Kolesnik N. Optimization of cervical insufficiency treatment.

The thesis are devoted to pathogenesis and treatment improvement of cervical insufficiency - a complication that occurs in 10 % of all pregnancies, nevertheless such small prevalence of pathology is accompanied by severe health and social consequences of prematurity. Painless shortening of the cervix is the cause of 15 to 40 % of all late miscarriage and 30 % of all premature births. The basis of group formation was the concentration of interleukin-8 (IL-8), which has a proinflammatory effect. The I group included pregnant women with cervical insufficiency in 28 gestational weeks, the concentration of IL-8 in cervical mucus up to 50 nmol / ml. Group II was formed by pregnant women with 28 gestational weeks, diagnosed cervical insufficiency and concentration of IL-8 in cervical mucus 50 nmol / ml and less. The control group was formed by 34 pregnant women with uncomplicated pregnancy in the same gestational terms. Patients with cervical incompetence with cervical mucus inflammatory changes in more peculiar was the high incidence of sexually transmitted diseases. Instead, patients without inflammatory changes of cervical mucus often have a history of reproductive losses, higher frequency subclinical manifestations of trombophilia, typical complications of current pregnancy. These women in 56 % of cases were carriers of one or more subtypes of antiphospholipid antibodies. Increased cervical concentration of IL-8 in patients was accompanied by rising system content of other proinflammatory cytokines - IL- 1 and IL-6. All pregnant women in the beginning of treatment was characterized by increased concentrations of primary lipid peroxidation products - diene conjugates. Nevertheless, by treatment of isthmic-cervical insufficiency using obstetric pessariy, patients with inflammatory cervical mucus changes demonstrate progressive rising of secondary lipid oxidation products - malon dialdehyde, accompanied with nonadeqate increasing of antioxidate system enxymes. The overall indicator for the balance of oxidants and antioxidants in these patients initially tends to increase - from 2.1 to 2.3 starting treatment on the sixth day. And since the second week indicator undergoes rapid decline from 0.88 to 0.65 in eight weeks of observation. This indicates depletion of antioxidant protection that enhances the activity of systemic inflammatory response - leading pathogenic mechanism of cervix changes this group of patients. As for group of patients with cervical insufficiency without inflammatory changes, the increase in the concentration of oxidation products and antioxidant enzymes are gradual and symmetrical, similar to that of the group of healthy pregnant women. As part of the study the effectiveness of the proposed pathogenic treatment in subgroup, that was managed by additional use of indomethacin the normalization of lipid peroxidation products was found, their normal or subnormal rates stay during 8 weeks of observation. This allows to mote the laboratory effectiveness of the proposed cervical insufficiency treatment. The feasibility of this approach is confirmed at the clinical level - the inclusion of indomethacin treatment regimens can significantly increase the proportion of women with term delivery. Furthermore, the improved treatment of pregnant women with cervical incompetence and a high content of IL-8 in cervical mucus reduces the frequency of premature rupture of membranes, including - preterm rupture of membranes, hyperthermia in labour and uterus subinvolution in the postpartum period. Neonatal results of proposed treatmet also were studied, that showed decreased frequency of intracranial haemorrhage, necrotic enterocolites, nessecity of invasive breathing care.