Fatiuk V. Optimization of postpartum observation of women with uterine leiomyoma.

The dissertation is devoted to reducing the frequency of obstetric and perinatal complications, preventing reproductive health disorders with uterine leiomyoma in the postpartum period through the improvement and implementation of the algorithm of diagnostic, treatment, and prophylactic measures. The dissertation shows the most insightful approaches for postpartum control in women with uterine leiomyoma, which helps to timely detect, prevent, and effectively treat obstetric and perinatal complications, reproductive health disorders. The treatment algorithm for women with uterine leiomyoma in the postpartum period has been improved and implemented. It has also been differentiated depending on the method of delivery according to lifestyle modification and drug correction. The results of studies indicate a high incidence of postpartum complications in women with uterine leiomyoma, depending on the method of delivery as well as the type of leiomyomatous nodes. The following complications were detected: early postpartum hemorrhage - up to 20%, uterine subinvolution - up to 27%, agalactia - up to 10%, postpartum anemia - up to 82%. The reasons for this are the presence of the morphological substrate (in postpartum women with uterine leiomyoma with preserved nodes), which causes a slower uterine involution as well as an increased uterine arteries Doppler blood flow; the hypercoagulation (common for all postpartum women with uterine leiomyoma), which leads to disruption of blood clotting processes with the development of complications, such as superficial thrombophlebitis and impaired blood supply to the nodes; the hormonal and immunological disorders in all postpartum women regardless of the method of delivery (elevated levels of estradiol and cortisol, decreased levels of prolactin due to increased blood levels of pro-inflammatory and reduced levels of anti-inflammatory cytokines), which causes changes in vaginal biocenosis with a possible risk of infectious complications as well as breastfeeding problems, also leading to further destabilization of the disease. The use of an improved algorithm of treatment and prevention measures can reduce the incidence of аgalactia by 2.67-4.5 times and anemia by 2.3-3.7 times depending on the method of delivery, stabilize the morpho-functional state of leiomyomatous nodes by reducing the disease progression and recurrence in order to enhance obstetric and perinatal outcomes, as well as prevent reproductive health disorders in women with uterine leiomyoma.