kharkiv National University. Sphere of application: medicine, obstetrics and gynаecology