Pavlova O. Prevention and treatment of obstetric and perinatal complications in women with adenomyosis.

The dissertation is devoted to reduction of the frequency of obstetric and perinatal complications in women with adenomyosis on the basis of improvement and implementation of an algorithm of diagnostic,preventive and treating measures. The most representative methods of treatment effectiveness monitoring and prevention of obstetric and perinatal complications in women with adenomyosis were shown. The algorithm of treatment in women with adenomyosis, as well as diagnostic, treating and preventive measures on basis of direct medical and psychological correction has been improved and implemented. Results of the study show that pregnancy in women with adenomyosis is complicated with high frequency of miscarriage – 35,3 %, premature birth – 52,9 %, placental dysfunction – 50,0 %, preeclampsia – 47,0 %, including severe one – 14,7 %, inflammatory diseases of the vagina and vulva – 55,8 %, frequent soft tissue trauma in labor – 29,4 %, obstetric bleeding – 20,6 %, placenta previa – 11,8 %, premature rupture of amniotic mambranes – 38,9 % and fetal growth restriction – 41,2 %. Also higher rate of deliveries by caesarean section was represented – 35.3%. The functional state of the fetoplacental complex in women with adenomyosis is characterized not only by a high level of disorders of the placenta, but also by the volume of amniotic fluid (32.4% – polyhydramnion, 20.6% – oligohydramnion) combined with doppler-confirmed disorders (increased blood flow) and endocrinological disorders (decreased levels of estriol, progesterone, chorionic gonadotropin and increased content of cortisol, tumor necrosis factor and interleukin-6). This improved algorithm of treatment and preventive measures allows us to reduce the frequency of placental dysfunction in 2.4 times, preeclampsia – 2 times, threat of premature birth – 2.3 times, bacterial vaginosis – 1,9 times, premature rupture of fetal membranes – 2 times, tissue injuries in labor - 9,9%, obstetric bleeding – 3,5 times, intrauterine fetal infection – 4 times, fetal distress – 2 times, fetal growth restriction – 2.8 times, labor asfixia – 2 times, caesarean section – 2 times, hypogalactia – 1,9 times, which allowed to improve obstetric and perinatal effects.