Shevchenko A. Differentiated approach to treatment tactics and perinatal complications in pregnant women with the threat of premature birth

The polyetiology of pretem labour and their consequences contribute to clarify clinical features of pregnancy and childbirth, changes and disorders of the hormone and psycho-emotional sphere, where a role of predicting the consequences takes an important place. To date, some pathogenetic mechanisms of stress-induced preterm labor remain unclear, as there are no clear data about mechanisms of the stress response and its influence on the health of both the pregnant woman and her fetus. A complex examination of women with determination of psychoemotional state, indicators of redox homeostasis and hormonal profile was carried out. On the basis of a comprehensive study of the parameters of clinical, laboratory and instrumental examination, it was established that pregnant women with the threat of premature birth during 22-34 weeks of gestation have significantly higher frequency of extragenital pathology (p˂0.05), and significantly (p˂0.05) more complications during pregnancy and childbirth. It was found that these women have a significantly higher level of perinatal morbidity (p˂0.05), primarily due to preterm delivery and the birth of premature babies. A violation of the psycho-emotional state with high levels of personal and situational anxiety, predominance of an anxious component in determining of the gestational dominant, an imbalance in the hormonal profile, with an increase in insulin level and a decrease in cortisol level, as well as an increase in oxidative potential , which is a manifestation of oxidative stress, and a decrease in the level of reduced glutathione – a marker of the antioxidant defense system occurs in women with the threat of preterm delivery. The proposed complex therapy ( morpholine-3-methyl-1,2,3-thiotriazoline-5- oacetate – rectal suppositories, and natural micronized progesterone – vaginal capsules) has had a positive effect on hormonal status, redox homeostasis, and, as a result – obstetric and perinatal outcomes of delivery, mainly due to the decreased frequency of preterm labour and the birth of full-term newborns. Risk assessment with using ROC analysis and logistic regression made it possible to establish predictors of both the threat of preterm labor and the spontaneous onset of clinical symptoms of preterm birth and to form the corresponding risk groups. In the course of the study it was established that in the case of presence of three from five factors, pregnant women belong to a high risk group for the development of the threat of preterm birth and development of clinical symptoms of preterm birth. This will allow to prevent the threat of preterm birth and premature delivery in this patients and prescribe appropriate treatment in timely manner.