Lishchenko I. Prevention of obstetric and perinatal complications in women at risk of post-term pregnancy

The dissertation aims to investigate reduction of frequencies of obstetric and perinatal complications in women facing a risk of post-term pregnancy. Differentiating algorithms were developed for the diagnosis and correction of disorders of maturation of the cervix. The calculations determine new pathogenetic mechanisms regarding a role of the cervix in the preparation for childbirth. The research data on the formation of the risk groups for post-term pregnancy in comparison with the control group were supplemented. Risk factors include: first childbirth (OR - 2.98); late reproductive age (OR - 1.95); post-term delivery in the anamnesis; late onset of menarche (OR - 4.8); IGI between births> 10 years (OR - 5.04); metabolic disorders (OR - 3.04); frequent SARS transferred in the childhood (OR - 3,16). For the first time, there were acquired data on the relationship between the level of the connective tissue synthesis marker, the concentration of the connective tissue resorption marker, the calcium content, and the cervical length that may constitute one of the mechanisms of premature cervical maturation in women at risk of post-term pregnancy. The data on the features of pregnancy hormonal support were clarified, namely the shift of the estrogen-progesterone ratio towards hypoestrogenia, the 4.2 times increase the concentration of stress-induced hormone cortisol, and twice lower levels of prolactin in comparison to the control group. The ultrasound criterion for timely maturation of the cervix on the eve of labor was determined for the first time – the presence of specific circulation in the intracervical vascular plexus (cavernous plexus), the absence of which allows the timely preparation of maternity tracts for delivery. There were clarified the peculiarities of the morphofunctional condition of the placenta in pregnant women with prolonged and post-term pregnancy (presence of dystrophic changes with increase in the number of intervertebral fibrinoid, stroma fibrosis, presence of calcifications and increased expression of Collagen type 4). New data were obtained regarding the role of tocophobia in the genesis of pregnancy tolerance. It was proved that the effect of fear of the beginning of childbirth in women with the risk of tolerance was manifested by the delay of the beginning of labor. In clinical conditions, the use of the developed complex of diagnostic and prophylactic-therapeutic measures aimed at reducing the frequency of obstetric and perinatal complications in pregnant women with the risk of post-term childbirth, allowed to (a) reduce the frequency of surgical delivery by 23.3 %, (b) reduce the frequency of birth trauma by 25.3 %, (c) shorten the duration of the second delivery period to 15.4 ± 6.4 minutes, and (d) improve the condition of babies at birth.