The thesis are devoted to pathogenesis of premature rupture of membranes and improving the treatment algorithm of this complication.The study of clinical data in pregnant women with preterm rupture of membranes revealed fundamental differences between them and pregnant with preterm labour and intact membranes - a young age, susceptibility to sexually transmitted diseases in the past and during this pregnancy, unencumbered reproductive history, as well as with from pregnant women with premature rupture of membranes at full-term pregnancy (history of acute or chronic infection by pregnancy, cervical insufficiency). Genetic testing found that the gene polymorphism of glutathione S- transferase is popular in all pregnant women with prematuremembrane rupture and it allows to predict thepathogenic impact of these enzymes insufficiency in the genesis of complication. However, among patients with preterm membrane rupture homozygotes for the mutant genes dominant, while in the third group of patients (premature membrane rupture up to 37 weeks) were tendentious. The prevalence of polymorphic genotypes A313G GSTP gen in group of women with preterm membrane rupture comparing with control group is proven. Study of lipid peroxidation products activity and antioxidant enzymes indicates some typical for pregnant women with premature membranerupture signs - namely, not onlyincreasing of primary lipid peroxidation products concentrations, proper to pregnancy, but also increased concentration of its secondary products. This oxidation increased activity is not accompanied by adequate growth of antioxidant enzymes content. This demonstrates the continued activation of oxidation, which, in fact, could cause a breach of membranes elasticity. Displaying a direct correlative relationship between glutathione-S-transferase gene mutations and increasing concentrations of secondary oxidation products, ie metabolism occurring on the edge of the cell membrane, which actually is a factor in premature rupture of membranes. In addition, the identified violations in oxidant regulation,promote the development and generalization of inflammation. These pathogenic features taken into account in developing improved tactics of patients with preterm membranerupture, the idea is the additional management of pentoxifylline in view of its positive impact on the peroxidation processes to prevent septic complications.Pentoxifylline inclusion in the complex treatment of patients with preterm membrane rupturehas a positive influence on the lipid peroxidation products dynamic, a namely - less intense increase of the secondary oxidation productsconcentration and therefore - a lesser propensity to generalized septic and inflammatory reactions development. The positive impact is also revealed in the normalization of lipid peroxidation functional parameters - instead of proper to traditional treatment group sharp falling, by pentoxifylline management it demonstrates strong equalization from the IV day. The effectiveness of this approach is confirmed also at clinical level - by proposed treatment the proportion of pregnant women, where there was a necessity to labor induction because of chorioamnionitis signs was reduced. In addiaton, several other indicators were decresed, namely - the frequency of hyperthermia in labour, uterus subinvolution in postpartum period. Longer prolongation of pregnancy have an impact on the health of newborns, shown to reduce the frequency of fetal infection, necrotic enterocolitis, intraventricular hemorrhageand the need for invasive ventilation.
