Кrotyk H. Prevention of preterm delivery in the setting of isthmic cervical insufficiency.

The scientific work is devoted to solution of the urgent issue of modern obstetrics and gynecology: improved efficiency of preterm delivery prevention, decreased obstetrical and perinatal complications in pregnant women in the setting of isthmic cervical insufficiency via implementation of a scientifically grounded complex of medical and preventive measures. Special features of clinical, untrasonic, endocrinologic, bacteriologic, and immune indexes in this population have been determined. It has been proved that the course of pregnancy in the setting of isthmic cervical insufficiency is complicated with disturbed hormonal function of placenta and reproductive tract microbiocenosis. Mathematical calculation has been carried out and prognostic criteria for the risk of isthmic cervical insufficiency development have been defined. Changes of cytokine concentrations have been analyzed from another point of view: marked misbalance of cytokine content in cervical mucus indicates to high risk of infection in these pregnant women; new regularities of pro- and anti-inflammatory cytokine (TNF-?, INF-?, IL-I, IL-4) levels as well as their prognostic and diagnostic value have been determined. An algorithm of complex prevention, diagnosis and treatment of preterm delivery in pregnant women with ICI has been developed, and diagnostic criteria of ultrasonic indexes of cervix assessment and hormonal indexes of fetoplacental complex for pregnancy course prognosis have been determined. This has improved understanding of functional isthmic cervical insufficiency etiopathogenesis. Methods to control cervix functional status, fetoplacental complex, immune homeostasis, and reproductive tract microbiocenosis in the pregnant women examined have been offered. The methods for treatment and prevention of preterm delivery, obstetrical and perinatal complications in pregnant women in the setting of isthmic cervical insufficiency offered allowed significant reduction of preterm delivery rate, in case of no early preterm delivery (22-28 weeks).