The scientific novelty of the dissertation is that the dissertation presents a new solution to the urgent problem of modern obstetrics – reducing the incidence of premature birth and perinatal morbidity in women at risk of early premature birth. It is determined that the threat of early premature birth occurs against the background of statistically significant reduction of hormone-producing function of the fetoplacental complex: reduction of progesterone production 1.27 times, free estriol – 1.28 times, human β-chorionic gonadotropin – 1.36 times, placental lactogen – 1.42 times against the background of an increase in cortisol 1.33 times, dehydroepiandrosterone sulfate – 2.76 times, corticotropin-releasing hormone – 1.24. Simultaneously, there is a marked increase in the expression of cytokines such as interleukin-1β 1.71 times, interferon-γ – 1.16 times, tumor necrosis factor-α – 1.50 times, interleukin-6 – 1.24 times on the background reduction of interleukin-10 production by 2.02 times.
It was found that changes in the hemostasis system at the risk of premature birth there are signs of hypercoagulation, which is manifested by a decrease in platelet count by 1.21 times (p<0.01), an increase in spontaneous platelet aggregation by 1.07 times (p<0.01) and platelet adhesion index 1.06 times (p<0.01), fibrinogen level 1.20 times (p<0.01), thrombin time – 1.24 times (p<0.01), D-dimer – 1.39 times (p<0.01) against the background of the absence of probable changes in the activated partial thrombin time and prothrombin index.
It was found that in women at risk of premature birth there is an increased level of total cholesterol, low-density lipoprotein, triglycerides, the atherogenic index against the background of a decrease in the serum content of high-density lipoproteins. There is an increased total average level of omega-6 polyunsaturated fatty acids, including: linoleic acid, γ-linolenic, digomo-γ-linolenic, eicosadiene, arachidonic. At the same time, the total amount of omega-3 polyunsaturated fatty acids is 1.30 times lower (p<0.01).
It is shown that personal anxiety in women at risk of premature birth in 3.08% of cases has a low level (OR 0.104 [0.028–0.385]), in 30.00% – moderate (OR 0.156 [0.064–0.380]), in 66.92% – high (OR 58.67 [7.73–445.28]), ie characterized by an increased overall level of personal anxiety in 1.45 times (p<0.01). The presence of the threat of premature birth is a pronounced stressful, psycho-traumatic factor, so such pregnant women have an increased level of reactive anxiety, while increasing the level of reactive anxiety of moderate and high degree.
In women at risk of premature birth, there are changes in blood flow in the fetoplacental complex, which are manifested in the umbilical arteries by increasing the resistance index 1.36 times (p<0.01) and systolic-diastolic ratio – 1.25 times (p<0.01), in the fetal aorta – an increase in the resistance index 1.37 times (p<0.01) and a decrease in the pulsation index 1.87 times (p<0.01).
It is proved that the inclusion of adjuvant metabolic therapy in the treatment and prevention measures at the risk of early premature birth improves the hormone-producing function of the placenta, cytokine profile, hemostasis, lipid metabolism, omega-3 and omega-6 polyunsaturated fatty acids, psycho-emotional state, fetoplacental blood flow, leading to prolongation of term of pregnancy.
Key words: pregnancy, threat of early preterm birth, hormone-producing function of the placenta, cytokines, lipid metabolism, omega-3 and omega-6 polyunsaturated fatty acids, hemostasis, psycho-emotional status, fetoplacental blood flow, pregnancy outcomes, perinatal morbidity.
